Direct carotid cavernous fistula after submucous resection of the nasal septum.

PubMed

Bizri, A R; al-Ajam, M; Zaytoun, G; al-Kutoubi, A

2000-01-01

A carotid cavernous fistula (CCF) is an abnormal arteriovenous anastomosis between the carotid artery and the cavernous sinus. Etiologies of this condition reported in the literature so far include facial trauma, rupture of an intracavernous aneurysm of the carotid artery, Ehler-Danlos syndrome and fibromuscular dysplasia of the cerebral arteries. Such fistulae were reported as complications of rhinoplasty, transsphenoidal surgery, embolization of cavernous sinus meningioma, and rhinocerebral mucormycosis. CCF may also occur spontaneously in children or as a congenital malformation. However, to our knowledge, submucous resection of the nasal septum has not been reported before to cause direct carotid-cavernous fistula. CT and angiographic findings are presented and a review of the literature for reported causes of CCF is made as well as a brief discussion of the possible pathophysiology.

Silent internal sinus of the pyriform fossa: a rare adult manifestation of a branchial anomaly.

PubMed

Lin, Chao-Jung; Lin, Yaoh-Shiang; Kang, Bor-Hwang; Lee, Jin-Chin

2003-03-01

Branchial anomalies present with a wide range of pathologic characteristics, including cysts, fistulas, and sinuses of the head and neck region. Branchial cysts are most commonly diagnosed during the second through fourth decades of life, while branchial sinuses and fistulas are diagnosed almost exclusively in children with infection episodes. Only rarely has an internal sinus of a third or fourth branchial anomaly manifested in adults as a noninfectious swelling in the neck during swallowing. In this report, we describe our experience treating a 21-year-old man with a left-sided swallowing-induced neck protrusion of 10 years' duration. Findings of physical examination, videolaryngoscopy, and a pharyngoesophagogram confirmed the diagnosis of internal sinus of the pyriform fossa, with uncertain origin of a third or fourth branchial anomaly. The patient underwent regular follow-up as an outpatient and experienced no further infectious episodes.

Endovascular Treatment of Dural Arteriovenous Fistulas: Single Center Experience

PubMed Central

Oh, Jae-Sang; Oh, Hyuk-Jin; Shim, Jai-Joon; Bae, Hack-Gun; Lee, Kyeong-Seok

2016-01-01

Objective Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. Methods Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. Results All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ≥2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. Conclusion Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route. PMID:26885282

Management of pediatric second branchial fistulae: is tonsillectomy necessary?

PubMed

Cheng, Jeffrey; Elden, Lisa

2012-11-01

To describe the surgical management of second branchial fistulae that extend to the pharynx, specifically to determine whether tonsillectomy, along with surgical excision of the tract affects the rate of recurrence. Retrospective chart review of pediatric patients (age<18) who underwent surgical excision of second branchial anomalies at a tertiary-care children's hospital between January 1, 2006 and September 1, 2011. Sinus tracts that extended to the pharynx were considered to be fistulae. Seventy-four patients were identified who underwent surgical excision of 85 total second branchial anomalies - 20 cysts (23.5%), 29 sinuses (34.1%), and 36 fistulae (42.4%). The 36 fistulae were removed from 32 patients, 23 males and 9 females, with an average age of 43.3 months. There were 16 right, 11 left, and 5 bilateral lesions. In 14 (43.8%) of the fistulae cases, a tonsillectomy was performed. There was only one recurrence (2.8%), which occurred 41 months postoperatively. No statistically significant difference for recurrence (p=1.0) was found between the group of patients that underwent tonsillectomy and those that did not. Pediatric branchial anomalies can present as a cyst, sinus, or fistula. They are developmental failures in the involution of the branchial apparatus during the embryologic period. Management of second branchial anomalies is with surgical excision of the tract and ligation of the terminal attachment to the pharynx. Our results suggest that the recurrence rates are not affected by whether or not an ipsilateral tonsillectomy is performed. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Perianal sinuses in neonates and infants.

PubMed

Al-Wattar, Kais M

2002-12-01

The aim of this study is to evaluate the etiology of perianal abscess or discharges in neonates and infants and some of them are perianal sinuses with blind inner end without connection to the anal canal, and some of these cases have a different histological pattern. Complete surgical excision and primary closure of their wounds can cure these patients. Between January 1988 and December 2000, (81) neonates and infants (aged 2 weeks to 2 years) with perianal sinuses, fistula-in-ano abscess dealt in the Al-Zahrawi and Al-Khansa Teaching Hospitals, Mosul, Iraq, were studied. Fifty-one patients displayed an onset of symptoms during their first year of age, all cases had a gentle probing and proctoscopy under general anesthesia, and the discharge from abscess from the patients were sent for culture. Thirty patients with proper sinuses had excision of the sinus and primary closure; children with fistulae underwent fistulectomy; perianal abscesses drained. All the excised specimens were examined histopathologically. All children, except 3, were boys. Out of the 81 cases studied, 30 patients (37%) proved to have proper sinuses with blind inner end. Eight of these showed a different histological pattern, and in 2 cases, the histopathology was that of rectal duplication, the microbiology of the discharge from the proper sinuses was showing a predominance of non-gut derived organisms. All patients cured by excision of the sinuses and primary closure. Fistulae are the most common perianal discharging lesions in neonates and infants, blind sinuses are another cause in a considerable number. We propose a diagnostic strategy and treatment for those children presenting with discharging perianal lesions; for anticipation of these sinuses 3 points need to be considered before attempting surgery. 1) Blind sinus tract on gentle probing. 2) Normal anal and rectal mucosa on proctoscopy. 3) High bacterial yield of non-gut derived organisms on culture of the pus or discharge. Their treatment is by simple excision (coring) and primary closure; this method will shorten the healing and recovery time.

Coexisting first and bilateral second branchial fistulas in a child with nonfamilial branchio-otic syndrome.

PubMed

Lapeña, Jose F; Jimena, Genilou Liv M

2013-07-01

We describe what we believe is only the third reported case of coexisting first and bilateral second branchial fistulas associated with nonfamilial branchio-otic syndrome. The patient was a 6-year-old girl who presented with bilaterally draining anterior neck puncta, a preauricular sinus, and moderately severe bilateral hearing loss. She had no family history of branchial anomalies. Compared with branchial cysts and sinuses, branchial fistulas are rare. Even more rare are bilateral second branchial fistulas coexisting with first branchial anomalies, as only 10 cases have been previously reported in the English-language literature. Of these 10 cases, 5 were associated with either branchio-otic syndrome or branchio-oto-renal syndrome; 2 patients had familial branchio-otic syndrome, 2 had nonfamilial branchio-otic syndrome, and 1 had nonfamilial branchio-oto-renal syndrome.

Recurrent thyroid abscess - Is it a fourth branchial archanomaly?

PubMed

Desai, A A; Pandya, V K; Chougule, Sachin; Nair, Unnikrishnnan

2006-04-01

Branchial fistulae are of congenital origin(6) and consists of skin lined tract opening internally at junction of cartilaginous and bony meatus in case of 1(st) arch anomaly, tonsillar fossa in case of 2(nd) arch, while 3(rd) and 4(th) arch sinuses have internal opening at level of pyriform sinus or below. A complete tract of 3(rd) or 4(th) arch fistulae is yet to be described. Fourth arch fistulae(1) have a distinct clinical pattern of internal opening at pyriform apex, are left sided and associated with suppurative thyroiditis(3), they manifest at a younger age and treatment involves excision of tract with ipsilateral thyroid lobectomy.

Transarterial Onyx Embolization for Patients with Cavernous Sinus Dural Arteriovenous Fistulas Who Have Failed Transvenous Embolization.

PubMed

Wen, Jun; Duan, Chuan-Zhi; Huang, Li-Jing; Zhang, Xin; He, Xu-Ying; Li, Xi-Feng

2015-09-01

Transvenous embolization is the treatment of choice for cavernous sinus dural arteriovenous fistulas (csDAVFs) despite occasional difficulty in transvenous catheterization. We reported our experience in the treatment of csDAVFs by transarterial Onyx embolization in patients who had failed transvenous catheterization. We reviewed the clinical and radiographic records of csDAVFs patients receiving transarterial Onyx embolization after failed transvenous Onyx embolization at our institution over a period of 31 months. Success was defined as complete or near complete occlusion upon angiographic examination. In seven cases, the microcatheter failed to reach the cavernous sinus; in the remaining case, the internal jugular vein was occlusive. Eight sessions of the embolization and catheterization procedures via the arterial routes were conducted. Among them, five cases via the middle meningeal artery and the other three via the accessory meningeal artery. Angiography, immediately after embolization, revealed complete occlusion in seven cases (87.5 %) and partial occlusion in the remaining case. Angiographic follow-up (range, 6-10 months) showed that all patients achieved complete embolization. In cases where transvenous embolization of the cavernous sinus is difficult, transarterial embolization of the fistulas offers a safe and effective alternative.

[Pay attention to the imaging diagnosis of complex anal fistula].

PubMed

Zhou, Zhiyang

2015-12-01

The diagnosis and treatment of complex anal fistula has been a significant challenge. Unwise incision and excessive exploration will lead to the secondary branch, sinus and perforation. A simple fistula may become a surgical problem and result in disastrous consequences. Preoperative accurate diagnosis of anal fistula, including in the internal opening, primary track and location of the fistula, extensions and abscess, is important for anal fistula treatment. In the diagnosis of anal fistula, imaging examination, especially MRI plays a crucial role. Localization and demarcation of anal fistula and the relationship with sphincter are important. MRI has been an indispensable confirmatory imaging examination.

Sinus of Valsalva Fistula to the Right Ventricle along with Coronary Artery Fistula to the Pulmonary Artery in a Young Native American Female

PubMed Central

Desai, Sarika; Loli, Akil; Maki, Peter

2013-01-01

Sinus of Valsalva aneurysm is a rare condition and associated with a high rate of mortality if rupture occurs. The aneurysms are rarely diagnosed until rupture occurs. This case describes a young Native American female whose only symptom was intermittent chest pain prior to the detection of the aneurysm along with a small ventricular septal defect. The patient was also found to have a coexisting coronary artery fistula, and it is rare phenomenon to have these coexisting anomalies. The anomalies were demonstrated on both cardiac computed tomography and coronary angiography. The patient underwent surgical closure of both anomalies, which is the recommended treatment to avoid future complications. PMID:24804114

Sinus of Valsalva Fistula to the Right Ventricle along with Coronary Artery Fistula to the Pulmonary Artery in a Young Native American Female.

PubMed

Desai, Sarika; Flores, Erica; Loli, Akil; Maki, Peter

2013-01-01

Sinus of Valsalva aneurysm is a rare condition and associated with a high rate of mortality if rupture occurs. The aneurysms are rarely diagnosed until rupture occurs. This case describes a young Native American female whose only symptom was intermittent chest pain prior to the detection of the aneurysm along with a small ventricular septal defect. The patient was also found to have a coexisting coronary artery fistula, and it is rare phenomenon to have these coexisting anomalies. The anomalies were demonstrated on both cardiac computed tomography and coronary angiography. The patient underwent surgical closure of both anomalies, which is the recommended treatment to avoid future complications.

[Odontogenic cyst of the left maxilla and oro-antral fistula].

PubMed

Gil Tutor, E

1999-01-01

We considered these cases of odontogenic cysts of the maxillary sinus. One of them complicated with an oroantral fistula. The aim of our paper is to consider the origine, the radiology and the surgery of those items.

Transvenous embolization in spontaneous direct carotid-cavernous fistula in childhood

PubMed Central

Mercado, Glenna B.; Irie, Keiko; Negoro, Makoto; Moriya, Shigeta; Tanaka, Teppei; Ohmura, Masahiro; Sadato, Akiyo; Hayakawa, Motuharu; Sano, Hirotoshi

2011-01-01

Carotid cavernous fistula (CCF) is an abnormal arteriovenous communication in the cavernous sinus. Direct CCF results from a tear in the intracavernous carotid artery. Typically, it has a high flow and usually presents with oculo-orbital venous congestive features such as exophthalmos, chemosis, and sometimes oculomotor or abducens cranial nerve palsy. Indirect CCF generally occurs spontaneously with subtle signs. We report a rare case of spontaneous direct CCF in childhood who did not have the usual history of craniofacial trauma or connective tissue disorder but presented with progressive chemosis and exophthalmos of the right eye. This report aims also to describe the safety and success of transvenous embolization with coils of the superior ophthalmic vein and cavernous sinus through the inferior petrosal sinus. PMID:22059104

Transvenous embolization of cavernous sinus dural arteriovenous fistulas using detachable coils and Glubran 2 acrylic glue via the inferior petrosal sinus approach.

PubMed

Li, Zheng-Ran; Jiang, Zai-Bo; Huang, Ming-Sheng; Zhu, Kang-Shun; Wang, Qing; Shan, Hong

2010-12-01

To describe the technique, efficacy, and safety of transvenous embolisation (TVE) of cavernous sinus arteriovenous fistulas (CSDAVFs) via the inferior petrosal sinus (IPS) with detachable coils and acrylic glue. Spontaneous unilateral CSDAVFs were confirmed by cerebral angiography in eight patients, with angiographic patency of the ipsilateral IPS in three and angiographic non-visualisation of the ipsilateral IPS in five. There were two patients with complete occlusion of the ipsilateral internal jugular vein (IJV). TVE with detachable coils and acrylic glue were performed through a femoral vein and an IPS approach. TVE viaipsilateral IPS was successfully performed in all eight patients in our group. The number of detachable coils for each patient ranged from 2 to 8 (mean, 5.0). Angiography immediately after TVE showed complete occlusion of the CSCAVFs in seven patients and nearly complete occlusion in one. Complete recovery of clinical symptoms was achieved in all eight patients. No recurrence of clinical symptoms was observed at follow-up. Transvenous embolisation via an IPS approach is a highly efficient and safe treatment for CSDAVFs. Embolisation with a combination of coils and acrylic glue may help to achieve complete occlusion of fistulas with fewer coils.

First Branchial Arch Fistula: A Rarity and a Surgical Challenge.

PubMed

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

2016-06-01

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

[A case of traumatic middle meningeal arteriovenous fistula on the side of the head opposite to the injured side].

PubMed

Takeuchi, Satoru; Takasato, Yoshio; Masaoka, Hiroyuki; Hayakawa, Takanori; Otani, Naoki; Yoshino, Yoshikazu; Yatsushige, Hiroshi; Sugawara, Takashi; Aoyagi, Chikashi; Suzuki, Go

2009-10-01

A rare case of a traumatic middle meningeal arteriovenous fistula on the side of the head opposite to the injured side was reported. A 21-year-old man was admitted to our hospital after a traffic accident in which the right side of his head was hit. CT scans and MR images on admission showed a right temporal bone fracture, traumatic subarachnoid hemorrhage, and a left frontal lobe contusion. Three months after the head injury, he complained of tinnitus and exophthalmos. One year after the head injury, left external carotid angiograms showed a dural arteriovenous fistula fed by the left dilated middle meningeal artery and draining into the middle meningeal vein. Early filling of the sphenoparietal sinus, cavernous sinus, superior ophthalmic vein, and the cortical vein were also detected. Transarterial embolization of the left middle meningeal fistula was performed, resulting in the disappearance of the lesion. The postoperative course was uneventful.

First branchial arch fistula: diagnostic dilemma and improvised surgical management.

PubMed

Prabhu, Vinod; Ingrams, Duncan

2011-01-01

First branchial cleft anomalies are uncommon, and only sporadic case reports are published in the literature. They account for 1% to 8% of all the branchial abnormalities. The often variable presentation and tract siting of first arch fistulae have led to misdiagnosis. The misdiagnosis results in inappropriate/ineffective treatment and recurrence of the sinus tract. We present a 19-year-old woman who presented to the ENT outpatient department with episodic discharge from a long-standing fistula anterior to the left sternomastoid muscle. This was associated with repeated episodes of ipsilateral tonsillitis. In relation to the history and because of the position of the fistula, a diagnosis of second branchial arch fistula was made. An attempt at excision was unfortunately followed by early recurrence of discharge. At review following the procedure, a defect of the left tympanic membrane in the form of a fibrous band was noted, and a revised diagnosis of first branchial arch sinus was made. Wide surgical excision of the tract with partial parotidectomy was performed. An uneventful postoperative course followed, with no recurrence of symptoms after 24 months of review. We discuss the case, the diagnostic pathway, and the wide local excision technique used for removal of branchial fistulae. Copyright © 2011 Elsevier Inc. All rights reserved.

A Rare Case Report of a Child Coexistence Thyroglossal Cyst and Second Branchial Cleft Fistulae.

PubMed

Mahdoufi, Rachid; Barhmi, Ismail; Tazi, Nabil; Rouadi, Sami; Abada, Reda; Roubal, Mohamed; Mahtar, Mohamed

2017-06-01

Thyroglossal duct cysts followed by branchial cleft anomalies are the most common congenital neck masses encountered in practice, second branchial cleft cysts and sinuses are the most common type (LaRiviere and Waldhausen in Surg Clin North Am 92(3):583-597, 2012). Although both abnormalities are common individually, but rarely seen associated in same patient as described in our case. Congenitalcervical anomalies are important to consider in the differential of head and neck masses in children and adults. These lesions can present as palpable cystic masses, infected masses, draining sinuses, or fistulae. Thyroglossal duct cysts are most common, followed by branchial cleft anomalies. A synchronous presentation of both type of cyst and fistula in a same child patient is very rare with no such cases reported in literature till date.

Dural arteriovenous fistula discovered in patient presenting with recent head trauma.

PubMed

Cooper, Chad J; Said, Sarmad; Nunez, Angelica; Quansah, Raphael; Khalillullah, Sayeed; Hernandez, German T

2013-01-01

Patient Male, 32 FINAL DIAGNOSIS: Dural arterio-venous fistula Symptoms: Eye redness • post-trauma headache • tinnitus - Clinical Procedure: Fistula embolization Specialty: Neurology. Mistake in diagnosis. A dural arteriovenous fistula (DAVF), is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus. The pathogenesis of DAVF still remains unclear. Sinus thrombosis, head trauma, chronic central nervous system, hypercoagulable state, surgery, and hormonal influence are the pre-disposing factors that initiate this disease. The symptoms experienced by the patient will depend on the location of the fistula. Thirty-two year old Hispanic male who presented one day after a rear ended motor vehicle collision (MVC) with a severe throbbing headache in the left parietal region, left eye redness but no retro-orbital pain and tinnitus in the left ear. He was initially misdiagnosed to have a carotid-cavernous fistula but upon cerebral angiogram was actually diagnosed with a dural arterio-venous fistula in the posterior fossa venous system followed by successful embolization of the fistula. A cerebral angiography is the gold standard for detection and characterization of a DAVF and will distinguish it from a CCF. Endovascular surgery involves a catheter-based technique for embolization of the lumen of arteries feeding the DAVF, or directly into the vein draining the DAVF. It is very important to recognize the typical findings of patients presenting with a DAVF then quickly proceeding with a cerebral angiogram to determine the exact location of the fistula and the appropriate treatment plan. By diagnosing and treating a DAVF as early as possible, the associated fatal complications can be averted.

Recurrent pyriform sinus fistula successfully treated by endoscopic Glubran 2 sealing: A rare case and literature review.

PubMed

Di Nardo, Giovanni; Valentini, Valentino; Angeletti, Diletta; Frediani, Simone; Iannella, Giannicola; Cozzi, Denis; Roggini, Mario; Magliulo, Giuseppe

2016-01-01

The authors present the case of a 3-year-old girl with a history of complicated surgery for removing a third branchial cleft fistula. An endoscopic approach using N-butyl-2-acrylate and metacrilosisolfolane glue (GLUBRAN 2) to seal the fistula was performed. The clinical and radiological 6-year follow-up confirmed the absence of the fistulous orifice and the persistence of scar due to previous open-neck surgical procedures. endoscopic Glubran 2 sealing has been an effective treatment procedure for branchial fistula.

Congenital cervical cysts, sinuses, and fistulae in pediatric surgery.

PubMed

LaRiviere, Cabrini A; Waldhausen, John H T

2012-06-01

Congenital cervical anomalies are essential to consider in the clinical assessment of head and neck masses in children and adults. These lesions can present as palpable cystic masses, infected masses, draining sinuses, or fistulae. Thyroglossal duct cysts are most common, followed by branchial cleft anomalies and dermoid cysts. Other lesions reviewed include median ectopic thyroid, cervical teratomas, and midline cervical clefts. Appropriate diagnosis and management of these lesions requires a thorough understanding of their embryology and anatomy. Correct diagnosis, resolution of infectious issues before definitive therapy, and complete surgical excision are imperative in the prevention of recurrence. Copyright © 2012 Elsevier Inc. All rights reserved.

Transarterial Onyx embolization of intracranial dural arteriovenous fistulas: a single center experience.

PubMed

Luo, Chao-Bao; Chang, Feng-Chi; Mu-Huo Teng, Michael; Lin, Chung-Jung; Wu, Hsiu-Mei; Guo, Wan-Yuo; Chang, Cheng-Yen

2014-04-01

Transarterial embolization of intracranial dural arteriovenous fistulas (DAVFs) is usually associated with inadequate embolization. The purpose of this study was to report our experience of transarterial Onyx embolization of intracranial DAVFs with an emphasis on treatment outcome with this new embolic agent in different types of DAVFs. In the past 3 years, a total of 14 intracranial DAVFs have been treated by transarterial Onyx embolization. Among these, there were nine males and five females, aged from 30 years to 82 years (mean = 62 years). We retrospectively analyzed the injection volume and time of Onyx embolization as well as outcomes in different types of DAVFs. The locations of the DAVFs were sigmoid sinus (n = 6), tentorium (n = 3), sinus confluence (n = 2), transverse-sigmoid sinus (n = 1), sigmoid sinus-jugular bulb (n = 1) and the superior petrous sinus (n = 1). The mean volume and time of Onyx injection were 3.4 mL and 28 minutes, respectively (Cognard type I: 4.9 mL, 40 minutes; type II: 4.5 mL, 34 minutes; type III: 2.2 mL, 21 minutes; type IV: 2 mL, 22 minutes). Total fistula occlusion was achieved in six out of seven patients of type III and type IV DAVFs, and in four out of seven patients of type I and type II DAVFs. Nine patients had total resolution of their symptoms, whereas partial regression occurred in five patients. No significant periprocedural complication was found. Mean clinical follow-up period was 16 months. Transarterial Onyx embolization of intracranial DAVFs is safe and effective. This technique is particularly useful in type III and type IV DAVFs with a high cure rate, and lower volume of Onyx as well as a short injection time. Copyright © 2014. Published by Elsevier B.V.

Spontaneous dural cavernous fistula in infancy.

PubMed

Johnson, Paul B; Lelli, Gary J; Khorsandi, Azita; Dellarocca, David A

2010-01-01

A 4-month-old boy presented with the sudden onset of proptosis and dilated episcleral veins. CT revealed an enlarged superior ophthalmic vein and diffusely thickened extraocular muscles. MRI and angiography confirmed a dural middle meningeal--cavernous sinus fistula. Embolization was performed leading to successful resolution of the patient's signs and symptoms. Spontaneous atraumatic arteriovenous cavernous fistulae in infancy are extremely rare, but should be included in the differential diagnosis of infants with orbital congestion. Appropriate treatment leads to prevention of amblyopia, glaucoma, and anisometropia.

Endoscopic treatment of cerebrospinal fluid leaks with the use of lower turbinate grafts: a retrospective review of 125 cases.

PubMed

Cassano, Michele; Felippu, Alexandre

2009-12-01

Endoscopic transnasal approaches to the skull base have revolutionized the treatment of cerebrospinal fluid (CSF) fistulae, making repair less invasive and more effective compared with craniotomy or extracranial techniques. This study evaluated, retrospectively, the results of endoscopic repair of dural defects with the use of mucoperiostal grafts taken from the lower turbinate. Between January 1997 and January 2007, 125 cases of anterior skull base CSF fistulae were treated endoscopically at the Instituto Felippu de Otorrinolaringologia, Sao Paolo, Brazil, and at the Department of Otolaryngology of the University Hospital "Ospedali Riuniti", Foggia, Italy. Fistula closure was achieved by overlay apposition of a lower turbinate mucoperiostal graft fixated with fibrin glue and Surgicell. The etiology of the fistula was accidental trauma in 41 cases, iatrogenic trauma in 29, skull base tumour in 12, and spontaneous in 43. The site of the defect was the sphenoid sinus in 43 patients, the cribriform plate in 42, the anterior ethmoid roof in 21, the posterior ethmoid roof in 17, and the posterior wall of the frontal sinus in 2. The success rate at first attempt was 94.4%; the 7 cases of postoperative recurrent CSF leakage involved patients presenting with spontaneous fistula and elevated intracranial pressure; 5 of these had a body-mass index > 30 and 3 suffered from diabetes mellitus. In our hands, the success rate of endoscopic fistula repair was high, even in defects larger than 2 cm. Success rates may be further improved with accurate diagnosis of elevated intracranial pressure, a contributing factor to failure of spontaneous fistula repair.

The association of carotid cavernous fistula with Graves’ ophthalmopathy

PubMed Central

Celik, Ozlem; Buyuktas, Deram; Islak, Civan; Sarici, A Murat; Gundogdu, A Sadi

2013-01-01

Graves’ ophthalmopathy (GO) is one of the frequent manifestations of the disorder which is an inflammatory process due to fibroblast infiltration, fibroblast proliferation and accumulation of glycosaminoglycans. Eye irritation, dryness, excessive tearing, visual blurring, diplopia, pain, visual loss, retroorbital discomfort are the symptoms and they can mimic carotid cavernous fistulas. Carotid cavernous fistulas are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical manifestations of GO can mimic the signs of carotid cavernous fistulas. Carotid cavernous fistulas should be considered in the differential diagnosis of the GO patients especially who are not responding to the standard treatment and when there is a unilateral or asymmetric eye involvement. Here we report the second case report with concurrent occurrence of GO and carotid cavernous fistula in the literature. PMID:23571267

[Endoscopic surgical treatment of patients with isolated sphenoid sinus disease].

PubMed

Strek, Pawel; Zagólski, Olaf; Składzień, Jacek; Oleś, Krzysztof; Konior, Marcin; Hydzik-Sobocińska, Karolina; Głowacki, Roman

2007-01-01

Cases of isolated lesions of the sphenoid sinus are rare. For descriptive purposes, clinicians divide them into inflammatory and non-inflammatory with prevalence of the former. Symptoms of the sphenoid sinus disease are difficult to characterise, the most common of them being vague headache and visual disturbances. Thorough preoperative evaluation of the lesion is essential - nasal endoscopy must be performed and computerised tomography or magnetic resonance imaging results analysed. The purpose of the study is to present the assessment of endoscopic surgery outcome in the own group of patients with isolated sphenoid disease. Clinical data of 22 subjects were analysed retrospectively. There were 5 patients with bacterial sinusitis, 6 with fungal sinusitis, 4 with allergic thickening of the mucous membrane with no evidence of bacterial or fungal infection, 2 with mucocele, 1 with sphenoid osteoma, 1 with inverted papilloma, 1 with a foreign body and 2 with cerebral fluid fistula. Each patient had preoperative nasal endoscopy and CT/MRI imaging performed. Then they underwent endoscopic transnasal sphenoethmoidectomy with removal of the lesion or closure of the fistula. The sphenoid sinus was approached through its front wall. The patients' postoperative course was uneventful. They noted improvement in all preoperative symptoms, except for bilateral oculomotor nerve paralysis in one individual, and were asymptomatic to ophthalmological examination. Isolated lesions of the sphenoid sinus, even very rare tumours like those presented here, can be in most cases safely approached and removed endoscopically. All risks of the method must be considered prior to the operation. High frequency of fungal sinusitis should be noted.

Upper eyelid abscess as a late complication of frontal sinus trauma

PubMed Central

Adriana, Iliescu Daniela; Cornel, Stefan; Mihaela, Timaru Cristina; Speranta, Schmitzer; Algerino, De Simone; Mehdi, Batras; Elena, Zeca Cristina; Bogdan, Maciuceanu-Zarnescu Mircea

2015-01-01

The authors report a case of upper eyelid abscess in a 30 year old male that presented in the ophthalmology department with complains of recurrent eyelid pyosis, hyperaemia and swelling that started 2 months earlier and that did not ease to repeated courses of antibiotic therapy. The reported history of the patient revealed frontal sinus trauma that occurred 5 years before and that required surgical treatment (fixation with titan plaque and screws) with total healing and giving no further complains over the next years. The present cranial CT imaging showed intraorbital fat infiltration with displacement of one orbital arcade screw. Clinical findings showed normal ocular mobility. Antibiotic treatment and screw extraction through eyelid fistula improved the outcome but did not resolve the fistulous communication. Final management involved surgical removal of orbital arcade plaque and remaining screw and excision of fistula tract. The postoperative outcome was very good and the fistula remained closed but left the patient with an upper eyelid retraction which will require oculoplastic surgery in the future. PMID:29450319

An Onyx tunnel: reconstructive transvenous balloon-assisted Onyx embolization for dural arteriovenous fistula of the transverse-sigmoid sinus.

PubMed

Kerolus, Mena G; Chung, Joonho; Munich, Stephen A; Matsuda, Yoshikazu; Okada, Hideo; Lopes, Demetrius K

2017-11-17

Transvenous embolization is an effective method for treating dural arteriovenous fistulas (DAVFs) of the transverse-sigmoid sinus (TSS). However, in cases of complicated DAVFs, it is difficult to preserve the patency of the dural sinus. The authors describe the technical details of a new reconstructive technique using transvenous balloon-assisted Onyx embolization as another treatment option in a patient with an extensive and complex DAVF of the left TSS. A microcatheter and compliant balloon catheter were navigated into the left internal jugular vein and placed at the distal end of the DAVF in the transverse sinus. The microcatheter was placed between the vessel wall of the TSS and the balloon. After the balloon was fully inflated, Onyx-18 was injected at the periphery of the balloon in a slow, controlled, progressive, stepwise manner; the balloon and microcatheter were simultaneously withdrawn toward the sigmoid sinus, with Onyx encompassing the entirety of the complex DAVF. The Onyx refluxed into multiple arterial feeders in a distal-to-proximal step-by-step manner, ultimately resulting in an Onyx tunnel. The final angiography study revealed complete obliteration of the DAVF and patency of the TSS. The Onyx tunnel, or reconstructive transvenous balloon-assisted Onyx embolization technique, may be an effective treatment option for large, complex DAVFs of the TSS. This technique may provide another option to facilitate the complete obliteration of the DAVF while preserving the functional sinus.

Cotton rats (Sigmodon hispidus) possess pharyngeal pouch remnants originating from different primordia.

PubMed

Nakamura, Teppei; Ichii, Osamu; Irie, Takao; Mizoguchi, Tatsuya; Shinohara, Akio; Kouguchi, Hirokazu; Sunden, Yuji; Otsuka-Kanazawa, Saori; Ali Elewa, Yaser Hosny; Koshimoto, Chihiro; Nagasaki, Ken-Ichi; Kon, Yasuhiro

2018-06-01

Pharyngeal pouches in mammals develop into specific derivatives. If the differentiation of the pharyngeal pouches is anomalous, their remnants can result in cysts, sinuses, and fistulae in the differentiated organs or around the neck. In the present study, we found several pharyngeal pouch remnants, such as cystic structures in thymus and parathyroid gland and fossulae extended from the piriform fossa, in the inbred cotton rats maintained at Hokkaido Institute of Public Health (HIS/Hiph) and University of Miyazaki (HIS/Mz). In HIS/Hiph, the fossulae extended from the apex of the piriform fossa into the thyroid glands and were lined with stratified squamous and cuboidal epithelium. Calcitonin-positive C-cells were present within their epithelium in HIS/Hiph. In contrast, the fossulae of HIS/Mz ran outside the thyroid glands toward the parathyroid glands; they were lined with columnar ciliated epithelium and a few goblet cells, but had no C-cells, which was consistent with the cystic structures in the thymus and the parathyroid gland. These results indicated that the fossulae were a remnant of the ultimobranchial body in HIS/Hiph and of the thymopharyngeal duct in HIS/Mz. Thus, the fossulae of the piriform fossa resembled the piriform sinus fistula in human. In conclusion, cotton rats frequently possessed pharyngeal pouch remnants, including the piriform sinus fistula, and therefore, might serve as a novel model to elucidate the mechanisms of pharyngeal pouch development.

Middle meningeal artery: Gateway for effective transarterial Onyx embolization of dural arteriovenous fistulas.

PubMed

Griessenauer, Christoph J; He, Lucy; Salem, Mohamed; Chua, Michelle H; Ogilvy, Christopher S; Thomas, Ajith J

2016-09-01

Curative transarterial embolization of noncavernous sinus dural arteriovenous fistulas (dAVFs) is challenging. We sought to evaluate the role of the middle meningeal artery (MMA) in endovascular treatment of these lesions. We performed a retrospective cohort study on patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVFs with contribution from the MMA at a major academic institution in the United States from January 2009 to January 2015. Twenty consecutive patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVF were identified. One patient was excluded as there was no MMA contribution to the dAVF. All of the remaining 19 patients (61.3 ± 13.8 years of age) underwent transarterial embolization through the MMA. Six patients (31.6%) presented with intraparenchymal or subarachnoid hemorrhage from the dAVF. The overall angiographic cure rate was 73.7% upon last follow up. In 71.4% of successfully treated patients transarterial embolization of the MMA alone was sufficient to achieve angiographic cure. When robust MMA supply was present, MMA embolization resulted in angiographic cure even after embolization of other arterial feeders had failed in 92.9% of patients. A robust contribution of the MMA to the fistula was the single most important predictor for successful embolization (P = 0.00129). We attribute our findings to the fairly straight, non-tortuous course of the MMA that facilitates microcatheter access, navigation, and Onyx penetration. Noncavernous sinus dAVF can be successfully embolized with transarterial Onyx through the MMA, as long as supply is robust. A transvenous approach is rarely necessary. Clin. Anat. 29:718-728, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Branchial cleft anomalies: a pictorial review of embryological development and spectrum of imaging findings.

PubMed

Adams, Ashok; Mankad, Kshitij; Offiah, Curtis; Childs, Lucy

2016-02-01

The branchial arches are the embryological precursors of the face, neck and pharynx. Anomalies of the branchial arches are the second most common congenital lesions of the head and neck in children, with second branchial arch anomalies by far the most common. Clinically, these congenital anomalies may present as cysts, sinus tracts, fistulae or cartilaginous remnants with typical clinical and radiological findings. We review the normal embryological development of the branchial arches and the anatomical structures of the head and neck that derive from each arch. The typical clinical and radiological appearances of both common and uncommon branchial arch abnormalities are discussed with an emphasis on branchial cleft anomalies. • Anomalies of the branchial arches usually present as cysts, sinuses or fistulae. • Second branchial arch anomalies account for approximately 95 % of cases. • There are no pathognomonic imaging features so diagnosis depends on a high index of suspicion and knowledge of typical locations. • Persistent cysts, fistulae or recurrent localised infection may be due to branchial arch anomalies. • Surgical excision of the cyst or tract is the most common curative option.

Current Status of the Application of Intracranial Venous Sinus Stenting

PubMed Central

Xu, Kan; Yu, Tiecheng; Yuan, Yongjie; Yu, Jinlu

2015-01-01

The intracranial venous sinus is an important component of vascular disease. Many diseases involve the venous sinus and are accompanied by venous sinus stenosis (VSS), which leads to increased venous pressure and high intracranial pressure. Recent research has focused on stenting as a treatment for VSS related to these diseases. However, a systematic understanding of venous sinus stenting (VS-Stenting) is lacking. Herein, the literature on idiopathic intracranial hypertension (IIH), venous pulsatile tinnitus, sinus thrombosis, high draining venous pressure in dural arteriovenous fistula (AVF) and arteriovenous malformation (AVM), and tumor-caused VSS was reviewed and analyzed to summarize experiences with VS-Stenting as a treatment. The literature review showed that satisfactory therapeutic effects can be achieved through stent angioplasty. Thus, the present study suggests that selective stent release in the venous sinus can effectively treat these diseases and provide new possibilities for treating intracranial vascular disease. PMID:26516306

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. © 2016 Japan Society of Obstetrics and Gynecology.

Flow diversion in the treatment of carotid injury and carotid-cavernous fistula after transsphenoidal surgery

PubMed Central

Lum, Cheemum; Ahmed, Muhammad E; Glikstein, Rafael; dos Santos, Marlise P; Lesiuk, Howard; Labib, Mohamed; Kassam, Amin B

2015-01-01

We describe a case of iatrogenic carotid injury with secondary carotid-cavernous fistula (CCF) treated with a silk flow diverter stent placed within the injured internal carotid artery and coils placed within the cavernous sinus. Flow diverters may offer a simple and potentially safe vessel-sparing option in this rare complication of transsphenoidal surgery. The management options are discussed and the relevant literature is reviewed. PMID:26015526

Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases.

PubMed

Spinelli, C; Rossi, L; Strambi, S; Piscioneri, J; Natale, G; Bertocchini, A; Messineo, A

2016-05-01

Branchial abnormalities occur when there is disturbance in the maturation of the branchial apparatus during fetal development. Branchial anomalies are congenital lesions usually present in childhood, even if they can be diagnosed later for enlargement or infection. A correct diagnosis will lead to proper management: complete surgical excision is the treatment of choice. The purpose of this article is to present clinical features, diagnostic methods and surgical treatment of branchial anomalies in childhood, based on a series of 50 patients. We conducted a retrospective analysis of a total of 50 pediatric patients operated from June 2005 to June 2014 for the presence of branchial cleft anomalies. 27 cases (54 %) presented a second branchial cleft fistula and 11 cases (22 %) a second branchial cleft cyst and one case (2 %) presented both cyst and sinus of the second branchial cleft; four cases (8 %) presented first branchial cleft cyst whereas four cases (8 %) a first branchial cleft sinus and two cases (4 %) a first branchial cleft fistula; one case (2 %) presented a piriform sinus fistula (third branchial cleft). None of our patients presented anomalies of the fourth branchial cleft. All patients underwent surgical treatment and lesions have been removed by excision or fistulectomy. No post-surgical complication occurred. The rate of recurrence was 4 %. Pre-operative diagnosis supplies important information to the surgeon for a proper therapy: a complete excision of the lesion without inflammatory signs is essential to avoid re-intervention and to achieve a good outcome.

KTP laser assisted endoscopic tissue fibrin glue biocauterization for congenital pyriform sinus fistula in children.

PubMed

Huang, Yun-Chen; Peng, Steve Shinn-Forng; Hsu, Wei-Chung

2016-06-01

This study aims to assess the efficacy of a novel endoscopic management for congenital pyriform sinus fistula (CPSF) using potassium titanyl phosphate (KTP) laser assisted endoscopic tissue fibrin glue biocauterization in children. From 2010 to 2014, a total of 5 children with recurrent or acute suppurative thyroiditis or neck abscess secondary to CPSF were enrolled retrospectively in this study. Mean age at the first time of endoscopic biocauterization was 6.2 ± 0.7 (5-7) years. The barium swallow study detected a fistula in four cases. Endoscopy identified an internal opening at the pyriform sinus in all cases with four on the left side and one on the right side. All patients underwent KTP laser assisted endoscopic tissue fibrin glue biocauterization as treatment for CPSF. Only one case required the second endoscopic procedure due to fluctuation of symptoms. Post-endoscopic follow-up duration of these patients was 24.6 ± 11.6 (7-36) months. Neither complications nor recurrences were noted during follow-up in all patients. For children presenting with repeated acute suppurative thyroiditis or neck infections, clinicians should highly suspect the possibility of CPSF. Endoscopy should be performed not only to confirm the diagnosis but also could be served as an initial treatment modality of biocauterization by KTP laser and tissue fibrin glue, which was demonstrated as a less invasive, safe, and effective method in children. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Heterotopic salivary gland tissue: a case report demonstrating evolution and association with the branchial apparatus.

PubMed

Chang, Wen-Yu; Lee, Ka-Wo; Tsai, Kun-Bow; Chen, Gwo-Shing

2005-09-01

Heterotopic salivary gland tissue (HSGT) in the lower neck is an unusual developmental anomaly with characteristic clinical and microscopic findings. The exact embryogenesis remains unclear. This rare entity must be considered in the differential diagnosis of neck mass with fistula. We present a typical HSGT totally removed using the stepladder excision technique and showing an internal fistula. Interpretation of this case from the anatomical and pathological points of view, we support the argument that the embryogenesis of HSGT is more probably related to ectodermal heteroplasia of the precervical sinus of His and further conclude that an association with branchial cleft sinus may exist and cannot be seen as an exclusion criteria for diagnosis of HSGT. Due to possible but infrequent neoplastic transformation, it is important to check HSGT in every encountered cervical anomaly related to any branchial apparatus derived lesion.

Post Ross procedure aortic right sinus of Valsalva fistula to right ventricle.

PubMed

Williams-Phillips, S

2011-12-01

Post Ross procedure complications have been limited predominantly to neoaortic valvular dilatation (10-30%) and insufficiency, right ventricular prosthetic deterioration or right ventricular pulmonary artery conduit obstruction. Arrhythmia has been documented to occur in a third of these patients. This is the first time that neoaortic right sinus of valsalva dissection and rupture to the right ventricle with a fistulous communication has occurred and been described, as far as the author is aware.

Brain stem venous congestion due to dural arteriovenous fistulas of the cavernous sinus.

PubMed

Kai, Y; Hamada, J I; Morioka, M; Yano, S; Ushio, Y

2004-10-01

Venous congestion of the brain stem due to dural arteriovenous fistulas (DAVFs) in the cavernous sinus is rare and presents therapeutic challenges. To assess the prognosis of patients with symptomatic DAVFs and brain stem dysfunction, we evaluated the degree of venous ischemia by examining pre- and post-treatment magnetic resonance images (MRI) in 2 patients presenting with venous congestion of the brain stem. A 56-year-old woman with left hemiparesis and a 70-year-old woman with gait disturbance attributable to right cavernous sinus DAVFs were referred to our hospital. In both cases, T2-weighted magnetic resonance imaging (MRI) disclosed a hyperintensity lesion in the brainstem due to venous congestion. Both patients underwent open surgery for direct embolization of the cavernous sinus because there were no approach routes for transvenous embolization. The patient whose pretreatment MRI demonstrated Gd enhancement continued to manifest neurological deficits and persistence of the abnormal hyperintensity on post-treatment T2-weighted MRI. In the other patient whose pretreatment MRI showed no Gd enhancement, treatment produced a complete response of her neurological deficit and disappearance of the abnormal hyperintensity area. We tentatively conclude that lesions corresponding to hyperintensity areas on non-Gd-enhanced, T2-weighted MRI may reflect a reversible condition whereas lesions identified as hyperintense areas on GD-enhanced T2-weighted MRI may be indicative of irreversibility.

Median mental sinus in twins.

PubMed

Ong, S T; Ngeow, W C

1999-05-01

Sinus on the chin can be the result of a chronic apical abscess due to pulp necrosis of a mandibular anterior tooth. The tooth is usually asymptomatic, and a dental cause is therefore not apparent to the patient or the unsuspecting clinician. Not infrequently, the patient may seek treatment from a dermatologist or general surgeon instead of a dentist. Excision and repair of the fistula may be carried out with subsequent breakdown because the dental pathology is not removed. This paper reports the presence of median mental sinus of dental origin in twins. One case healed following root canal therapy while the other required both root canal therapy and surgery to eliminate the infection.

First Branchial Cleft Fistula Associated with External Auditory Canal Stenosis and Middle Ear Cholesteatoma

PubMed Central

Abdollahi fakhim, Shahin; Naderpoor, Masoud; Mousaviagdas, Mehrnoosh

2014-01-01

Introduction: First branchial cleft anomalies manifest with duplication of the external auditory canal. Case Report: This report features a rare case of microtia and congenital middle ear and canal cholesteatoma with first branchial fistula. External auditory canal stenosis was complicated by middle ear and external canal cholesteatoma, but branchial fistula, opening in the zygomatic root and a sinus in the helical root, may explain this feature. A canal wall down mastoidectomy with canaloplasty and wide meatoplasty was performed. The branchial cleft was excised through parotidectomy and facial nerve dissection. Conclusion: It should be considered that canal stenosis in such cases can induce cholesteatoma formation in the auditory canal and middle ear. PMID:25320705

First branchial cleft fistula associated with external auditory canal stenosis and middle ear cholesteatoma.

PubMed

Abdollahi Fakhim, Shahin; Naderpoor, Masoud; Mousaviagdas, Mehrnoosh

2014-10-01

First branchial cleft anomalies manifest with duplication of the external auditory canal. This report features a rare case of microtia and congenital middle ear and canal cholesteatoma with first branchial fistula. External auditory canal stenosis was complicated by middle ear and external canal cholesteatoma, but branchial fistula, opening in the zygomatic root and a sinus in the helical root, may explain this feature. A canal wall down mastoidectomy with canaloplasty and wide meatoplasty was performed. The branchial cleft was excised through parotidectomy and facial nerve dissection. It should be considered that canal stenosis in such cases can induce cholesteatoma formation in the auditory canal and middle ear.

Bilateral congenital lacrimal fistulas in an adult as part of ectrodactyly-ectodermal dysplasia-clefting syndrome: A rare anomaly.

PubMed

Ghosh, Debangshu; Saha, Somnath; Basu, Sumit Kumar

2015-10-01

Ectrodactyly-ectodermal dysplasia and clefting syndrome or "Lobster claw" deformity is a rare congenital anomaly that affects tissues of ectodermal and mesodermal origin. Nasolacrimal duct (NLD) obstruction with or without atresia of lacrimal passage is a common finding of such a syndrome. The authors report here even a rarer presentation of the syndrome which manifested as bilateral NLD obstruction and lacrimal fistula along with cleft lip and palate, syndactyly affecting all four limbs, mild mental retardation, otitis media, and sinusitis. Lacrimal duct obstruction and fistula were managed successfully with endoscopic dacryocystorhinostomy (DCR) which is a good alternative to lacrimal probing or open DCR in such a case.

Percutaneous closure of acute aorto-right ventricular fistula following transcatheter bicuspid aortic valve replacement.

PubMed

Nakamura, Kenta; Passeri, Jonathan J; Inglessis-Azuaje, Ignacio

2017-07-01

We report a case of acute aorto-right ventricular fistula following transcatheter bicuspid aortic valve replacement and subsequent percutaneous closure. The diagnosis and treatment of this rare complication is illustrated through multi-modality imaging. We hypothesize that the patient's heavily calcified bicuspid aortic valve anatomy led to asymmetric deployment of the transcatheter aortic valve replacement (TAVR) prosthesis, traumatizing the right sinus of Valsalva at the distal edge of the TAVR stent and ultimately fistulized to the right ventricle. The patient acutely decompensated with heart failure five days after TAVR and underwent emergent intervention. The aorto-right ventricular fistula was closed using an 18-mm septal occluder device with marked clinical recovery. Transcatheter closure is a viable treatment option for acute aorto-right ventricular fistula. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Second branchial cleft fistulae: patient characteristics and surgical outcome.

PubMed

Kajosaari, Lauri; Mäkitie, Antti; Salminen, Päivi; Klockars, Tuomas

2014-09-01

Second branchial cleft anomalies predispose to recurrent infections, and surgical resection is recommended as the treatment of choice. There is no clear consensus regarding the timing or surgical technique in the operative treatment of these anomalies. Our aim was to compare the effect of age and operative techniques to patient characteristics and treatment outcome. A retrospective study of pediatric patients treated for second branchial sinuses or fistulae during 1998-2012 at two departments in our academic tertiary care referral center. Comparison of patient characteristics, preoperative investigations, surgical techniques and postoperative sequelae. Our data is based on 68 patients, the largest series in the literature. One-fourth (24%) of patients had any infectious symptoms prior to operative treatment. Patient demographics, preoperative investigations, use of methylene blue, or tonsillectomy had no effect on the surgical outcome. There were no re-operations due to residual disease. Three complications were observed postoperatively. Our patient series of second branchial cleft sinuses/fistulae is the largest so far and enables analyses of patient characteristics and surgical outcomes more reliably than previously. Preoperative symptoms are infrequent and mild. There was no difference in clinical outcome between the observed departments. Performing ipsilateral tonsillectomy gave no outcome benefits. The operation may be delayed to an age of approximately three years when anesthesiological risks are and possible harms are best avoided. Considering postoperative pain and risk of postoperative hemorrhage a routine tonsillectomy should not be included to the operative treatment of second branchial cleft fistulae. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Magnetic resonance imaging (MRI) of the renal sinus.

PubMed

Krishna, Satheesh; Schieda, Nicola; Flood, Trevor A; Shanbhogue, Alampady Krishna; Ramanathan, Subramaniyan; Siegelman, Evan

2018-04-09

This article presents methods to improve MR imaging approach of disorders of the renal sinus which are relatively uncommon and can be technically challenging. Multi-planar Single-shot T2-weighted (T2W) Fast Spin-Echo sequences are recommended to optimally assess anatomic relations of disease. Multi-planar 3D-T1W Gradient Recalled Echo imaging before and after Gadolinium administration depicts the presence and type of enhancement and relation to arterial, venous, and collecting system structures. To improve urographic phase MRI, concentrated Gadolinium in the collecting systems should be diluted. Diffusion-Weighted Imaging (DWI) should be performed before Gadolinium administration to minimize T2* effects. Renal sinus cysts are common but can occasionally be confused for dilated collecting system or calyceal diverticula, with the latter communicating with the collecting system and filling on urographic phase imaging. Vascular lesions (e.g., aneurysm, fistulas) may mimic cystic (or solid) lesions on non-enhanced MRI but can be suspected by noting similar signal intensity to the blood pool and diagnosis can be confirmed with MR angiogram/venogram. Multilocular cystic nephroma commonly extends to the renal sinus, however, to date are indistinguishable from cystic renal cell carcinoma (RCC). Solid hilar tumors are most commonly RCC and urothelial cell carcinoma (UCC). Hilar RCC are heterogeneous, hypervascular with epicenter in the renal cortex compared to UCC which are centered in the collecting system, homogeneously hypovascular, and show profound restricted diffusion. Diagnosis of renal sinus invasion in RCC is critically important as it is the most common imaging cause of pre-operative under-staging of disease. Fat is a normal component of the renal sinus; however, amount of sinus fat correlates with cardiovascular disease and is also seen in lipomatosis. Fat-containing hilar lesions include lipomas, angiomyolipomas, and less commonly other tumors which engulf sinus fat. Mesenchymal hilar tumors are rare. MR imaging diagnosis is generally not possible, although anatomic relations should be described to guide diagnosis by percutaneous biopsy or surgery.

Rare Location for Pilonidal Sinus: the Nasal Dorsum.

PubMed

Kars, Ayhan; Atalay, Fatma; Kilic, Korhan; Bingöl, Fatih; Can, Yusuf

2018-05-14

Pilonidal sinuses are recurrent chronic inflammatory lesions which may occur due to penetration of hair particles into skin. Herein, the authors report a pilonidal sinus case that is unusually seen on nasal dorsum and totally excised with the open technique rhinoplasty method. A 20-year-old male patient was admitted to the authors' outpatient clinic with complaints of dysmorphism and discharge from nasal dorsum. Physical examination revealed a swelling in nasal dorsum and hair-containing fistula. Excision was performed with an open rhinoplasty approach. Histo-pathology examination revealed pilonidal sinus. While pilonidal sinus is usually located in sacro-coccygeal region, it may also be seen in atypical localizations like nasal dorsum. Although the prediagnosis of a hair-containing lesion usually includes dermoid cyst, pilonidal sinus should also be considered and histo-pathological examination should certainly be performed. It is a problematic condition when it is symptomatic; however, management and treatment of the disease is easy when correct diagnosis is made.

Surgical cannulation of the superior ophthalmic vein for the treatment of previously embolized cavernous sinus dural arteriovenous fistulas: serial studies and angiographic follow-up.

PubMed

Luo, Bin; Zhang, Xin; Duan, Chuan-Zhi; He, Xu-Ying; Li, Xi-Feng; Karuna, Tamrakar; Gu, Da-Qun; Long, Xiao-Ao; Li, Tie-Lin; Zhang, Shi-Zhong; Ke, Yi-Quan; Jiang, Xiao-Dan

2013-04-01

The purpose of this study was to evaluate the safety and efficacy of transorbital puncture for the retreatment of previously embolized cavernous sinus dural arteriovenous fistulas (DAVFs) via a superior ophthalmic vein (SOV) approach. During a 12-year period, 9 consecutive patients with previously embolized cavernous sinus DAVFs underwent retreatment via the transorbital SOV approach. All of the nine cases of previously embolized cavernous sinus DAVFs were successfully embolized. Clinical follow-ups were conducted in all nine cases at the duration of 17-141 months (61.22 ± 39.13 months). No recanalization occurred during the follow-up period. A subtle ptosis appeared in two patients and disappeared in one of the two cases after a 4-year follow-up. One patient suffered from paroxysmal positional vertigo and bruit for nearly 2 years after the treatment, but the follow-up angiography demonstrated no recurrence. One patient had persistent visual impairment caused by the initial venous stasis retinopathy. One patient with a history of a procedure-related transient decrease in visual acuity had it return to the normal level. The remaining four cases had clear improvement in the ocular symptoms and became completely asymptomatic during the follow-up period. No patient worsened or developed new symptoms. The approach of surgical cannulation of the SOV for the retreatment of previously embolized cavernous sinus DAVFs was proved feasible and efficient, especially when the transarterial and transfemoral venous approaches were inaccessible. However, if the SOV is not dilated enough or is located deeply in the orbit, transorbital venous puncture access may not be possible.

Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms

PubMed Central

Pashapour, Ali; Mohammadian, Reza; Salehpour, Firooz; Sharifipour, Ehsan; Mansourizade, Reza; Mahdavifard, Ali; Salehi, Mohamadgharib; Mirzaii, Farhad; Sariaslani, Payam; Fatahzade Ardalani, Ghasem; Altafi, Davar

2014-01-01

Summary Ocular symptoms are regularly observed in patients with cavernous sinus dural arteriovenous fistulas (cDAVF). We aimed to evaluate the long-term efficacy and safety of endovascular approaches in patients with cDAVF presenting with different ocular symptoms. In a prospective study between June 2008 and March 2013, 46 patients with ocular symptoms due to cDAVF who were not eligible for conservative therapy, met the inclusion criteria and underwent endovascular treatment. They underwent a transarterial approach with histoacryl glue injections or transvenous coil embolization, all in one session. They were followed up for a mean period of 17.3 months (range 7 to 30 months) clinically and using angiography. The mean age of patients was 36.8 years (18-60) and 65% of them were male. All patients showed venous drainage into the superior and inferior orbital veins. Access to the cavernous sinus was transvenous in ten patients, transarterial in 26 patients, and mixed in ten patients. Initial symptoms were improved in 97.8% of patients and did not recur during the study follow-up. The procedural complications included: blurred vision, transient sixth nerve palsy and exacerbation of chemoproptosis in two, one and two patients respectively that completely resolved in initial weeks with no recurrence. No patient worsened or developed new symptoms suggestive of a recurrent fistula during the follow-up period. One patient experienced intracranial dissection of the internal carotid artery and ischemic stroke with an unfinished procedure. The relief of early presentation was durable in long-term follow-up and the cured lesions were stable in angiographic controls. Favorable and durable outcomes could be obtained following endovascular approaches for cDAVF presenting with different ocular symptoms. PMID:25196621

Onyx removal after embolization of a superior sagittal sinus dural arteriovenous fistula involving scalp artery.

PubMed

Watanabe, Jun; Maruya, Jun; Nishimaki, Keiichi; Ito, Yasushi

2016-01-01

Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. A 59-year-old male presented with involuntary movements of both legs and progressive dementia. Cerebral angiography demonstrated the DAVF in the SSS fed by bilateral superficial temporal, occipital, and middle meningeal arteries. The posterior SSS was thrombosed, and the main drainers were cortical veins. Combined treatment with transarterial embolization using Onyx and transvenous embolization using coils was performed. Although symptoms were improved, a small DAVF remained. Two months later, Onyx cast extrusion through the scalp was observed, requiring removal and debridement because of infection at the extrusion sites. Surgery for the residual DAVF would be difficult because of scalp condition; therefore, an additional endovascular treatment was conducted, completely occluding DAVF. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures.

Endovascular management of sigmoid sinus dural arteriovenous fistula associated with sinus stenosis in an infant.

PubMed

Cohen, José E; Gomori, John M; Benifla, Moni; Itshayek, Eyal; Moscovici, Samuel

2013-01-01

A 4-month-old female presented with a dural arteriovenous fistula (DAVF), which was successfully managed using endovascular techniques. There are very few case series reporting DAVF in infants younger than 12 months and, to our knowledge, only 60 pediatric patients with DAVF have been reported to date. Although most DAVF have a benign course, they can result in life-threatening hemorrhage. Endovascular therapies are usually indicated in the management of these neurosurgical vascular malformations. Endovascular therapy of DAVF in neonatal patients presents some major issues. Gaining arterial access may be problematic in femoral arteries too small for the introduction of a sizeable guiding catheter. The volumes of contrast and infused fluids must be carefully monitored to prevent fluid overload. Radiation exposure should be restricted as far as possible. This report contributes to the limited body of evidence on neonatal DAVF and its endovascular management. Copyright © 2012 Elsevier Ltd. All rights reserved.

Pediatric Endoscopic Pilonidal Sinus Treatment, a Revolutionary Technique to Adopt in Children with Pilonidal Sinus Fistulas: Our Preliminary Experience.

PubMed

Esposito, Ciro; Izzo, Serena; Turrà, Francesco; Cerulo, Mariapina; Severino, Giovanni; Settimi, Alessandro; Iannazzone, Marta; Masieri, Lorenzo; Cortese, Giuseppe; Escolino, Maria

2018-03-01

This study aimed to report our preliminary experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT). We retrospectively reviewed the reports of 15 patients, 6 girls and 9 boys, with an average age of 16 years (range 13-18) with noninfected pilonidal sinus disease who underwent PEPSiT in our institution over an 18-month period. Four cases were redo-procedures, for recurrence of disease after open excision repair. Surgical outcomes of sinus healing, recurrence of disease, postoperative pain, hospital stay, analgesic requirements, and patient satisfaction levels were evaluated and a comparison analysis with classic open repair was performed. All procedures were performed under subarachnoid spinal anesthesia. We always adopted a fistuloscope, an endoscopic forceps, and a monopolar electrode to remove the hairs and to heal the fistula. The average length of surgery was 28.5 minutes (range 26-41). No intraoperative or postoperative complications were reported. The average pain score evaluated using Visual Analogue Scale (VAS) pain scale during the first 48 postoperative hours was 3.2 (range 2-5). The average analgesic requirement was 22 hours (range 16-28). The average hospital stay length was 28 hours (range 22-48). They changed dressing daily, by applying a topical solution of eosin 2% and a silver sulfadiazine spray. At 1 month postoperatively, the external openings were closed in all patients and no recurrence was recorded at a mean follow-up of 6 month. PEPSiT was associated with a significantly shorter, painless, and better outcome compared to open technique. On the basis of our preliminary experience, we believe that PEPSiT is a promising technique for surgical treatment of pilonidal sinus in children. It is technically easy and quick to perform, with a short and painless hospital stay, without recurrences in our series. It allows operated patients an early return to full daily activities without restrictions that happen for the classic treatment.

A true branchial fistula in the context of branchiootic syndrome: challenges of diagnosis and management.

PubMed

Jovic, Thomas H; Saldanha, Francesca; Kuo, Rachel; Ahmad, Tariq

2014-09-01

The presence of a branchial fistula with communication both internally and externally: a 'true' branchial fistula is rare, and may arise in the context of autosomal dominant conditions such as branchiootic syndrome and branchiootorenal syndrome. We discuss the case of a true branchial fistula, which recurred after initial surgical excision, in a patient with branchiootic syndrome. The residual tract was dissected in a second operation through stepladder neck incisions and removed in toto via an intraoral approach. No renal abnormalities were detected on investigation with ultrasound. Incomplete excision of a branchial sinus is likely to cause recurrence however intraoperative visualisation of the tract can can sometimes prove challenging. An combined intraoral and external approach aids delineation and tract definition when there is a true branchial fistula and can therefore facilitate a complete excision. Suspicion of an hereditary aetiology should be raised in patients with bilateral or preauricular features, or a positive family history, which may then prompt additional renal and genetic investigation. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Coronary artery to pulmonary artery fistula.

PubMed

Dadkhah-Tirani, Heidar; Salari, Arsalan; Shafighnia, Shora; Hosseini, Seyed Fazel; Naghdipoor, Misa

2013-01-01

Male, 69 FINAL DIAGNOSIS: Coronary artery to pulmonary artery fistula Symptoms: Chest pain Medication: - Clinical Procedure: Echocardiography • angiography • surgical intervention Specialty: Cardiology • Cardiac Surgery. Rare disease. A coronary artery fistula is an abnormal communication between a coronary artery and one of the cardiac chambers or a great vessel, so bypassing the myocardial capillary network. They are usually discovered incidentally upon coronary angiography. Clinical manifestations are variable depending on the type of fistula, the severity of shunt, site of shunt, and presence of other cardiac condition. We report a 69-year-old man without any previous medical history, who was admitted to our hospital with chest pain. The electrocardiogram (ECG) showed a sinus rhythm with ST depression in V2 to V6 precordial leads. Coronary angiography revealed a coronary artery fistula from left anterior descending coronary artery (LAD) to the main pulmonary artery, right coronary artery blockage and significant stenoses on the LAD and left circumflex artery (LCX). Surgical treatment was chosen because of the total occlusion of the right coronary artery and to relieve of pain to improve quality of life.

Root Cause Analysis: An Examination of Odontogenic Origins of Acute Maxillary Sinusitis in Both Immunocompetent & Immunocompromised Patients.

PubMed

McCarty, Jennifer L; David, Ryan M; Lensing, Shelly Y; Samant, Rohan S; Kumar, Manoj; Van Hemert, Rudy L; Angtuaco, Edgardo J C; Fitzgerald, Ryan T

Dental and periodontal diseases represent important but often overlooked causes of acute sinusitis. Our goal was to examine the prevalence of potential odontogenic sources of acute maxillary sinusitis according to immune status and their associations with sinusitis. A retrospective review of maxillofacial computed tomography studies from 2013 to 2014 was performed. Each maxillary sinus and its ipsilateral dentition were evaluated for findings of acute sinusitis and dental/periodontal disease. Eighty-four patients (24 immunocompetent, 60 immunocompromised) had 171 maxillary sinuses that met inclusion criteria for acute maxillary sinusitis. Inspection of dentition revealed oroantral fistula in 1%, periapical lucencies in 16%, and projecting tooth root(s) in 71% of cases. Immunocompromised patients were more likely to have bilateral sinusitis than immunocompetent patients (67% vs 33%, P = 0.005). A paired case-control analysis in a subset of patients with unilateral maxillary sinusitis (n = 39) showed a higher prevalence of periapical lucency in association with sinuses that had an air fluid level-29% of sinuses with a fluid level had periapical lucency compared with 12% without sinus fluid (P = 0.033). Potential odontogenic sources of acute maxillary sinusitis are highly prevalent in both immunocompetent and immunocompromised patients, although the 2 patient populations demonstrate no difference in the prevalence of these potential odontogenic sources. Periapical lucencies were found to be associated with an ipsilateral sinus fluid level. Increased awareness of the importance of dental and periodontal diseases as key components of maxillofacial computed tomography interpretation would facilitate a more appropriate and timely treatment.

Lateral Sinus Dural Arteriovenous Fistulas: Sinovenous Outflow Restriction Outweighs Cortical Venous Reflux as a Parameter Associated with Hemorrhage.

PubMed

Hu, Yong-Sin; Lin, Chung-Jung; Wu, Hsiu-Mei; Guo, Wan-Yuo; Luo, Chao-Bao; Wu, Chih-Chun; Chung, Wen-Yuh; Liu, Kang-Du; Yang, Huai-Che; Lee, Cheng-Chia

2017-11-01

Purpose To investigate whether sinovenous outflow restriction (SOR) is more strongly associated with hemorrhage than cortical venous reflux (CVR) in patients with lateral sinus dural arteriovenous fistulas (DAVFs). Materials and Methods An institutional review board approved this retrospective study and waiver of informed consent was obtained. From 1995 to 2016, 163 cases of lateral sinus DAVFs were included and divided into hemorrhagic and nonhemorrhagic groups based on initial presentation. Their angiograms and magnetic resonance images were evaluated, with two evaluators independently grading CVR and SOR. The SOR was scored as the combined conduit score (CCS), ranging from zero (total occlusion) to 8 (fully patent). The CVR and CCS of the hemorrhagic and nonhemorrhagic groups were compared. Logistic regression models were established for both the CVR and CCS to compare their performances in discriminating DAVF hemorrhage. Results Sinovenous outflow was significantly more restrictive (lower median CCS) in the hemorrhagic group than in the nonhemorrhagic group (1 vs 6.5; P < .001). A CCS of less than or equal to 2 best discriminated between the groups with a sensitivity of 90.0% and a specificity of 88.1%. The CCS model had a higher discriminative performance than did the CVR model (area under the curve, 0.933 vs 0.843; P = .018). Conclusion The CCS grading system semiquantifies SOR. SOR may represent a stronger risk factor associated with hemorrhage in patients with lateral sinus DAVFs than does CVR, and thus may offer guidance in therapeutic decision making. © RSNA, 2017.

A novel surgical management of hypopharyngeal branchial anomalies.

PubMed

Givens, Daniel J; Buchmann, Luke O; Park, Albert H

2015-04-01

To review our experience treating hypopharyngeal branchial anomalies utilizing an open transcervical approach that: (1) includes recurrent laryngeal nerve (RLN) monitoring and identification if needed; (2) resection of tract if present; and (3) a superiorly based sternothyroid muscle flap for closure. A retrospective chart review was performed to identify all patients at a tertiary level children's hospital with branchial anomalies from 2005 to 2014. The clinical presentation, evaluation, treatment and outcome were analyzed for those patients with hypopharyngeal branchial anomalies. Forty-seven patients who underwent excision of branchial anomalies with a known origin were identified. Thirteen patients had hypopharyngeal branchial anomalies. Six of these patients were treated by the authors of this study and are the focus of this analysis. All six underwent an open transcervical procedure with a sternothyroid muscle flap closure of a piriform sinus opening over a nine year period. Definitive surgery included a microlaryngoscopy and an open transcervical approach to close a fistula between the piriform sinus and neck with recurrent laryngeal nerve monitoring or dissection. A superiorly based sternothyroid muscle flap was used to close the sinus opening. There were no recurrences, recurrent laryngeal nerve injuries or other complications from these procedures. This study supports complete surgical extirpation of the fistula tract using an open cervical approach, recurrent laryngeal nerve monitoring or identification, and rotational muscle flap closure to treat patients with hypopharyngeal branchial anomalies. Published by Elsevier Ireland Ltd.

Congenital cutaneous fistula at the sternoclavicular joint - Not a dermoid fistula but the remnant of the fourth branchial (pharyngeal) cleft ?

PubMed

Ohno, Michinobu; Kanamori, Yutaka; Tomonaga, Kotaro; Yamashita, Tatsuya; Migita, Misato; Takezoe, Toshiko; Watanabe, Toshihiko; Fuchimoto, Yasushi; Matsuoka, Kentaro

2015-12-01

A fourth branchial pouch remnant is well known as a pyriform sinus fistula. However, there has been no report of a fistula composed of the complete remnant of the fourth branchial apparatus. We experienced patients with a congenital lower neck cutaneous fistula which was thought to be the skin-side remnant of the fourth branchial cleft. Seven children were referred to our hospital from 2009 to 2015 for the treatment of a cutaneous fistula situated near the sternoclavicular joint. All of them were surgically resected and their pathological characteristics were examined. Clinical charts were retrospectively reviewed. In six cases, the left side was affected. All cutaneous fistulas had a small skin orifice near the sternoclavicular joint and they were situated at the anterior edge of the sternocleidomastoid muscle. Abscess formation was seen in four cases. Surgical resection was performed at the age of 6 months to 9 years. These fistulas ran deep into the subcutaneous tissue and had a blind end. Pathological examination showed that the epithelial layer was mainly composed of a stratified squamous epithelium. In two cases the epithelium was composed of ciliated columnar epithelium. Recurrence has not been observed in any of the cases. The seven cases had a common clinical feature and were a definite clinical entity. Judging from the characteristics of our cases and the previous literature, we concluded that this lower neck cutaneous fistula was most likely a congenital skin-side remnant of the fourth branchial cleft. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Anal fistula with foot extension—Treated by kshara sutra (medicated seton) therapy: A rare case report

PubMed Central

Ramesh, P. Bhat

2013-01-01

INTRODUCTION An ‘anal’ fistula is a track which communicates anal canal or rectum and usually is in continuity with one or more external openings. Distant communication from rectum is rare. It is a challenging disease because of its recurrence especially, with high level and distant communications. Ksharasutra (medicated seton) therapy is being practiced in India with high success rate (recurrence of 3.33%) in the management of complicated anal fistula. PRESENTATION OF CASE A 56 year old man presented with recurrent boils in the left lower limb at different places from thigh to foot. He underwent repeated incision and drainage at different hospitals. Examination revealed sinus with discharge and multiple scars on left lower limb from thigh up to foot. Suspecting anal fistula, MRI was advised which revealed a long cutaneous fistula from rectum to left lower limb. Patient was treated with Ksharasutra therapy. Within 6 months of treatment whole tract was healed completely. DISCUSSION Sushrutha (500BC) was the first to explain the role of surgical excision and use of kshara sutra for the management of anal fistula. Ksharasutra therapy showed least recurrence. Fistula from rectum to foot is of extremely rare variety. Surgical treatment of anal fistula requires hospitalization, regular post-operative care, is associated with a significant risk of recurrence (0.7–26.5%) and a high risk of impaired continence (5–40%). CONCLUSION Rectal fistula communicating till foot may be a very rare presentation in proctology practice. Kshara sutra treatment was useful in treating this condition, with minimal surgical intervention with no recurrence. PMID:23702360

Giant Circumflex Artery Aneurysm with a Coronary Sinus Fistula.

PubMed

Libertini, Richard; Walbridge, David; Jones, Hefin R; Gunning, Mark; Satur, Christopher Mr

2018-05-12

Giant coronary artery aneurysms (GCCAA) are extremely rare entities, and of the circumflex artery we are aware of only 13 case reports. We therefore provide this case report to add evidence of the natural history and pathophysiology and describe successful surgical treatment of the condition. Copyright © 2018. Published by Elsevier Inc.

Tadpole-shaped lateralized parietal atretic cephalocele associated with an ipsilateral lacrimal gland fistula and schizencephalic clefts.

PubMed

Murakami, Nobuya; Morioka, Takato; Suzuki, Satoshi O; Mukae, Nobutaka; Hashiguchi, Kimiaki; Iihara, Koji

2017-02-01

Parietal atretic cephalocele (AC) and its associated intracranial venous anomalies, such as vertical embryonic positioning of the straight sinus (VEP of SS), have, in previous reports, been exclusively restricted to the midline. We report a patient with lateralized parietal AC on the right side. The AC was in the shape of a tadpole, with a large head and a long tail, extending to the proximity of the right external canthus, where a lacrimal gland fistula was observed. The superior sagittal sinus and VEP of SS were also displaced to the right side, although the sagittal suture was located at the midline. Schizencephalic clefts in the right posterior cortex were also observed. The parietal AC, which was initially located in the midline, could conceivably have been displaced to the right side by other developmental processes. However, the relationship between lateralized AC and associated multiple anomalies on the ipsilateral side is difficult to explain monogenetically. Our case study indicates that AC might have a broader spectrum of clinical symptoms than was once thought to be the case.

Branchial sinus of the piriform fossa: reappraisal of third and fourth branchial anomalies.

PubMed

James, Adrian; Stewart, Craig; Warrick, Paul; Tzifa, Constance; Forte, Vito

2007-11-01

The objective of this study was to review clinical and embryologic aspects of third and fourth branchial anomalies. Retrospective study. We reviewed the institutional and departmental databases at our institution to identify all cases of third and fourth branchial anomalies encountered from 1992 to 2006. All patient records were examined with respect to demographics, clinical history, and radiologic and pathologic reports. We identified 17 cases of third and fourth branchial anomalies, the largest series of its kind reported to date. The lesions were predominantly left sided, all presenting with neck infection. Fistula formation was iatrogenic, secondary to incision and drainage. Preoperative direct laryngoscopy always revealed a pit within the apex of the piriform fossa. Surgical excision involved ipsilateral thyroidectomy as the lesion passed through the thyroid gland. No lesions following the classical course of a either a third or fourth branchial anomaly were identified. The clinical presentation of branchial sinuses arising from the piriform fossa is more in keeping with derivation from the thymopharyngeal duct (of the third pouch) than the hypothetical course of third and fourth branchial fistulae.

Onyx removal after embolization of a superior sagittal sinus dural arteriovenous fistula involving scalp artery

PubMed Central

Watanabe, Jun; Maruya, Jun; Nishimaki, Keiichi; Ito, Yasushi

2016-01-01

Background: Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Case Description: A 59-year-old male presented with involuntary movements of both legs and progressive dementia. Cerebral angiography demonstrated the DAVF in the SSS fed by bilateral superficial temporal, occipital, and middle meningeal arteries. The posterior SSS was thrombosed, and the main drainers were cortical veins. Combined treatment with transarterial embolization using Onyx and transvenous embolization using coils was performed. Although symptoms were improved, a small DAVF remained. Two months later, Onyx cast extrusion through the scalp was observed, requiring removal and debridement because of infection at the extrusion sites. Surgery for the residual DAVF would be difficult because of scalp condition; therefore, an additional endovascular treatment was conducted, completely occluding DAVF. Conclusion: Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures. PMID:27313969

May the Inferior Petrosal Sinus Recanalization During Endovascular Treatment for Carotid-Cavernous Fistulas Increase the Risk of Sixth Nerve Palsy?

PubMed

Robert, Thomas; Valsecchi, Daniele; Sylvestre, Philippe; Blanc, Raphaël; Ciccio, Gabriele; Smajda, Stanislas; Redjem, Hocine; Piotin, Michel

2018-05-03

Sixth nerve palsy is a common complication of endovascular treatment for carotid-cavernous fistulas (CCF). Two hypotheses are evoked: the spontaneous venous congestion into the cavernous sinus and the direct compression of the nerve by the embolic agent into the cavernous sinus. Nevertheless, the evidence is still uncertain. Knowing the vicinity of the sixth nerve with the inferior petrosal sinus (IPS) in the Dorello canal, we hypothesized that the recanalization of the IPS increased the risk of nerve damage. We analyzed a prospective database of patients treated for CCFs from March 2009 to April 2016. We excluded patients who did not need treatment, cases of high-flow CCF, and patients lost to follow-up, obtaining a homogeneous population of 82 patients with indirect CCFs. This population was divided in 2 groups: patients without new-onset/worsening of sixth nerve palsy and patients with this postprocedural complication. Our main endpoints were the potential differences between patients with or without recanalization of IPS and between those who underwent or not an embolization with Onyx-18. We did not find any statistically meaningful difference between the 2 groups concerning the necessity of IPS recanalization (P > 0.999, odds ratio 0.97, 95% confidence interval 0.32-2.96) or with the use of Onyx-18 as an embolic agent (P = 0.56; odds ratio 1.41, 95% confidence interval 0.41-2.45). The recanalization of a thrombosed IPS does not increase the risk of procedural sixth nerve damage. The initial injury seems to relate with development/worsening of a sixth nerve palsy. Copyright © 2018 Elsevier Inc. All rights reserved.

Anal fistula with foot extension-Treated by kshara sutra (medicated seton) therapy: A rare case report.

PubMed

Ramesh, P Bhat

2013-01-01

An 'anal' fistula is a track which communicates anal canal or rectum and usually is in continuity with one or more external openings. Distant communication from rectum is rare. It is a challenging disease because of its recurrence especially, with high level and distant communications. Ksharasutra (medicated seton) therapy is being practiced in India with high success rate (recurrence of 3.33%) in the management of complicated anal fistula. A 56 year old man presented with recurrent boils in the left lower limb at different places from thigh to foot. He underwent repeated incision and drainage at different hospitals. Examination revealed sinus with discharge and multiple scars on left lower limb from thigh up to foot. Suspecting anal fistula, MRI was advised which revealed a long cutaneous fistula from rectum to left lower limb. Patient was treated with Ksharasutra therapy. Within 6 months of treatment whole tract was healed completely. Sushrutha (500BC) was the first to explain the role of surgical excision and use of kshara sutra for the management of anal fistula. Ksharasutra therapy showed least recurrence. Fistula from rectum to foot is of extremely rare variety. Surgical treatment of anal fistula requires hospitalization, regular post-operative care, is associated with a significant risk of recurrence (0.7-26.5%) and a high risk of impaired continence (5-40%). Rectal fistula communicating till foot may be a very rare presentation in proctology practice. Kshara sutra treatment was useful in treating this condition, with minimal surgical intervention with no recurrence. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

[The role of computed tomography after functional surgery on the paranasal sinuses. Normal findings and an assessment of the surgical failures].

PubMed

Scribano, E; Ascenti, G; Cascio, F; Bellinvia, A; Mazziotti, S; Lamberto, S

1999-09-01

Functional endoscopic sinus surgery has become the technique of choice to treat benign or inflammatory diseases of paranasal sinuses resistant to medical therapy. The goal of this type of surgery is to open the obstructed sinus ostia and restore normal aeration and mucociliary clearance. Messerklinger's is the most widely used technique. We investigated the role of CT after functional endoscopic sinus surgery and describe CT findings of postoperative anatomical changes together with frequent complications and surgical failures. Twenty-seven patients with relapsing symptoms were examined with CT of paranasal sinuses 8-32 weeks after functional endoscopic sinus surgery. In all cases both preoperative CT and surgical reports were available: CT and surgical results were compared. In 21/27 patients nasosinusal changes were demonstrated with CT. Recurrent disease secondary to inflammation and/or fibrosis was observed in 14 cases. Residual disease was seen in 5 patients. A major orbital complication was found in 1 patient with diplopia. One patient exhibited a large interruption of cribriform plate with CSF fistula. CT permitted an accurate assessment of extension and results of functional endoscopic sinus surgery. CT is indicated in the postoperative study of the patients who a) present symptoms of cerebral and ocular complications (early after functional endoscopic sinus surgery); and b) do not respond to medical treatments 8-32 weeks after unsuccessful functional endoscopic sinus surgery. In these patients CT can demonstrate recurrent and/or residual nasosinusal disease and bony defects unintentionally caused by the surgeon during the procedure.

Management of acute maxillary sinusitis after sinus bone grafting procedures with simultaneous dental implants placement - a retrospective study.

PubMed

Chirilă, Lucian; Rotaru, Cristian; Filipov, Iulian; Săndulescu, Mihai

2016-03-08

The sinus lift was first described in 1974 and it has proven to be a predictable procedure ever since. The complications of this surgical procedure are reported in the literature to be low, and can include acute maxillary sinusitis, scattering of the grafting material into the sinus cavity, wound dehiscence and Schneiderian membrane perforations. We aimed to evaluate the rate of acute maxillary sinusitis after sinus lift procedures and the appropriate management strategies. Between 2013 and 2015, 245 dental implants were placed in 116 patients (76 males and 40 females) with concomitant bone augmentation of the maxillary sinus floor. The sinus lifting procedure was bilateral in 35 patients and unilateral in 81 patients (a total of 151 sinuses). Maxillary sinusitis occurred in 5 patients (4.3 %). The clinical signs of infection were: headache, locoregional pain, cacosmia, inflammation of the oral buccal mucosa and rhinorrhea or unilateral nasal discharge. A mucosal fistula was observed during inspection in one patient. The management included only the removal of the grafting material in 3 patients, in 1 patient the grafting material was removed together with all the implants, and in 1 patient only 2 implants and the grafting material were removed, 1 implant being left in place. The sinus cavity was irrigated with metronidazole solution and antibiotic therapy with clindamycin and metronidazole was prescribed for 10 days. Subsequently, all signs of infection disappeared within 5 to 7 days and normal sinus function and drainage were restored. Although sinus lift is regarded as a safe and reliable procedure, acute sinusitis is a possible complication which has to be managed immediately in order to reduce the risk of further complications like pansinusitis, osteomyelitis of the maxillary bone, and spreading of the infection in the infratemporal space or orbital cavity. To minimize risk, caution must be taken with all the steps of the procedure, in order not to obliterate the ostium, impairing maxillary sinus clearance.

Botryomycosis presenting as nasal cutaneous fistulas caused by Prevotella melaninogenica.

PubMed

Huang, C-F; Liaw, F-Y; Dai, N-T; Ou, K-W; Wang, C-C; Wang, W-M

2012-07-01

Botryomycosis is an uncommon chronic suppurative granulomatous bacterial infection that can affect the skin and viscera. Clinically, lesions typically consist of small tender nodules from which draining sinuses may develop to expel a purulent discharge. Histopathological features include characteristic aggregation of microorganisms (grain) within the inflammatory infiltrate. The commonest causative organisms are Staphylococcus aureus and Pseudomonas aeruginosa, of others. Botryomycosis resulting from Prevotella melaninogenica has not been reported previously. We report the case of a middle-aged patient with botryomycosis presenting as nasal cutaneous fistulas caused by P. melaninogenica, which was successfully treated with surgical intervention combined with systemic antibiotic treatment. © The Author(s). CED © 2011 British Association of Dermatologists.

Angio-Architectural Features of High-Grade Intracranial Dural Arteriovenous Fistulas: Correlation With Aggressive Clinical Presentation and Hemorrhagic Risk.

PubMed

Della Pepa, Giuseppe Maria; Parente, Paolo; D'Argento, Francesco; Pedicelli, Alessandro; Sturiale, Carmelo Lucio; Sabatino, Giovanni; Albanese, Alessio; Puca, Alfredo; Fernandez, Eduardo; Olivi, Alessando; Marchese, Enrico

2017-08-01

High-grade dural arteriovenous fistulas (dAVFs) can present shunts with very different angio-architectural characteristics. Specific hemodynamic factors may affect clinical history and determine very different clinical courses. To evaluate the relationship between some venous angio-architectural features in high-grade dAVFs and clinical presentation. Specific indicators of moderate or severe venous hypertension were analyzed, such as altered configurations of the dural sinuses (by a single or a dual thrombosis), or overload of cortical vessels (restrictions of outflow, pseudophlebitic cortical vessels, and venous aneurysms). The institutional series was retrospectively reviewed (49 cases), and the pattern of venous drainage was analyzed in relationship with clinical presentation (benign/aggressive/hemorrhage). Thirty-five of 49 cases displayed cortical reflux (high-grade dAVFs). This subgroup displayed a benign presentation in 31.42% of cases, an aggressive in 31.42%, and hemorrhage in 37.14%. Our data confirm that within high-grade dAVFs, 2 distinct subpopulations exist according to severity of clinical presentation. Some indicators we examined showed correlation with aggressive nonhemorrhagic manifestations (outflow restriction and pseudophlebitic cortical vessels), while other showed a correlation with hemorrhage (dual thrombosis and venous aneurysms). Current classifications appear insufficient to identify a wide range of conditions that ultimately determine the organization of the cortical venous drainage. Intermediate degrees of venous congestion correlate better with the clinical risk than the simple definition of cortical reflux. The angiographic aspects of venous drainage presented in this study may prove useful to assess dAVF hemodynamic characteristics and identify conditions at higher clinical risk. Copyright © 2017 by the Congress of Neurological Surgeons

Branchial anomalies in the pediatric population.

PubMed

Schroeder, James W; Mohyuddin, Nadia; Maddalozzo, John

2007-08-01

We sought to review the presentation, evaluation, and treatment of branchial anomalies in the pediatric population and to relate these findings to recurrences and complications. We conducted a retrospective study at a tertiary care pediatric hospital. Ninety-seven pediatric patients who were treated for branchial anomalies over a 10-year period were reviewed. Patients were studied if they underwent surgical treatment for the branchial anomaly and had 1 year of postoperative follow-up; 67 children met criteria, and 74 anomalies were studied. Patients with cysts presented at a later age than did those with branchial anomaly fistulas or sinus branchial anomalies. 32% of branchial anomalies were previously infected. Of these, 71% had more than one preoperative infection. 18% of the BA were first arch derivatives, 69% were second arch derivatives and 7% were third arch derivatives. There were 22 branchial cysts, 31 branchial sinuses and 16 branchial fistulas. The preoperative and postoperative diagnoses differed in 17 cases. None of the excised specimens that contained a cystic lining recurred; all five recurrences had multiple preoperative infections. Recurrence rates are increased when there are multiple preoperative infections and when there is no epithelial lining identified in the specimen.

Evaluation of arteriovenous fistulas and pseudoaneurysms in renal allografts following percutaneous needle biopsy. Color-coded Doppler sonography versus duplex Doppler sonography.

PubMed

Hübsch, P J; Mostbeck, G; Barton, P P; Gritzmann, N; Fruehwald, F X; Schurawitzki, H; Kovarik, J

1990-02-01

One hundred one patients with renal allografts were studied by two independent observers using duplex Doppler sonography (DDS) and color-coded Doppler sonography (CCDS). In all patients, single or multiple percutaneous needle biopsies of the transplant had been performed 1 to 30 days before. In 6 patients CCDS following the biopsy demonstrated an area of combined red and blue color-coded blood flow within the renal parenchyma (n = 5) or within the sinus (n = 1); the Doppler waveform was abnormal in these areas with signals above and below the zero line indicating turbulent blood flow. Consecutive intraarterial digital subtraction angiography (DSA) revealed the presence of an arteriovenous fistula (n = 4) or of a pseudoaneurysm (n = 2). In one patient, gross hematuria with obstruction of the bladder occurred as a complication of a pseudoaneurysm within the renal sinus; the bleeding could not be stopped by embolization of the lesion and the kidney had to be removed. DDS demonstrated the lesion in only one of the six patients. Thus, CCDS is the method of choice for noninvasive detection of vascular lesions due to percutaneous biopsy.

Onyx Migration in the Endovascular Management of Intracranial Dural Arteriovenous Fistulas

PubMed Central

Wang, H.; Lv, X.; Jiang, C.; Li, Y.; Wu, Z.; Xu, K.

2009-01-01

Summary Onyx migration in the endovascular treatment of dural arteriovenous fistulas (dural AVFs) is uncommon. We describe five cases of Onyx migration to the heart and draining vein and its avoidance. Between February 2007 and August 2008, Onyx migration was encountered in five patients with dural AVFs treated endovascularly at our institute. Procedures performed under general anesthesia consisted of two arterial approaches and three venous approaches. Two patients with dural AVFs involving the transverse-sigmoid sinus were treated by tran- sarterial embolization using Onyx-18 via the occipital artery and the posterior branch of the middle meningeal artery, respectively. A piece of Onyx was found in the right ventricle on post- embolization chest X-ray film in both patients, one developed tricuspid valve dysfunction requiring thoracic surgery and one was asymptomatic. The other three patients were treated with a combination of Onyx (34 or 18) and coils transvenously with venous Onyx migration leading to draining vein occlusion, one with dur- al AVF involving the tentorium died from venous rupture, two patients with bilateral dural AVFs of the cavernous sinus (one with deterioration of ocular symptoms and one without symptoms). Postoperative digital subtraction an- giography confirmed the elimination of dural AVF in one patient, and residual fistulae in three patients. The follow-up study ranging from two to nine months (average, 4.5 months). Three patients recovered to their full activities, while one had visual disturbance. Although Onyx has been considered a controllable embolic agent, its migration to other locations causing clinical deterioration can occur. This problem should be noted and prevented. PMID:20465913

Surgical Approaches to the Nasal Cavity and Sinuses.

PubMed

Weeden, Alyssa Marie; Degner, Daniel Alvin

2016-07-01

The nasal cavity and sinuses may be exposed primarily via a dorsal or ventral surgical approach. Surgical planning involves the use of advanced imaging, such as computed tomography or MRI. Surgical treatment of lesions of the nasal cavity usually is limited to benign lesions or can also be used in combination with adjunctive therapy, such as radiation therapy. Extreme caution must be exercised with a dorsal approach to the nasal cavity to avoid complications of inadvertent penetration into the brain case. Gentle tissue handling and careful closure of the mucoperiosteum must be exercised following a ventral approach to minimize the risk of oronasal fistula formation. Copyright © 2016 Elsevier Inc. All rights reserved.

Intra- and Postoperative Complications of Lateral Maxillary Sinus Augmentation in Smokers vs Nonsmokers: A Systematic Review and Meta-Analysis.

PubMed

Ghasemi, Samaneh; Fotouhi, Akbar; Moslemi, Neda; Chinipardaz, Zahra; Kolahi, Jafar; Paknejad, Mojgan

This meta-analysis and systematic review focused on the following question: Does tobacco smoking increase the risk of intra- or postoperative complications of lateral maxillary sinus floor elevation? The following electronic databases were searched up to and including November 2015 without language restriction: CENTRAL, MEDLINE, Google Scholar, Scopus, Sirous, and Doaj. Studies were included if rates of intra-or postoperative complications of sinus floor elevation in smokers and nonsmokers were recorded separately. The following complications were assessed: sinus membrane perforation, bleeding, wound dehiscence, wound infection, sinusitis, hematoma, and oroantral fistula. The Critical Appraisal Skills Programme was used to assess the risk of bias in included studies. Random-effects meta-analyses were used to assess the number of each complication in smokers and nonsmokers. Out of 929 eligible publications, 11 articles were included. Meta-analysis of the studies revealed a significantly increased risk of developing wound dehiscence after sinus floor elevation among smokers compared with nonsmokers (Risk Ratio [RR]: 7.82; 95% confidence interval [CI]: 2.38, 25.74; P = .0007). Moreover, risk of developing wound infection was greater in smokers when prospective studies were included in the meta-analysis (RR: 5.33; 95% CI: 1.34, 21.25; P = .02). However, the meta-analysis of included studies did not show significant differences between smokers and nonsmokers concerning risk of sinus membrane perforation and bleeding during sinus floor elevation (P = .46 and P = .33, respectively). Considering the lack of randomized controlled trials and the small number of included studies, the results indicate that smoking seems to be associated with increased risk of wound dehiscence and infection after the sinus augmentation procedure.

Recurrent neck lesions secondary to pyriform sinus fistula.

PubMed

Zhang, Peijun; Tian, Xiufen

2016-03-01

Recurrent neck lesions associated with third or fourth branchial arch fistula are much less common than those of second arch and usually present with acute suppurative thyroiditis or neck abscess. Our aim is to describe clinical features, management and treatment outcomes of 64 cases of congenital pyriform sinus fistula (PSF). Medical record of these 64 patients (33 males, 31 females) treated at the First Affiliated Hospital of Zhengzhou University from 2011 to 2014 were reviewed. The patients comprised 33 males and 31 females, and their ages ranged from 18 months to 47 years (median 10 years, mean 12.7 years). Neck abscess and recurrent infection was the mode of presentation in 37 cases (57.8 %), 4 patients (6.3 %) presented with acute suppurative thyroiditis, neck mass was the mode of presentation in 17 cases (26.6 %), 2 patients (3.1 %) presented with neck mass with respiratory distress, and cutaneous discharging fistula was the mode of presentation in 1 cases (1.6 %). The remaining 3 patients (4.7 %) presented with cutaneous discharging fistula with neck infection. Investigations performed include barium swallow, CT scan, and ultrasound which were useful in delineating PSF tract preoperatively. Barium swallow was taken as the gold standard for diagnosis. Our patients were treated by fistulectomy with hemithyroidectomy, fistulectomy, fistulectomy with endoscopic electric cauterization, endoscopic electric cauterization or endoscopic coblation cauterization, respectively. Histopathologic examination of the surgical specimens revealed that they were lined with ciliated epithelium, stratified cuboid epithelium with chronic inflammatory cell infiltration and fibrosis. Voice hoarseness occurred after operation in seven patients, but disappeared 1 week later. PSF recurred in 6 patients, 4 of them were cured by a successful re-excision. One patient was cured by successful endoscopic electric cauterization. The other 1 has remained asymptomatic for 5 months. In our series, mean follow-up period was 13.3 months and median follow-up period was 12.5 months (range 2-40 months). Presence of congenital PSF should be suspected when intra-thyroidal abscess formation occurs as the gland is resistant to infection. Strong clinical suspicion, barium swallow study, CT scan and ultrasound are the key to diagnosis. Both fistulectomy with hemithyroidectomy and endoscopic treatment have comparable success rate. Endoscopic coblation cauterization may prove a useful and equally effective method of treatment for PSF in future.

First branchial cleft anomaly, a case for misdiagnosis.

PubMed

Lanisnik, Bostjan; Didanovic, Vojko; Cizmarevic, Bogdan

2004-01-01

First branchial cleft anomaly is a rare condition that is often misdiagnosed and falsely mistreated before complete and definitive surgical treatment. Its origin is uncertain and the presence of ectodermal and sometimes also mesodermal elements has led some authors to the conclusion that it represents buried nests of cells forming the first branchial cleft and the underlying mesoderm. First branchial cleft anomaly can be presented as a cystic lesion, fistula or sinus extending towards the membranous external ear canal. The sinus tract runs through the parotid gland in close association with the facial nerve. There is no imaging method capable of identifying a first branchial cleft anomaly with certainty. The danger of facial nerve injury during surgery and the failure to identify the sinus tract running to the external ear canal are the main reasons for incomplete excision. The facial nerve must be identified and preserved and the lesion completely excised. Facial nerve injury is more common in attempts to remove recurrent branchial cleft lesions.

A branchial cyst of the pyriform fossa transoral laser resection: a case report.

PubMed

Abdelfattah, Hesham Mostafa; Ahmed, Mohammed Elrabie; Ahmed, Mona El-Rabie; Ahmed, Mohamed Abd El-Kader; Moussa, Abd-Elmateen

2016-02-01

Pyriform sinus malformations represent rare third and fourth branchial anomalies. Fistulae at the latter site were initially described and make up less than 1 % of all brachial anomalies. They may be discovered incidentally, or may present as a neck mass with recurrent infection, dysphagia, or airway compromise, and can be an unusual cause of dysphonia in infant and children. Here, we present a case of third branchial cyst located in pharyngeal wall of the left pyriform sinus which presented with dysphonia since birth in a 6-year-old girl. Transoral CO2 laser excision was carried out successfully with no communicating tract. The patient's dysphonia showed progressive regression at 1-year follow-up. Third branchial cyst in the left pyriform sinus (Bailey's type IV) is an unusual cause of dysphonia in pediatric. Our present case report is the first brachial cyst to be reported in the pyriform fossa and the second branchial anomalies to be excised transorally with CO2 laser.

Acquired Pial and Dural Arteriovenous Fistulae following Superior Sagittal Sinus Thrombosis in Patients with Protein S Deficiency: A Report of Two Cases

PubMed Central

MATSUBARA, Shunji; SATOH, Koichi; SATOMI, Junichiro; SHIGEKIYO, Toshio; KINOUCHI, Tomoya; MIYAKE, Hajimu; NAGAHIRO, Shinji

2014-01-01

Two patients with protein S deficiency with acquired multiple pial and dural arteriovenous fistulae (AVFs) following superior sagittal sinus (SSS) thrombosis are reported. Case 1 is a 38-year-old male with protein S deficiency who developed generalized seizure due to SSS thrombosis. Local fibrinolysis was achieved in the acute stage. His 10-month follow-up angiogram revealed an asymptomatic acquired dural AVF arising from the middle meningeal artery and the anterior cerebral artery with drainage to the thrombosed cortical vein in the right frontal lobe. Furthermore, his 2-year follow-up angiogram revealed a de novo pial AVF from the middle cerebral artery in the Sylvian fissure with drainage to the cortical vein initially thrombosed. However, this asymptomatic pial AVF caused bleeding in the ipsilateral cerebral hemisphere 12 years after onset, whereas the dural AVF spontaneously disappeared. Surgical disconnection was successfully performed to eliminate the source of hemorrhage. Case 2 is a 50-year-old male with a past history of SSS thrombosis with protein S deficiency who developed pulsatile tinnitus and generalized seizure. His angiogram showed a cortical dural AVF in the left parietal lobe and a sporadic dural AVF involving the right sigmoid sinus. The parietal lesion was eliminated by transarterial embolization followed by craniotomy. However, a de novo pial AVF emerged from the middle cerebral artery adjacent to the previously treated lesion. Of four cortical AVFs in two patients, thrombosis of cortical veins caused by protein S deficiency might play an important role in their formation. Long-term follow-up is required because this peculiar disorder has an unusual clinical course. PMID:24162240

Updating concepts of first branchial cleft defects: a literature review.

PubMed

D'Souza, Alwyn R; Uppal, Harpreet S; De, Ranit; Zeitoun, Hisham

2002-02-01

The Sinuses and fistulae of first branchial cleft origin have been widely reported in the literature and their variable relationship to the facial nerve has been described. Most published series however are too small to allow a detailed analysis of the relative frequency of various relationships of these lesions to the facial nerve and therefore enabling the determination of risks to the nerve at surgery. The aim of this study was to perform a comprehensive review of literature in an attempt to identify those patients with a deep tract (lying deep to the main trunk of the facial nerve and/or its branches, and/or between the branches) and to recognize the incidence of the complications of surgical management. Available English, French and German literature between 1923 and 2000 was reviewed and variables including patient's age, sex, side and type of anomaly, opening of the lesion and the relationship of the tract are analyzed in relation to the position of the facial nerve. The complications due to their surgical excision are also reported. Of the total number of cases with fistulae and sinuses identified (n=158) fistulous tracts were more likely to lie deep to the facial nerve compared with sinus tracts (P=0.01). Lesions with openings in the external auditory meatus are associated with a tract superficial to the facial nerve (P=0.05). Patients presenting at a younger age were more likely to have a deep tract with consequent increased risk of facial nerve damage. Identification of the facial nerve trunk at an early stage of dissection is critical. Extra care and caution should be exercised in younger patients (<6 months), those with fistulous tracts and in patients with a tract opening elsewhere other than the external auditory canal.

Treatment outcomes of intracranial dural arteriovenous fistulas of the transverse and sigmoid sinuses from a single institute in Asia.

PubMed

Cho, Won-Sang; Han, Jung Ho; Kang, Hyun-Seung; Kim, Jeong Eun; Kwon, O-Ki; Oh, Chang Wan; Han, Moon Hee; Chung, Young Seob

2013-07-01

Intracranial dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses (TSS) are rare in Asian populations. This study sought to evaluate the treatment outcomes of intracranial TSS DAVFs at a single Asian institute. Between 1989 and 2007, 122 patients presented to the Seoul National University Hospital with intracranial DAVFs; we performed a retrospective analysis of the 38 patients (31.1%) with TSS DAVFs. The common clinical presentations were headache (44.7%), tinnitus (39.5%), and intracranial hemorrhage (26.3%), and 71.1% had Borden type II or III lesions. Two patients were conservatively managed, two underwent surgery, and 34 were treated endovascularly with transarterial embolization (TAE), transvenous embolization (TVE), or both. The complete occlusion rate immediately after treatment was 50%. Of the 31 patients (81.6%) who underwent follow-up angiography, initial complete occlusion was achieved in 51.6%, and, at the last follow-up, the complete occlusion rate was 64.5%, with the surgery and TVE groups achieving 100% occlusion. The clinical cure rate was 34.2%, and 86.8% of patients had a favorable clinical outcome. However, all patients in both the surgery and TVE groups achieved a favorable clinical outcome. Four (26.7%) of 15 lesions with initially partial embolization showed delayed occlusion. Five patients (13.2%) exhibited clinical or angiographic signs of recurrence, and five patients had permanent complications. TSS DAVFs were less common than cavernous sinus DAVFs, unlike in Western countries, but the angiographic and clinical characteristics of TSS DAVFs were similar to those in Western countries. TSS DAVFs were successfully managed with different modalities, but both surgery and TVE were superior to conservative management or TAE. Copyright © 2012 Elsevier Ltd. All rights reserved.

Direct access to the middle meningeal artery for embolization of complex dural arteriovenous fistula: a hybrid treatment approach

PubMed Central

Lin, Ning; Brouillard, Adam M; Mokin, Maxim; Natarajan, Sabareesh K; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H

2014-01-01

Endovascular embolization has become increasingly favored over microsurgical resection for treatment of complex dural arteriovenous fistulas (DAVFs). However, endovascular treatment can be restricted by tortuous transarterial access and a transvenous approach is not always feasible. We present a Borden III DAVF treated by direct access to the middle meningeal artery (MMA) and Onyx embolization performed in a hybrid operating room–angiography suite. A middle-aged patient with pulsatile headaches was found to have left transverse sinus occlusion and DAVF with retrograde cortical venous drainage fed by multiple external carotid artery (ECA) feeders. Endovascular attempts via conventional transvenous and transarterial routes were unsuccessful, and the major MMA feeder was accessed directly after temporal craniotomy was performed under neuronavigation. Onyx embolization was performed; complete occlusion of the fistula was achieved. Three-month follow-up angiography showed no residual filling; the patient remains complication-free. A combined surgical–endovascular technique in a hybrid operating room–angiography suite can be an effective treatment for DAVFs complicated by inaccessible arterial and transvenous approaches. PMID:24903968

Osteoradionecrosis of the head and neck: a case of a clavicular-tracheal fistula secondary to osteoradionecrosis of the sternoclavicular joint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stofman, G.M.; Lowry, L.D.; Cohn, J.R.

1988-09-01

Radiation therapy is an integral part of treatment for head and neck cancer, but its use is not without complications. We describe the first reported sternoclavicular-tracheal fistula resulting from osteoradionecrosis (ORN) at the medial clavicle. This ORN resulted from definitive radiation therapy for a primary pyriform sinus squamous cell carcinoma. The diagnosis of ORN was made by fiberoptic bronchoscopy. The physiologic damage of ORN is based on a compromised blood supply and altered metabolism of bone formation secondary to effects of ionizing radiation. Treatment requires meticulous hygiene, antibiotics, and debridement as conservative therapy. Radical surgery and reconstruction may be indicatedmore » in refractory cases. A thorough preirradiation assessment of patients is mandatory to decrease the incidence of radiation-induced ORN.« less

A case of residual inferior sinus venosus defect after ineffective surgical closure.

PubMed

Uga, Sayuri; Hidaka, Takayuki; Takasaki, Taiichi; Kihara, Yasuki

2014-10-03

A 38-year-old woman presented with cyanosis and heart failure 34 years after patch closure of an atrial septal defect and partial anomalous pulmonary venous connection. CT and cardiac catheterisation showed a residual defect that caused right-to-left shunting. The patch almost blocked the inferior vena cava from the right atrium, resulting in uncommon drainage of the inferior vena cava into the left atrium. Other anomalies included the coronary-to-pulmonary artery fistula and duplicate inferior vena cava with dilated azygos venous system. A second surgery was performed, and we confirmed an inferior sinus venosus defect, which is rare and can be misdiagnosed. The ineffective patch closure had caused a haemodynamic status that rarely occurs. We describe the diagnostic process and emphasise the importance of correctly understanding the entity. 2014 BMJ Publishing Group Ltd.

Branchial Cleft Cyst.

PubMed

Nahata, Vaishali

2016-01-01

Branchial cleft cyst, sinuses, and fistulae are among the most commonly encountered congenital anomalies in pediatric otolaryngic practice. They can present difficulty in diagnosis and surgical management. Here, I report a case of 14-year-old boy who presented with asymptomatic, congenital swelling located just below the jawline in the lateral part of the neck. The lesion was excised surgically. Histopathology showed the cyst lined by squamous as well as columnar ciliated epithelium, which was a characteristic finding of branchial cleft cyst. The aim of presenting this case is its rarity.

Patent omphalomesenteric duct of the vermiform appendix in a neonate: congenital appendicoumbilical fistula.

PubMed

Crankson, S J; Ahmed, G S; Palkar, V

1998-12-01

Umbilical anomalies arise from fetal structures such as the omphalomesenteric duct (OMD) or urachus or from failure of closure of the umbilical fascial ring. Persistence of the OMD may lead to several anomalies including umbilical sinus, umbilical cyst, Meckel's diverticulum, or patent OMD (POMD). A POMD is usually associated with the ileum, but rarely may be with the caecum or appendix. We describe a POMD of the vermiform appendix and discuss the possible pathogenesis and management.

Cataract surgery in a case of carotid cavernous fistula

PubMed Central

Nair, Akshay Gopinathan; Praveen, Smita Vittal; Noronha, Veena Olma

2014-01-01

A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The ocular manifestations include conjunctival chemosis, proptosis, globe displacement, raised intraocular pressure and optic neuropathy. Although management of CCF in these patients is necessary, the ophthalmologist may also have to treat other ocular morbidities such as cataract. Cataract surgery in patients with CCF may be associated with many possible complications, including suprachoroidal hemorrhage. We describe cataract extraction surgery in 60-year-old female with bilateral spontaneous low-flow CCF. She underwent phacoemulsification via a clear corneal route under topical anesthesia and had an uneventful postoperative phase and recovered successfully. Given the various possible ocular changes in CCF, one must proceed with an intraocular surgery with caution. In this communication, we wish to describe the surgical precautions and the possible pitfalls in cataract surgery in patients with CCF. PMID:25370401

A Review Over the Past 15 Years of the Management of the Internal Piriform Apex Sinus Tract of a Branchial Pouch Anomaly and Case Description.

PubMed

Josephson, Gary D; Black, Kaelan

2015-12-01

Literature review of treating the piriform apex sinus tract through microlaryngoscopy and a case description. Fourteen papers were identified in PubMed using the search criteria of piriform sinus fistula, microlaryngoscopic repair, and endoscopy. Institutional Review Board approval was obtained. One hundred forty-five cases including ours were available for review, with 182 procedures. Sixty-two cases were male, 73 female, and 10 genders were not reported. Multiple treatment options were used, including electrocautery, chemocautery, mass excision, fibrin glue, lasers, suture closure, or combination of stated modalities. Of the 182 procedures, 147 procedures were performed endoscopically. There were 37 recurrences (25%). These patients either underwent a repeat endoscopic procedure or an open excision. One hundred and ten (75%) endoscopic procedures were successful. Piriform sinus tract anomalies often present as a mass and recurrent neck infections. This review reveals that treating the internal piriform sinus opening alone can be successful. This procedure has low morbidity, short operative time, and high success. We advocate this approach first with a combined open/laryngoscopic approach for failed cases. To our knowledge, our technique of CO₂laser ablation of the tract followed by suture closure has not been previously described. We believe this to be the first comprehensive review of this topic and the largest series of cases included in a single report. © The Author(s) 2015.

Onyx 18 embolisation of dural arteriovenous fistula via arterial and venous pathways: preliminary experience and evaluation of the short-term outcomes

PubMed Central

Long, X-A; Karuna, T; Zhang, X; Luo, B; Duan, C-Z

2012-01-01

Objective This paper mainly focuses on our preliminary experience and short-term outcome evaluation of embolisation of non-cavernous dural arteriovenous fistulas (ncsDAVFs) and cavernous sinus dural arteriovenous fistulas (csDAVFs) using Onyx 18 (ev3, Plymouth, MN), and in combination with coils, via arterial and venous approaches, respectively. Methods Between August 2008 and March 2010, 21 DAVFs (11 ncsDAVFs and 10 csDAVFs; age range: 28–68 years; 12 females and 9 males) were undertaken. Borden classification showed Type III in 1 and Type II in 10 ncsDAVFs, and Type II in 4 and Type I in 6 csDAVFs. Onyx 18 was used in 11 ncsDAVFs (10 via single feeder and 1 via 2 feeders). Onyx 18 or in combination with coils was used in 10 csDAVFs (9 via the inferior petrosal sinus and 1 via the superior ophthalmic vein). Results Total occlusion in immediate angiography was achieved in 18 cases (85.7%; 10 ncsDAVFs and 8 csDAVFs), and near-total occlusion in 1 ncsDAVF and 2 csDAVFs. Onyx 18 was migrated into normal vasculature in two ncsDAVFs without any sequelae. One csDAVF had VI cranial nerve palsy post-operatively, which completely recovered 2 weeks post-embolisation. Follow-up angiography at 3–12 months showed complete occlusion in 20 cases (95.2%; 10 ncsDAVFs and 10 csDAVFs). One ncsDAVF (4.8%) recurred after 3 months and was successfully re-embolised. Conclusion Preliminary results achieved after embolising 11 ncsDAVFs and 10 csDAVFs using Onyx 18 and in combination with coils via arterial and venous pathways, respectively, appeared to be safe, feasible and effective, as 95.2% of cases were totally occluded without any clinical sequelae. PMID:22374275

Successful surgical treatment of intramural aortoatrial fistula, severe aortic regurgitation, mitral prolapse, and tricuspid insufficiency in a patient with Ehlers-Danlos syndrome type IV.

PubMed

Jiang, Shengli; Gao, Changqing; Ren, Chonglei; Zhang, Tao

2012-06-01

Patients with Ehlers-Danlos syndrome (EDS) type IV, an inherited connective tissue disorder, are predisposed to vascular and digestive ruptures, and arterial ruptures account for the majority of deaths. A 31-year-old man with EDS presented with an intramural aortoatrial fistula, severe aortic regurgitation, mitral valve prolapse, and severe tricuspid valve insufficiency combined with a severely dilated left ventricle. Determining the best surgical option for the patient was not easy, especially regarding the course of action for the aortic root with a tear in the sinus of Valsalva. The fistula tract was closed at the aorta with suture and with a patch in the right atrium, the mitral valve was repaired with edge-to-edge suture and then annuloplasty with a Cosgrove ring, the aortic valve was replaced with a mechanical prosthesis, and a modified De Vega technique was used for the tricuspid valvuloplasty. The postoperative course was uncomplicated, and the patient was discharged 2 weeks later. The considerations made to arrive at the chosen surgical course of action in this complex case are reviewed.

Direct traumatic carotid cavernous fistula: angiographic classification and treatment strategies. Study of 172 cases.

PubMed

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

2014-01-01

We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Only type A CCF patients (Barrow's classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced sacrifice of the parent vessels and it was associated with sizes of the fistula. Total severe complication was about 2.4% which included 1 death (0.6%) due to vagal shock; 1 transient hemiparesis post-sacrifice occlusion of the carotid artery but the patient had recovered after 3 months; 1 acute thrombus embolism and the patient was completely saved with recombinant tissue plaminogen activator (rTPA); 1 balloon dislodgement then got stuck at the anterior communicating artery but the patient was asymptomatic. Endovascular intervention as the treatment of direct traumatic CCF had high cure rate and low complication with its ability to preserve the carotid artery. It also can supply flexible accesses to the fistulous site with various alternative embolic materials. The new classification of type A CCF based on angiographic features was helpful for planning for the embolization. Coil should be considered as the first embolic material for small size fistula meanwhile detachable balloons was suggested as the first-choice embolic agent for the medium and large size fistula.

[Relationship between Work Ⅱ type of congenital first branchial cleft anomaly and facial nerve and surgical strategies].

PubMed

Zhang, B; Chen, L S; Huang, S L; Liang, L; Gong, X X; Wu, P N; Zhang, S Y; Luo, X N; Zhan, J D; Sheng, X L; Lu, Z M

2017-10-07

Objective: To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies. Methods: Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases. Results: Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web. Conclusions: CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.

Predictors of Salivary Fistulas in Patients Undergoing Salvage Total Laryngectomy

PubMed Central

Wang, Steven J.

2014-01-01

Background. Salivary fistula is a common complication after salvage total laryngectomy. Previous studies have not considered the number of layers of pharyngeal closure and have not classified fistulas according to severity. Our objective was to analyze our institutional experience with salvage total laryngectomy, categorize salivary fistulas based on severity, and study the effect of various pharyngeal closure techniques on fistula incidence. Methods. Retrospective analysis of 48 patients who underwent salvage total laryngectomy, comparing pharyngeal closure technique and use of a pectoralis major flap with regard to salivary fistula rate. Fistulas were categorized into major and minor fistulas based on whether operative intervention was required. Results. The major fistula rate was 18.8% (9/48) and the minor fistula rate was 29.2% (14/48). The overall (major plus minor) fistula rate was 47.9%. The overall fistula and major fistula rates decreased with increasing the number of closure layers and with use of a pectoralis major flap; however, these correlations did not reach statistical significance. Other than age, there were no clinicopathologic variables associated with salivary fistulas. Conclusion. For salvage total laryngectomies, increasing the number of closure layers or use of a pectoralis major flap may reduce the risk of salivary fistula. PMID:27355065

Branchial fistula arising from pyriform fossa: CT diagnosis of a case and discussion of radiological features.

PubMed

Chauhan, Narvir Singh; Sharma, Yash Paul; Bhagra, Tilak; Sud, Bindu

2012-01-01

Anomalies of third or fourth branchial apparatus origin are very uncommon and present as recurrent neck infections or thyroiditis with a predominant left-sided involvement. Radiological diagnosis requires a high index of suspicion and is critical for initiation of proper treatment. We describe a case of branchial sinus of pyriform fossa with external fistulization that presented in adulthood and was diagnosed on computed tomographic scan. The radiological features of this rare anomaly are revisited. Copyright © 2012 Elsevier Inc. All rights reserved.

Branchial Cleft Cyst

PubMed Central

Nahata, Vaishali

2016-01-01

Branchial cleft cyst, sinuses, and fistulae are among the most commonly encountered congenital anomalies in pediatric otolaryngic practice. They can present difficulty in diagnosis and surgical management. Here, I report a case of 14-year-old boy who presented with asymptomatic, congenital swelling located just below the jawline in the lateral part of the neck. The lesion was excised surgically. Histopathology showed the cyst lined by squamous as well as columnar ciliated epithelium, which was a characteristic finding of branchial cleft cyst. The aim of presenting this case is its rarity. PMID:27904209

A thrombophilic patient with a dural arteriovenous fistula presenting sensory aphasia and complicated with an acute pulmonary embolism.

PubMed

Chou, Chung-Hsing; Lin, Jiann-Chyun; Hsueh, Chun-Jen; Peng, Giia-Sheun

2008-09-01

Neuropsychiatric symptoms as the initial presentation of dural arteriovenous fistula (DAVF) are unusual. Anticoagulation therapy may be warranted for prevention of further thromboembolism if an underlying thrombophilia condition is diagnosed. We present a 70-year-old woman with sensory aphasia, who was diagnosed with a DAVF, Cognard type II a + b, by cerebral angiography. Her stroke-like syndrome resolved after transarterial embolization of the left occipital and middle meningeal arteries. Meanwhile, hypercoagulability was found because of hyperhomocysteinemia and the presence of a lupus anticoagulant. One month later, she suffered an acute pulmonary embolism and was started on anticoagulation therapy before stereotactic radiosurgery. Sensory aphasia may be the initial manifestation of a transverse-sigmoid sinus DAVF even if there are no symptoms such as headache or tinnitus. We postulate that early anticoagulation therapy is indicated for preventing thromboembolism in DAVF patients with thrombophilia because the possibility of intracranial bleeding has been reduced by embolization.

Ten years of experience with third and fourth branchial remnants.

PubMed

Liberman, Moishe; Kay, Saundra; Emil, Sherif; Flageole, Hélène; Nguyen, Luong T; Tewfik, Ted L; Oudjhane, Kamal; Laberge, Jean-Martin

2002-05-01

Third and fourth branchial remnants may result in cysts and abscesses that are in close contact with the thyroid gland. These anomalies are rare and often present diagnostic and therapeutic challenges. The charts of patients diagnosed with a branchial anomaly between July 1991 and July 2001 at the Montreal Children's Hospital were reviewed. All cases of third and fourth branchial remnants or pyriform sinus fistulae were identified. Clinical presentation, imaging, treatment, and outcome were recorded. Eight patients with a third or fourth branchial anomaly were identified and ranged in age from birth to 13 years. All anomalies were left sided. Presenting symptoms consisted of an asymptomatic cervical mass (n = 1), an infected mass (n = 5), neonatal respiratory distress (n = 1), and 1 incidental cyst found on magnetic resonance imaging. Ultrasonography was useful in suggesting the diagnosis in 7 cases. Barium swallow was performed in 3 patients with 2 positive results. Pharyngoscopy results showed the internal opening in 2 of 7 patients. A portion of the thyroid gland was resected in 6 patients. One patient has not yet undergone a definitive procedure. There was 1 recurrence in a patient whose pathology did not confirm a branchial remnant. The diagnosis and management of pyriform sinus anomalies are challenging. Ultrasound scan, computed tomography scan, barium swallow, and pharyngoscopy are all useful. The portion of thyroid involved in the fistula must be excised en bloc with the inflammatory mass, and the tract should be ligated at the level of the pharynx to minimize recurrence. Copyright 2002, Elsevier Science (USA). All rights reserved.

Correlation between presumed sinusitis-induced pain and paranasal sinus computed tomographic findings.

PubMed

Mudgil, Shikha P; Wise, Scott W; Hopper, Kenneth D; Kasales, Claudia J; Mauger, David; Fornadley, John A

2002-02-01

The correlation between facial and/or head pain in patients clinically suspected of having sinusitis and actual localized findings on sinus computed tomographic (CT) imaging are poorly understood. To prospectively evaluate the relationship of paranasal sinus pain symptoms with CT imaging. Two hundred consecutive patients referred by otolaryngologists and internists for CT of the paranasal sinuses participated by completing a questionnaire immediately before undergoing CT. Three radiologists blinded to the patients' responses scored the degree of air/fluid level, mucosal thickening, bony reaction, and mucus retention cysts using a graded scale of severity (0 to 3 points). The osteomeatal complexes and nasolacrimal ducts were also evaluated for patency. Bivariate analysis was performed to evaluate the relationship between patients' localized symptoms and CT findings in the respective sinus. One hundred sixty-three patients (82%) reported having some form of facial pain or headache. The right temple/forehead was the most frequently reported region of maximal pain. On CT imaging the maxillary sinus was the most frequently involved sinus. Bivariate analysis failed to show any relationship between patient symptoms and findings on CT. Patients with a normal CT reported a mean 5.88 sites of facial or head pain versus 5.45 sites for patients with an abnormal CT. Patient-based responses of sinonasal pain symptoms fail to correlate with findings in the respective sinuses. CT should therefore be reserved for delineating the anatomy and degree of sinus disease before surgical intervention.

[Manifestation of first branchial anomaly:56 cases reportrhinitis].

PubMed

Zhang, B; Chen, L S; Huang, S L; Liang, L; Wu, P N; Zhang, S Y; L, Z M; Liang, L

2016-09-05

Objective: To sum up and conclude manifestation of congenital first branchial anomaly(CFBCA). Method: The clinical data of 56 patients from 2005 to 2015 in our hospital were retrospective reviewed. Result: Manifestation:mass without pain(26.8%),repeated sore and discharge(71.4%),otological symptom(external auditory discharge､hearing loss,28.6%).Eleven cases bacterial sample showed positive result,and most of them show pseudomonas aeruginosa and staphylococcus aureus.Auricular endoscopy typically performed stricture of external auditory canal,cholesteatoma samples accumulated in ear canal,fistula at the conjunction of the bone and cartilage and tympanic membranous attachment.Typical performance of CT(MRI)was that there were cystic,lobulated or tubular abnormal shadow related with ear canal in Pochet's triangle area whose cyst wall or pipe wall could been enhanced in enhanced CT(MRI) scans,and part of that could be connected with skin.The statistical difference between type Oslen and Work and clinical characteristics( P <0.01),and the relationship between type Oslen and Work( P <0.01).Most of Work Ⅰ were cyst type,and these two type often had no infected symptom.Most of them were young patients.Most of Work Ⅱ were sinus and fistula type ,and these two type often had infected symptom.Most of them were teenagers.Part of patients of type Work Ⅱ showed tympanic membranous attachment. Conclusion: CFBCA was rare,and it is more common in young patients and often in left part.It always performed as mass without pain､repeated sore and discharge､external auditory discharge.Most of Work Ⅰ were cyst type,and these two type often had no infected symptom and most of them were young patients .Most of Work Ⅱ were sinus and fistula type,and these two type often had infected symptom and most of them were teenagers.Auricular endoscopy,CT,MRI could help make diagnose.Doctors clinical need to differentiate it with related diseases according to different manifestations. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

Effects of sinus surgery in patients with cystic fibrosis after lung transplantation: a 10-year experience.

PubMed

Holzmann, David; Speich, Rudolf; Kaufmann, Thomas; Laube, Irene; Russi, Erich W; Simmen, Daniel; Weder, Walter; Boehler, Annette

2004-01-15

Chronic infectious rhinosinusitis with Pseudomonas aeruginosa is common in cystic fibrosis and may result in allograft infection after lung transplantation. Sinus surgery followed by nasal care may reduce these adverse effects. Sinus surgery was performed in 37 patients with cystic fibrosis after transplantation. Bacteriology of sinus aspirates (n=771) and bronchoalveolar lavage (BAL) (n=256) was correlated with clinical data. Sinus surgery was successful in 54% and partially successful in 27% of patients. A significant correlation between negative sinus aspirates and negative BAL and between positive sinus aspirates and positive BAL (P<0.0001) was found. Successful sinus management led to a lower incidence of tracheobronchitis and pneumonia (P=0.009) and a trend toward a lower incidence of bronchiolitis obliterans syndrome (P=0.23). Sinus surgery followed by daily nasal douching may control posttransplant lower airway colonization and infection. In the long term, this concept may lead to less bronchiolitis obliterans syndrome by decreasing bronchiolar inflammation.

MRI cisternography with gadolinium-containing contrast medium: its role, advantages and limitations in the investigation of rhinorrhoea.

PubMed

Aydin, K; Guven, K; Sencer, S; Jinkins, J R; Minareci, O

2004-01-01

Our purpose was to evaluate the utility of intrathecal gadopentetate dimeglumine -enhanced magnetic resonance cisternography (GdMRC). We injected 0.5 ml contrast medium into the subarachnoid space via lumbar puncture in 20 patients with suspected cerebrospinal fluid (CSF) rhinorrhoea. MRC showed CSF leakage in 14 patients with rhinorrhoea at the time of the examination, into the ethmoid air cells in nine, the sphenoid sinus in three and the frontal sinus in two cases. In 12 of these the site leakage was confirmed during surgical repair of the fistula. No leakage was observed in four patients with intermittent rhinorrhoea, not present at the time of the examination. GdMRC showed leakage in two patients with negative CT cisternography. GdMRC may prove better than CT cisternography, especially with slow CSF flow. We also showed low-dose GdMRC to be a feasible and relative safe way of confirming the presence of and localising active CSF leaks prior to surgical repair.

[Radiographic study of maxillary sinus associated with molars in adult].

PubMed

Hu, Zhi; Sun, Daming; Zhou, Quansheng; Wang, Yuli; Gu, Jingcheng; Han, Yaohua

2014-12-01

to explore the relationship between the maxillary sinus volume and the amount of alveolar bone, and the effect of molar loss upon the maxillary sinus was further analyzed,by measuring adult maxillary sinus volume, sinus ridge distance, and calculating the gasification coefficient of maxillary sinus. One hundred and ninety cases (361 maxillary sinus) with CT examinations were collected, they were divided into group A and group B, 121 cases (242 maxillary sinus) of normal subjects served as group A, 42 cases (65 maxillary sinus) with molar part off were B group, in which 31 maxillary sinus with a molar loss were group B1,22 maxillary sinus with two molar loss were B2 group,12 maxillary sinus with three molar loss (one molar remains) were B3 group, 27 cases (54 maxillary sinus) with upper teeth off were C group. Bymeasureing the maxillary sinus volume, sinus ridge distance and the size of the maxillary sinus, calculating the gasification coefficient, we analyzed the relationship between maxillary volume and sinus ridge distance, and comparatively analyzed the differences among the three groups in the size, gasification coefficient, volume of maxillary sinus and sinus ridge distance. In the normal group,the volume of maxillary sinus and sinus ridge distance had a correlation coefficient of -0. 63,(P< 0.05); Sinus ridge distance in group A was larger than the other two groups (P<0.05), and larger in B group than in C group (P<0. 05), anteroposterior maxillary sinus diameter and reft-right diameter in C group was greater than in A group and B group(P<0.05), group C gasification coeffiecent was less than A group and B group (P<0. 05). The volume of maxillary sinus is negatively correlated with the amont of alveolar bone; Upper teeth's shedding promotes maxillary sinus deformation; Maxiuary sinus volume has a tendency to decrease.

Klotho protein lowered in senile patients with brady sinus arrhythmia.

PubMed

Wang, Ying; Yang, Wei; Zheng, Ernv; Zhang, Wei; Su, Xianming

2015-01-01

To explore the correlationship between brady sinus arrhythmia and the levels of serum klotho protein in aged. 104 patients over 75 years old with brady sinus arrhythmia (experiment group) were enrolled, including 34 cases of sinus arrest, 43 cases of sinus bradycardia and 25 cases of atrioventricular block. 109 patients over 75 years old without brady sinus arrhymia were chosen as control group. All subjects were monitored by Holter. The levels of serum klotho protein were detected and compared among three groups. The correlation between the frequency of sinus arrest and the levels of serum klotho protein was analyzed simultaneously. The levels of serum klotho protein in experiment group were lower than that in control group (P<0.01); the sinus arrest frequency was negatively correlated with the levels of serum klotho protien. The levels of serum klotho protein in patients with sinus arrest were lower than that with sinus bradycardia and atrioventricularblock (P<0.05). But there was no significant difference between sinus bradycardia group and atrioventricular block group. The levels of serum klotho protein may reflect the function of sinoatrial node and could be used as an index to estimate the function of sinoatrial node.

Klotho protein lowered in senile patients with brady sinus arrhythmia

PubMed Central

Wang, Ying; Yang, Wei; Zheng, Ernv; Zhang, Wei; Su, Xianming

2015-01-01

Objective: To explore the correlationship between brady sinus arrhythmia and the levels of serum klotho protein in aged. Methods: 104 patients over 75 years old with brady sinus arrhythmia (experiment group) were enrolled, including 34 cases of sinus arrest, 43 cases of sinus bradycardia and 25 cases of atrioventricular block. 109 patients over 75 years old without brady sinus arrhymia were chosen as control group. All subjects were monitored by Holter. The levels of serum klotho protein were detected and compared among three groups. The correlation between the frequency of sinus arrest and the levels of serum klotho protein was analyzed simultaneously. Results: The levels of serum klotho protein in experiment group were lower than that in control group (P<0.01); the sinus arrest frequency was negatively correlated with the levels of serum klotho protien. The levels of serum klotho protein in patients with sinus arrest were lower than that with sinus bradycardia and atrioventricularblock (P<0.05). But there was no significant difference between sinus bradycardia group and atrioventricular block group. Conclusion: The levels of serum klotho protein may reflect the function of sinoatrial node and could be used as an index to estimate the function of sinoatrial node. PMID:26550342

Incompletely obliterated cranial arteriovenous fistulae are safely and effectively treated with adjuvant ε-aminocaproic acid.

PubMed

Howard, Brian M; Grossberg, Jonathan A; Prater, Adam; Cawley, C Michael; Dion, Jacques E; Tong, Frank C

2018-07-01

Administration of ε-aminocaproic acid (εACA), as adjuvant therapy following incompletely embolized cranial dural arteriovenous (dAVFs) and direct carotid artery to cavernous sinus fistulae (CCFs), is a strategy to promote post-procedural thrombosis. However, the efficacy of εACA to treat incompletely obliterated dAVFs and CCFs has not been published. The purpose of this study was to determine if administration of εACA following incomplete embolization of cranial dAVFs or CCFs was associated with an increased likelihood of cure on follow-up imaging compared with patients not given adjuvant εACA. A retrospective cohort study was performed. All patients who underwent treatment of a dAVF or CCF at our institution between 1998 and 2016 were reviewed (n=262). Patients with residual shunting following the first attempted endovascular embolization were included in the analysis (n=52). The study groups were those treated with εACA following incomplete obliteration of the fistula and those who were not. The primary outcome was obliteration of the fistula on initial follow-up imaging. Complication rates between cohorts were compared. 20 (38%) patients with incompletely obliterated fistulae were treated with adjuvant εACA. A trend towards an improved rate of complete obliteration on initial follow-up imaging was observed in the group treated with εACA (55% vs 34% in the group not treated with εACA, p=0.14). No difference in clinical outcomes or thromboembolic complications was observed between the groups. In summary, these data suggest that administration of εACA is a safe adjuvant therapy in the management of cranial dAVFs and CCFs that are incompletely treated endovascularly. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Maxillary sinus augmentation by crestal access: a retrospective study on cavity size and outcome correlation.

PubMed

Spinato, Sergio; Bernardello, Fabio; Galindo-Moreno, Pablo; Zaffe, Davide

2015-12-01

Cone-beam computed tomography (CBCT) and radiographic outcomes of crestal sinus elevation, performed using mineralized human bone allograft, were analyzed to correlate results with maxillary sinus size. A total of 60 sinus augmentations in 60 patients, with initial bone ≤5 mm, were performed. Digital radiographs were taken at surgical implant placement time up to post-prosthetic loading follow-up (12-72 months), when CBCT evaluation was carried out. Marginal bone loss (MBL) was radiographically analyzed at 6 months and follow-up time post-loading. Sinus size (BPD), implant distance from palatal (PID) and buccal wall (BID), and absence of bone coverage of implant (intra-sinus bone loss--IBL) were evaluated and statistically evaluated by ANOVA and linear regression analyses. MBL increased as a function of time. MBL at final follow-up was statistically associated with MBL at 6 months. A statistically significant correlation of IBL with wall distance and of IBL/mm with time was identified with greater values in wide sinuses (WS ≥ 13.27 mm) than in narrow sinuses (NS < 13.27 mm). This study is the first quantitative and statistically significant confirmation that crestal technique with residual ridge height <5 mm is more appropriate and predictable, in terms of intra-sinus bone coverage, in narrow than in WS. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Negative Pressure Wound Therapy for the Treatment of the Open Abdomen and Incidence of Enteral Fistulas: A Retrospective Bicentre Analysis

PubMed Central

Dold, Stefan; Doberauer, Johannes P.; Mai, Peter

2013-01-01

Introduction. The open abdomen (OA) is often associated with complications. It has been hypothesized that negative pressure wound therapy (NPWT) in the treatment of OA may provoke enteral fistulas. Therefore, we analyzed patients with OA and NPWT with special regard to the occurrence of intestinal fistulas. Methods. The present study included all consecutive patients with OA treated with NWPT from April 2010 to August 2011 in two hospitals. Patients' demographics, indications for OA, risk factors, complications, outcome and incidence of fistulas before, during and after NPWT were recorded. Results. Of 81 patients with OA, 26 had pre-existing fistulas and 55 were free from a fistula at the beginning of NPWT. Nine of the 55 patients developed fistulas during (n = 5) or after NPWT (n = 4). Seventy-five patients received ABThera therapy, 6 patients other temporary abdominal closure devices. Only diverticulitis seemed to be a significant predisposing factor for fistulas. Mortality was slightly lower for patients without fistulas. Conclusion. The present study revealed no correlation between occurrence of fistulas before, during, and after NWPT, with diverticulitis being the only risk factor. Fistula formation during NPWT was comparable to reports from literature. Prospective studies are mandatory to clarify the impact of NPWT on fistula formation. PMID:24285953

Maxillary Sinus Dimensions Decrease as Age and Tooth Loss Increase.

PubMed

Velasco-Torres, Miguel; Padial-Molina, Miguel; Avila-Ortiz, Gustavo; García-Delgado, Raúl; OʼValle, Francisco; Catena, Andrés; Galindo-Moreno, Pablo

2017-04-01

To investigate the correlation between patient-dependent variables and dimensional variations of the maxillary sinus. In this cross-sectional study, a total of 394 individual cone-beam computed tomography scans were evaluated by one calibrated examiner to measure the total volume of the maxillary sinus, the distance between the medial and the lateral walls at 5, 10, and 15 mm vertically from the sinus floor, the height of septa (if present), and the height of the maxillary sinus cavity from both the alveolar crest and the sinus floor to the meatus. Recorded patient-dependent variables were age, gender, and edentulism status. Total maxillary sinus volume was significantly smaller in completely and partially edentulous patients than in dentate subjects. This finding was influenced by age, as older patients exhibited less volume, regardless of gender and edentulism status. Age showed an indirect correlation with the distance to the meatus, the sinus volume, and the mediolateral dimensions. Additionally, the prevalence of accessory meatus in this population was 29.19%. The dimensions of the maxillary sinus are influenced by age and edentulism status being reduced by aging and tooth loss.

A Study of Correlation of Various Growth Indicators with Chronological Age.

PubMed

Singh, Sarabjeet; Sandhu, Navreet; Puri, Taruna; Gulati, Ritika; Kashyap, Rita

2015-01-01

The aim of this study was to assess the relationship of chronological age with cervical vertebrae skeletal maturation, frontal sinus width and antegonial notch depth and a correlation, if any, among the three variables. The samples were derived from lateral cephalometric radiographs of 80 subjects (40 males, 40 females; age range: 10 to 19 years). Cervical vertebral development was evaluated by the method of Hassel and Farman, frontal sinus width was measured by the method described by Ertürk and antegonial notch depth as described by Singer et al. The Pearson's correlation coefficients were estimated to assess the relationship of chronological age with cervical vertebrae skeletal maturation, frontal sinus width and antegonial notch depth. The Pearson's correlation coefficient were 0.855 (p < 0.001) between chronological age and cervical vertebrae skeletal maturation, and 0.333 (p < 0.001) between chronological age and frontal sinus width. A highly significant positive correlation was found between chronological age and cervical vertebrae skeletal maturation, and between chronological age and frontal sinus width. Nonsignificant correlation was found between chronological age and antegonial notch depth. How to cite this article: Singh S, Sandhu N, Puri T, Gulati R, Kashyap R. A Study of Correlation of Various Growth Indicators with Chronological Age. Int J Clin Pediatr Dent 2015;8(3): 190-195.

Magnetic Resonance Imaging (MRI): Operative Findings Correlation in 229 Fistula-in-Ano Patients.

PubMed

Garg, Pankaj; Singh, Pratiksha; Kaur, Baljit

2017-06-01

To correlate the operative findings of patients with fistula-in-ano with preoperative MRI and quantify the information added with MRI. All consecutive fistula-in-ano patients operated between July 2013 and May 2015 were prospectively enrolled. Preoperative MRI was done in every patient. The details of tracts, internal opening and "complex parameters" (additional tract or additional internal opening, horseshoe tract, associated abscess and supralevator extension) found at surgery were compared to the findings determined by MRI. A total of 229 patients (424 tracts) with mean age-49.0 ± 11.3 years were included. M/F 198/31. James hospital classification: Type I 58, II 20, III 49, IV 86 and V 16. The sensitivity and specificity of MRI in diagnosing fistula tracts were 98.8 and 99.7%, respectively, and in identifying internal opening were 97.7 and 98.6%, respectively. MRI added significant information in 46.7% (107/229) patients which was presence of additional tracts in 71 (66.3%), horseshoe tract in 63 (58.8%), supralevator extension in 16 (14.9%), unsuspected abscess in 11 (10.3%) and multiple internal openings in one patient (1%). The proportion of simple/complex fistula (based on history and clinical examination alone) was 32.8/67.2% which changed to 21.4/78.6% after the MRI scan. MRI added significant information about unsuspecting complex parameters which were missed on history and clinical examination in more than one-third (26/75: 34.6%) of simple fistulae and more than half (81/154: 52.5%) of already known complex fistulae. MRI is highly accurate in diagnosing fistula-in-ano and added significant information about unsuspected complex parameters in over one-third (34.6%) of simple and in half (52.5%) of complex fistula-in-ano.

The relationship between frontal sinus morphology and skeletal maturation.

PubMed

Buyuk, Suleyman Kutalmıs; Simsek, Huseyin; Karaman, Ahmet

2018-01-03

The aim of this study is to evaluate the relationship between frontal sinus morphology and hand-wrist bone maturation by using postero-anterior (PA) cephalometric radiographs. The study sample consisted of 220 patients divided into eleven groups based on the hand-wrist radiographs. The right and left maximum height, width and area of the frontal sinus parameters were measured in postero-anterior cephalometric radiographs 220 subjects aged 8-18 years. The hand-wrist skeletal maturation stages were evaluated on the hand-wrist radiographs using the method of Fishman. The Kendall tau-b values were analyzed to evaluate the correlation between the hand-wrist skeletal maturation stages and the frontal sinus parameters. The right and left frontal sinus areas and widths were found to be larger in males than in females (p < 0.05). In males, a significant difference was observed in all frontal sinus parameters in different maturation stages (p < 0.001), while a statistically significant correlation was found in females between the left frontal sinus area, right frontal sinus height, right frontal sinus width and different maturation stages (p < 0.05). In conclusion, the relationship between frontal sinus dimensions obtained from PA cephalometric radiographs and hand-wrist maturation stages suggests that frontal sinuses can be used in determining growth and development.

Normal flow signal of the pterygoid plexus on 3T MRA in patients without DAVF of the cavernous sinus.

PubMed

Watanabe, K; Kakeda, S; Watanabe, R; Ohnari, N; Korogi, Y

2013-01-01

Cavernous sinuses and draining dural sinuses or veins are often visualized on 3D TOF MRA images in patients with dural arteriovenous fistulas involving the CS. Flow signals may be seen in the jugular vein and dural sinuses at the skull base on MRA images in healthy participants, however, because of reverse flow. Our purpose was to investigate the prevalence of flow signals in the pterygoid plexus and CS on 3T MRA images in a cohort of participants without DAVFs. Two radiologists evaluated the flow signals of the PP and CS on 3T MRA images obtained from 406 consecutive participants by using a 5-point scale. In addition, the findings on 3T MRA images were compared with those on digital subtraction angiography images in an additional 171 participants who underwent both examinations. The radiologists identified 110 participants (27.1%; 108 left, 10 right, 8 bilateral) with evidence of flow signals in the PP alone (n = 67) or in both the PP and CS (n = 43). Flow signals were significantly more common in the left PP than in the right PP. In 171 patients who underwent both MRA and DSA, the MRA images showed flow signals in the PP with or without CS in 60 patients; no DAVFs were identified on DSA in any of these patients. Flow signals are frequently seen in the left PP on 3T MRA images in healthy participants. This finding may be the result of flow reversal and should not be considered to indicate occult DAVF.

Surgical management of first branchial cleft anomaly presenting as infected retroauricular mass using a microscopic dissection technique.

PubMed

Chan, Kai-Chieh; Chao, Wei-Chieh; Wu, Che-Ming

2012-01-01

This is a detailed description of the clinical and anatomical presentation of the first branchial cleft anomaly presenting as retroauricular infected mass. Our experience with a microscopic dissection with control of the sinus lumen from within the cyst is also described. Between 2001 and 2008, patients with the final histologic diagnosis of first branchial cleft anomaly in the retroauricular area were managed with a microscopic dissection technique with control of the sinus lumen from within the cyst. Classifications were done in accordance with Work, Olsen, and Chilla. Outcomes measured intervention as a function of disease recurrence and complications including facial nerve function was used. Eight patients with a mean age of 14.2 years were enrolled, and this included 4 females and 4 males. Four type 1 and 4 type 2 lesions as per the Work's and Chilla's classification were found, and there were 5 sinuses, 2 fistulae, and 1 cyst according to Olsen's classification. All patients presented to the department with acute infection at the time of diagnosis. Five of the 8 patients had previous surgical treatment, 2 of those had up to 3 previous operations. None of the patients were complicated by disease recurrence or had surgical related complications (facial nerve paresis or paralysis, infection, canal stenosis) requiring reoperation with more than 1 year of follow-up. First branchial cleft anomaly presenting as retroauricular infected mass can be effectively treated by adopting a microscopic dissection technique with control of the sinus lumen from within the cyst. Copyright © 2012 Elsevier Inc. All rights reserved.

Prevalence of Sinus Tract in the Patients Visiting Department of Endodontics, Kermanshah School of Dentistry.

PubMed

Miri, Shima Sadat; Atashbar, Omid; Atashbar, Fardin

2015-04-23

Sinus tract is one of the manifestations of chronic dental infections, which is a path for the drainage of the infection and pus. The present study was aimed to investigate the prevalence of sinus tract with dental origin analyze the correlation between sinus tract and related factors. This study was conducted on 1527 patients, visiting Kermanshah school of dentistry, in 2014.The related teeth were examined in terms of vitality test and exact location of sinus tract. Moreover, the causes of this lesion and the needs for root canal treatment were assessed in these teeth. Having obtained the data from the patients, analyzed by Mann-Whitney, Chi-square tests. The frequency of sinus tract was 9.89% patients. There was a significant correlation between the prevalence of sinus tract and factors such as age, general health status, location of sinus tract and history of root canal treatment. The prevalence of sinus tract in maxilla was higher than the mandible (p=0.087). The prevalence of sinus tract in the posterior teeth (69.54%) was significantly higher than that of anterior teeth (30.46%) (p=0.000). From 724 teeth with periapical inflammation and radiolucency, 9.89% teeth had odontogenic sinus tract, and 23.42% teeth with history of root canal treatment had sinus tract. The most common cause of sinus tract incidence was previous root canal treatment. Therefore, clinicians need to pay a more attention to examining the posterior teeth referred for endodontic treatment.

Correlation between frontal sinus dimensions and cephalometric indices: A cross-sectional study

PubMed Central

Tehranchi, Azita; Motamedian, Saeed Reza; Saedi, Sara; Kabiri, Sattar; Shidfar, Shireen

2017-01-01

Objective: Growth prediction plays a significant role in accurate diagnosis and treatment planning of orthodontics patients. It was hypothesized that the unique pattern of pneumatization of the frontal sinus as a component of craniofacial structure would influence the skeletal growth pattern and may be used as a growth predictor. Materials and Methods: A total of 144 subjects (78 females and 66 males) with a mean age of 19.26 ± 4.66 years were included in this retrospective study. Posterior-anterior and lateral cephalograms (LCs) were used to measure the frontal sinus dimensions. The skeletal growth pattern and relations of craniofacial structures were analyzed on LC using variables for sagittal and vertical analyses. Correlation between the frontal sinus dimensions and cephalometric indices was assessed by the Pearson's correlation coefficient. Results: The SN-FH and SNA angles had significant associations with frontal sinus dimensions in all enrolled subjects (P < 0.05). In males, the SN-FH, sum of posterior angles, Pal-SN, and Jarabak index were significantly associated with the size of frontal sinus (P < 0.05). In females, the associations of SN-FH and gonial angles with frontal sinus dimensions were significant (P < 0.05). Conclusion: The results show that larger size of frontal sinus was associated with reduced inclination of the anterior cranial base, increased anterior facial height (in males), and increased gonial angle (in females) in the study population. PMID:28435368

[Branchiogen cyst at unusual age and in rare localization. A case report].

PubMed

Horvath, Dóra; Redl, Pál; Hegedűs, Csaba

2015-12-01

Branchiogen anomalies represent a heterogeneous group of developmental abnormalities, they arise from incomplete obliteration of branchial clefts and pouches during embriogenesis. Clinically they can present as a cyst, fistula or sinus. Second cleft lesions account for 95% of the branchial anomalies. Second branchial cleft cysts are usually located in the neck, along the anterior border of the stenocleidomastoid muscle, but they can be anywhere along the course of the second branchial fistula from the tonsillar fossa to the supraclavicular region. Their presence in the nasopharynx is extremely rare. Ultrasound, computed tomography (CT) or magnetic resonance imaging is recommended for diagnosis. Definitive treatment is surgical excision, these lesions do not regress spontaneously and often result recurrent infections. A 7 month old infant applied to a pediatrician with gastrointestinal viral infection. During examination a cystic mass was discovered in the right lateral nasopharyngeal wall, the lesion extended to the oropharynx. Marsupialisation was performed via transoral approach. In case of cystic lesion in the lateral epipharynx, branchial cleft cyst should be considered in the differential diagnosis.

Evaluation of the Effect of Hemoglobin or Hematocrit Level on Dural Sinus Density Using Unenhanced Computed Tomography

PubMed Central

Cha, Sang-Hoon; Lee, Sung-Hyun; Shin, Dong-Ick

2013-01-01

Purpose To identify the relationship between hemoglobin (Hgb) or hematocrit (Hct) level and dural sinus density using unenhanced computed tomography (UECT). Materials and Methods Patients who were performed UECT and had records of a complete blood count within 24 hours from UECT were included (n=122). We measured the Hounsfield unit (HU) of the dural sinus at the right sigmoid sinus, left sigmoid sinus and 2 points of the superior sagittal sinus. Quantitative measurement of dural sinus density using the circle regions of interest (ROI) method was calculated as average ROI values at 3 or 4 points. Simple regression analysis was used to evaluate the correlation between mean HU and Hgb or mean HU and Hct. Results The mean densities of the dural sinuses ranged from 24.67 to 53.67 HU (mean, 43.28 HU). There was a strong correlation between mean density and Hgb level (r=0.832) and between mean density and Hct level (r=0.840). Conclusion Dural sinus density on UECT is closely related to Hgb and Hct levels. Therefore, the Hgb or Hct levels can be used to determine whether the dural sinus density is within the normal range or pathological conditions such as venous thrombosis. PMID:23225795

Cutaneous fistula due to pulmonary actinomycosis in a Mapuche girl.

PubMed

Briceño, Gaston; Guzman, Pablo; Schafer, Fabiola

2013-01-01

Actinomycosis is a chronic granulomatous disease caused by Gram-positive anaerobic bacteria of the genus Actinomyces. Pulmonary actinomycosis is a rare infection in children, and its extension into the chest wall is infrequently reported. We report a case of pulmonary actinomycosis in a 14-year-old girl of Mapuche descent who presented with chronic respiratory symptoms and multiple discharging skin sinuses on her right lower chest wall. The diagnosis was made by skin biopsy, which showed sulfur granules with actinomyces colonies. She was successfully treated with intravenous ceftriaxone and penicillin G for 6 weeks, followed by oral amoxicillin for 6 months. © 2013 Wiley Periodicals, Inc.

Prevalence of Sinus Tract in the Patients Visiting Department of Endodontics, Kermanshah School of Dentistry

PubMed Central

Miri, Shima Sadat; Atashbar, Omid; Atashbar, Fardin

2015-01-01

Introduction: Sinus tract is one of the manifestations of chronic dental infections, which is a path for the drainage of the infection and pus. The present study was aimed to investigate the prevalence of sinus tract with dental origin analyze the correlation between sinus tract and related factors. Methods: This study was conducted on 1527 patients, visiting Kermanshah school of dentistry, in 2014.The related teeth were examined in terms of vitality test and exact location of sinus tract. Moreover, the causes of this lesion and the needs for root canal treatment were assessed in these teeth. Having obtained the data from the patients, analyzed by Mann-Whitney, Chi-square tests. Results: The frequency of sinus tract was 9.89% patients. There was a significant correlation between the prevalence of sinus tract and factors such as age, general health status, location of sinus tract and history of root canal treatment. The prevalence of sinus tract in maxilla was higher than the mandible (p=0.087). The prevalence of sinus tract in the posterior teeth (69.54%) was significantly higher than that of anterior teeth (30.46%) (p=0.000). From 724 teeth with periapical inflammation and radiolucency, 9.89% teeth had odontogenic sinus tract, and 23.42% teeth with history of root canal treatment had sinus tract. Conclusions: The most common cause of sinus tract incidence was previous root canal treatment. Therefore, clinicians need to pay a more attention to examining the posterior teeth referred for endodontic treatment. PMID:26153170

Correlation between sinus and lung cultures in lung transplant patients with cystic fibrosis.

PubMed

Choi, Kevin J; Cheng, Tracy Z; Honeybrook, Adam L; Gray, Alice L; Snyder, Laurie D; Palmer, Scott M; Abi Hachem, Ralph; Jang, David W

2018-03-01

Lung transplantation has revolutionized the treatment of end-stage pulmonary disease due to cystic fibrosis. However, infection of the transplanted lungs can lead to serious complications, including graft failure and death. Although many of these patients have concurrent sinusitis, it is unclear whether bacteria from the sinuses can infect the allograft. This is a single-institution retrospective study of all patients who underwent lung transplantation for cystic fibrosis from 2005 to 2015 at Duke University Hospital. Pre- and posttransplant nasal and pulmonary cultures obtained via nasal endoscopy and bronchoalveolar lavage (BAL), respectively, were analyzed. A total of 141 patients underwent 144 lung transplants. Sinus cultures were available for 76 patients (12 pretransplant, 42 posttransplant, 22 both pre- and posttransplant). Pretransplant BAL cultures were available for 139 patients, and posttransplant BAL cultures were available for all patients. Pseudomonas aeruginosa (PsA) and methicillin-resistant Staphylococcus aureus (MRSA) were the most common organisms cultured. There was a significant correlation between pretransplant sinus and posttransplant BAL cultures for PsA (p = 0.003), MRSA (p = 0.013), and Burkholderia cepacia (p = 0.001). There was a high correlation between pretransplant sinus cultures and posttransplant BAL cultures for PsA, MRSA, and Burkholderia sp. This suggests that the paranasal sinuses may act as a reservoir for allograft colonization in patients with cystic fibrosis. Further studies are needed to determine whether treatment of sinusitis affects allograft colonization and transplant outcomes. © 2017 ARS-AAOA, LLC.

Embolization of dural arteriovenous fistula of the anterior cranial fossa through the middle meningeal artery with Onyx.

PubMed

Deng, Jian-Ping; Li, Jiang; Zhang, Tao; Yu, Jia; Zhao, Zhen-Wei; Gao, Guo-Dong

2014-02-01

Dural arteriovenous fistula (DAVF) of the anterior cranial fossa is usually treated by surgical disconnection or endovascular embolization via the ophthalmic artery. The middle meningeal artery is a rarely used approach. This study investigated the safety and efficacy of embolization of DAVF of the anterior cranial fossa with Onyx through the middle meningeal artery. A retrospective review of a prospective cerebral vascular disease database was performed. Patients with DAVF of the anterior cranial fossa managed with embolization through the middle meningeal artery with Onyx were selected. Information on demography, symptoms and signs, angiographic examinations, interventional treatments, angiographic and clinical results, and follow-up was collected and analyzed. Five patients were included in this study, four of whom had hemorrhage. All fistulas were fed by the bilateral ethmoidal arteries arising from the ophthalmic artery and by the anterior branch of the middle meningeal artery. The abnormal shunt unilaterally drained into the superior sagittal sinus with interposition of the cortical veins all five patients. All endovascular treatments were successful with evidence of an angiographic cure. No complications occurred, and all patients recovered uneventfully without neurologic deficits. There were nearly no symptoms among the patients during follow-up. Embolization of DAVF of the anterior cranial fossa via the middle meningeal artery with Onyx is safe, effective, and a good choice for management of DAVF. More cases are needed to verify these findings. Copyright © 2013. Published by Elsevier B.V.

Open and Endoscopic Management of Fourth Branchial Pouch Sinus – Our Experience

PubMed Central

Arunachalam, Pavai; Vaidyanathan, Venkatraman; Sengottan, Palaninathan

2015-01-01

Introduction Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common and usually present with recurrent left thyroid lobe abscesses. Objectives The authors present their experience in treating such cases that were observed exclusively in children. Methods The study involved performing a retrospective review of five cases in PSG Institute of Medical Sciences & Research. All cases were evaluated radiologically and with Direct Rigid hypopharyngoscopy. Definitive surgery was performed, including hemithyroidectomy. Results The patients consisted of five children, two boys and three girls. All of them presented with recurrent episodes of neck infection. Investigations performed included computed tomography (CT) fistulography, rigid hypopharyngoscopy and ultrasound, which were useful in preoperatively delineating pyriform sinus fistulous tract. All patients underwent neck exploration with excision of the fistulous tract and hemithyroidectomy. Upon follow-up, all patients are asymptomatic. Conclusions Recurrent neck abscesses in a child should alert the clinician to the possibility of a fourth branchial arch anomaly; therefore, children with this condition require a complete evaluation so the anomaly can be ruled out. PMID:26491476

Open and Endoscopic Management of Fourth Branchial Pouch Sinus - Our Experience.

PubMed

Arunachalam, Pavai; Vaidyanathan, Venkatraman; Sengottan, Palaninathan

2015-10-01

Introduction Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common and usually present with recurrent left thyroid lobe abscesses. Objectives The authors present their experience in treating such cases that were observed exclusively in children. Methods The study involved performing a retrospective review of five cases in PSG Institute of Medical Sciences & Research. All cases were evaluated radiologically and with Direct Rigid hypopharyngoscopy. Definitive surgery was performed, including hemithyroidectomy. Results The patients consisted of five children, two boys and three girls. All of them presented with recurrent episodes of neck infection. Investigations performed included computed tomography (CT) fistulography, rigid hypopharyngoscopy and ultrasound, which were useful in preoperatively delineating pyriform sinus fistulous tract. All patients underwent neck exploration with excision of the fistulous tract and hemithyroidectomy. Upon follow-up, all patients are asymptomatic. Conclusions Recurrent neck abscesses in a child should alert the clinician to the possibility of a fourth branchial arch anomaly; therefore, children with this condition require a complete evaluation so the anomaly can be ruled out.

Imaging of the coronary sinus: normal anatomy and congenital abnormalities.

PubMed

Shah, Sanket S; Teague, Shawn D; Lu, Jimmy C; Dorfman, Adam L; Kazerooni, Ella A; Agarwal, Prachi P

2012-01-01

Knowledge of the anatomy of the coronary sinus (CS) and cardiac venous drainage is important because of its relevance in electrophysiologic procedures and cardiac surgeries. Several procedures make use of the CS, such as left ventricular pacing, mapping and ablation of arrhythmias, retrograde cardioplegia, targeted drug delivery, and stem cell therapy. As a result, it is more important for physicians interpreting the results of computed tomographic (CT) examinations dedicated to the heart or including the heart to be able to identify normal variants and congenital anomalies and to understand their clinical importance. Abnormalities of the CS range from anatomic morphologic variations to hemodynamically significant anomalies such as an unroofed CS, anomalous pulmonary venous connection to the CS, and coronary artery-CS fistula. It can be important to identify some anatomic variations, even though they are clinically occult, to ensure appropriate preprocedural planning. Both CT and magnetic resonance imaging provide excellent noninvasive depiction of the anatomy and anomalies of the CS. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.324105220/-/DC1.

Delayed retrieval of a displaced maxillary third molar from infratemporal space via trans-sinusoidal approach: a case report and the review of the literature.

PubMed

Sencimen, Metin; Gülses, Aydin; Secer, Sencer; Zerener, Tamer; Özarslantürk, Savaş

2017-03-01

The aim of this case report is to present the trans-sinusoidal pathway used to remove a displaced maxillary third molar from the infratemporal fossa and review the English literature regarding the techniques used. A 21-year-old male patient was referred with the findings of an oroantral fistula on the left maxillary vestibular first molar region and slight restriction of mouth opening. The patient underwent a maxillary sinus surgery in order to remove a sinus retention cyst via Caldwell-Luc access in a dental clinic 4 years ago. A computerized tomography scan showed the inverted third molar to be located in the infratemporal fossa, just between zygomatic arch and lateral pterygoid plate. The tooth was accessed through the remaining lateral bone defect from the Caldwell-Luc approach of the lateral sinus wall. The bone defect was extended. The posterior bony wall of the maxillary sinus was removed via a surgical burr. After that, the displaced tooth was exposed. The tooth was mobilized via Warwick James elevator downwards and removed with a forceps. Access for surgical removal of the tooth from the infratemporal fossa is not only difficult but also has potential for morbidity due to the structures running through it. Wide incision in the maxillary sulcus and blunt dissection are reported with lower success rates and usually necessitate a second intervention via extraoral route. Trans-sinusoidal approach might be an old fashioned but relatively successfully attempt in the removal of the upper third molars from the infratemporal fossa. Considering the time of removal, if no symptoms were present, it is beneficial to wait for a couple of weeks thus facilitating development of fibrous surrounding around the tooth.

Expression of Clara cell 10-kDa protein and trefoil factor family 1 in patients with chronic rhinosinusitis and nasal polyps

PubMed Central

Wang, Yuanyuan; Wang, Zong-Feng; Zhang, Zhili; Su, Yi

2018-01-01

The current study measured the expression of Clara cell 10-kDa protein (CC10) and trefoil factor family 1 (TFF1) in the sinus mucosa of patients exhibiting chronic rhinosinusitis (CRS) and nasal polyps (NP). CC10 and TFF1 expression in the sinus mucosa of the control group and patients with CRS and NP was determined using reverse transcription-quantitative polymerase chain reaction (RT-qPCR), western blotting and immunohistochemistry. The correlation between CC10 and TFF1 expression was further analyzed using Spearman's correlation analysis. The expression of TFF1 was significantly increased in the sinus mucosa of patients with CRS and NP, whereas CC10 expression was significantly decreased compared with controls. Spearman's correlation analysis identified a negative correlation between CC10 and TFF1 expression in the sinus mucosa of patients with CRS and NP. The results of immunohistochemistry and RT-qPCR were consistent with each other. Hematoxylin and eosin staining revealed notable lesions in the mucous membranes, goblet cells and cilia of sinus mucosa samples from patients with CRS and NP. The negative correlation between CC10 and TFF1 expression during the progression of CRS and NP suggest that CC10 and TFF1 may serve important roles in its pathogenesis. PMID:29456658

[Study on the correlation between the severity of chronic rhinosinusitis and bronchial asthma and pulmonary function].

PubMed

Liu, Yonggang

2015-07-01

To explore the correlation between the severity of patients with rhinitis-nasosinusitis and the bronchial asthma and the pulmonary function. Sixty-four cases of patients with rhinitis-nasosinusitis and 53 cases of patients with chronic sinusitis from June 2012 to September 2013 were randomly selected, and the patients were divided into group of rhinitis-nasosinusitis with nasal polyps and group of chronic sinusitis according to disease species, and analyzed the correlation between the severity of the deseases and the changes of the pulmonary function respectively for the patients of two groups by using Spearman method. The incidence of asthma for patients with different levels of sinusitis and nasal polyps seemed no significant difference (P > 0.05); the incidence of allergic rhinitis also seemed no significant difference (P > 0.05); the incidence of asthma for patients with different lesion range of sinusitis and nasal polyps seemed no significant difference (P > 0.05); the incidence of allergic rhinitis also seemed no significant different (P < 0.05). The conditions of the patients with different levels of sinusitis and nasal polyps were directly related to the reduction of pulmonary function (r = 2.431, P < 0.05); The conditions of the patients with different lesion range of sinusitis were directly related to the reduction of pulmonary function (r = 2.641, P < 0.05). There was some correlation between the severity of patients with rhinitis-nasosinusitis and the bronchial asthma and the condition of pulmonary function of patients.

Association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity.

PubMed

Mahmood, Hafiz Taha; Shaikh, Attiya; Fida, Mubassar

2016-10-01

Various methods have been proposed to evaluate a patient's developmental status. However, most of them lacked precision and failed to give a reliable estimate of skeletal maturity. The aims of this study were to evaluate the association between frontal sinus morphology and cervical vertebral maturation for the assessment of skeletal maturity and to determine its validity in assessing the different stages of the adolescent growth spurt. A cross-sectional study was performed on the pretreatment lateral cephalograms of 252 subjects aged 8 to 21 years. The sample was divided into 6 groups based on the cervical vertebral maturation stages. The frontal sinus index was calculated by dividing the frontal sinus height and width, and the cervical stages were evaluated on the same radiograph. The Kruskal-Wallis test was applied to compare frontal sinus index values at different cervical stages, and the post hoc Dunnett T3 test was applied to compare frontal sinus index values between adjacent cervical stages for each sex. The Kendall tau-b values were computed to assess the correlation between the cervical stages and the sinus index. A P value of ≤0.05 was considered statistically significant. The height and width of the frontal sinus were significantly larger in the male subjects than in the females. A significant association was found between the frontal sinus height and width and cervical stages (P ≤0.001) in both sexes. However, the changes in the frontal sinus index across the different cervical stages were found to be significant (P ≤0.001) in male subjects only. Similarly, a weak negative correlation was found between the sinus index and the cervical stages in male subjects (tau-b = -0.271; P <0.001), whereas no correlation was found in female subjects (tau-b = -0.006; P <0.928). However, the post hoc analysis showed that the values of the sinus index were comparable between any 2 adjacent cervical stages. The frontal sinus index cannot be used to identify the prepubertal, pubertal, and postpubertal stages of the adolescent growth spurt. Therefore, it cannot be used as a reliable maturity indicator. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

[The recent news in endoscopic surgery: a review of the literature and meta-analysis].

PubMed

Klimenko, K É

2012-01-01

During a few recent years, endonasal surgery has become the principal tool for the operative treatment of many pathologies affecting the base of the skull. The present work was designed to estimate the possibilities of using endoscopic endonasal surgery to treat sinus and skull base lesions and illustrate the recent progress in the development of endoscopic equipment and instrumentation. The meta-analysis of the results of on-going research on the application of the endonasal endoscopic technology is described with the special emphasis on the plastic treatment of liquor fistulas, removal of juvenile nasopharyngeal angiofibromas, treatment of pathological changes in the clivial region and odontoid cervicomedullary junction.

Oral Health–Related Quality of Life and Self-Rated Speech in Children With Existing Fistulas in Mid-Childhood and Adolescence

PubMed Central

Long, Ross E.; Wilson-Genderson, Maureen; Grayson, Barry H.; Flores, Roberto; Broder, Hillary L.

2016-01-01

Objective To report the associations of oro-nasal fistulae on the patient-centered outcomes oral health–related quality of life and self-reported speech outcomes in school aged-children. Design Prospective, nonrandomized multicenter design. Setting Six ACPA-accredited cleft centers. Participants Patients with cleft palate at the age of mixed dentition. Interventions None. Main Outcome Measures Prevalence of fistula and location of fistula (Pittsburgh Classification System). Patients were placed into one of three groups based on the following criteria: alveolar cleft present, no previous repair (Group 1); alveolar cleft present, previously repaired (Group 2); no congenital alveolar cleft (Group 3). Presence of fistula and subgroup classification were correlated to oral health–related quality of life (Child Oral Health Impact Profile [COHIP]) and perceived speech outcomes. Results The fistula rate was 5.52% (62 of 1198 patients). There was a significant difference in fistula rate between the three groups: Group 1 (11.15%), Group 2 (4.44%), Group 3 (1.90%). Patients with fistula had significantly lower COHIP scores (F1,1188 = 4.79; P = .03) and worse self-reported speech scores (F1,1197 = 4.27; P = .04). Group 1 patients with fistula had the lowest COHIP scores (F5,1188 = 4.78, P =.02) and the lowest speech scores (F5,1188 = 3.41, P = .003). Conclusions Presence of palatal fistulas was associated with lower oral health–related quality of life and perceived speech among youth with cleft. The poorest outcomes were reported among those with the highest fistula rates, including an unrepaired alveolar cleft. PMID:26437081

A Type-II First Branchial Cleft Anomaly Presenting as a Post-Auricular Salivary Fistula: A Rare Presentation.

PubMed

Jain, S; Deshmukh, Pt; Gupta, M; Shukla, S

2014-01-01

First branchial cleft anomalies are rare with the average age of presentation as 19 years. There is an average delay of 3.5 years between initial presentation and adequate treatment due to diagnostic dilemma. A very rare variant of first branchial cleft anomaly presenting as a post-auricular salivary fistula is reported. A 12-year-old girl presented with a history of intermittent watery discharge, more so at the time of meals from a right post-auricular opening for last 3 years. Computed tomography sialography revealed a fistulous tract connecting the sub segmental duct of the parotid gland extending along the pre-tragus region in subcutaneous plane up to mastoid tip after passing inferior to external auditory canal. Superficial parotidectomy with identification of facial nerve branches was carried out for excision of the tract. Histopathology revealed sinus tract comprising of ectodermal components and acini of the parotid gland. We classified our case into work's type-2 based on anatomical location at an angle of mandible, its relationship to parotid gland and facial nerve and previous history of ear discharge. To the best of our knowledge, this is the first case of its type to be reported.

A Type-II First Branchial Cleft Anomaly Presenting as a Post-Auricular Salivary Fistula: A Rare Presentation

PubMed Central

Jain, S; Deshmukh, PT; Gupta, M; Shukla, S

2014-01-01

First branchial cleft anomalies are rare with the average age of presentation as 19 years. There is an average delay of 3.5 years between initial presentation and adequate treatment due to diagnostic dilemma. A very rare variant of first branchial cleft anomaly presenting as a post-auricular salivary fistula is reported. A 12-year-old girl presented with a history of intermittent watery discharge, more so at the time of meals from a right post-auricular opening for last 3 years. Computed tomography sialography revealed a fistulous tract connecting the sub segmental duct of the parotid gland extending along the pre-tragus region in subcutaneous plane up to mastoid tip after passing inferior to external auditory canal. Superficial parotidectomy with identification of facial nerve branches was carried out for excision of the tract. Histopathology revealed sinus tract comprising of ectodermal components and acini of the parotid gland. We classified our case into work's type-2 based on anatomical location at an angle of mandible, its relationship to parotid gland and facial nerve and previous history of ear discharge. To the best of our knowledge, this is the first case of its type to be reported. PMID:24669347

Is there a correlation between the clinical findings and the radiological findings in chronic maxillary sinus atelectasis?

PubMed

Eyigör, Hülya; Çekiç, Bülent; Turgut Çoban, Deniz; Selçuk, Ömer Tarık; Renda, Levent; Şimşek, Emine Handan; Yılmaz, Mustafa Deniz

2016-07-01

Silent sinus syndrome (SSS) is a clinical syndrome that occurs as a result of chronic maxillary sinus atelectasis (CMA) and is seen with progressive enophthalmos and hypoglobus. The aim of this study was to investigate the correlation between radiological findings and clinical findings in patients with radiologically asymmetrical reduced maxillary sinus volume. A comparison was made of patients with CMA through evaluation of paranasal sinus computed tomography, magnetic resonance imaging examination of maxillary sinus volume of the CMA side and the contralateral side, thickness of the retroantral fat tissue, infraorbital bone curve, uncinate process lateralisation measurement, middle concha diameter, and calculation of the change in location of the inferior rectus muscle. The study included 16 patients. Although a statistically significant difference was determined between the healthy and the pathological sides in respect to maxillary sinus volume, thickness of the retroantral fat tissue, infraorbital bone curve, uncinate process lateralisation measurement, and middle concha diameter (p = 0.00, p = 0.002, p = 0.020, p = 0.020, p = 0.007), no significant difference was determined in respect to the change in location of the inferior rectus muscle (p = 0.154). A positive correlation was determined between the increase in sulcus depth and maxillary sinus volume and inferior orbital bone curve (p < 0.05). In CMA patients suspected of having SSS, radiological maxillary sinus volume analysis, determination of retroantral fat thickness, measurement of the infraorbital bone curve, and measurement of the uncinate process lateralisation can be used as objective tests. However, it should be kept in mind that radiological findings may not always be compatible with the ophthalmological examination findings. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

[Pilonidal sinus: an retrospective analysis of 205 cases].

PubMed

Castronovo, G; Ciulla, A; Urso, G; Tomasello, G; Damiani, S

2003-01-01

Sinus pilonidalis or the sacrococcigea cyst, normally is considered a "small surgical pathology" and actually it is controversial disease regarding its pathogenesis and treatment. Today the congenital hypothesis of this pathology is not considered. The etiopathogenesis exclude vestigia embryonic origin and consider it an inflammatory disease. Traumatism of the sacral region, hirsutism, hormonal secretion stimulating, and furrow sacral furrow cutaneous, explain the prevalence of this pathology in the male sex and in the puberale age. It usually appears after the pubertà and extension one various frequency of presentation in males sex (1.3%) regarding females (0.11%). The symptomatology can be rare or introduce itself in violent and intense way with on abscess of the region, or with only or multiple fistulas orifices from which exit materialclarly purulent. Normally cystic cavity is one, situated in the subcutaneous tissue with annexed inflammatory phenomena. This cavity to times communicates with the skyn fistulating. The treatment of election is surgical and must weighted and be regulated in relation to the entity of the lesion and its inflammatory picture. Sometimes the medical therapy with anti-inflammatory and antibiotic is not control the symptomatology and it need the surgical treatment.

Bilateral first branchial cleft anomaly with evidence of a genetic aetiology.

PubMed

Gonzalez-Perez, L M; Prats-Golczer, V E; Montes Carmona, J F; Heurtebise Saavedra, J M

2014-03-01

Anomalies of the first branchial cleft (FBC) are uncommon, and recognizing them can be difficult. Although present at birth, many cases do not become evident until later in childhood or adolescence, with an initial clinical presentation in adulthood being encountered only rarely. Typically, FBC anomalies present as a unilateral cyst, sinus, or fistula associated with the external auditory canal, or with swelling or an inflammatory opening in the peri-auricular/parotid area. They are commonly misdiagnosed and are often treated inadequately before being excised completely. A 40-year-old woman presented to the maxillofacial outpatient clinic with an episode of bilateral pre-auricular tumefaction, initially diagnosed as temporomandibular dysfunction syndrome. This was associated with bilateral pre-auricular pain that increased with mandibular movements. In relation to the patient's history, and given the bilateral presence of a pre-auricular pit, a diagnosis of FBC anomaly was made. Further investigation showed a related asymptomatic history in five other cases across four generations of the same family. The authors describe here the case, the diagnostic methodology, and the wide local excision technique used for removal of the branchial sinus. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Changes in Sinus Membrane Thickness After Lateral Sinus Floor Elevation: A Radiographic Study.

PubMed

Makary, Christian; Rebaudi, Alberto; Menhall, Abdallah; Naaman, Nada

2016-01-01

To radiographically monitor sinus membrane swelling after lateral sinus floor elevation surgery at short and long healing periods. For 26 patients seeking posterior maxillary implant-supported reconstruction, 32 lateral sinus floor elevations were performed using Piezosurgery. Sinus membranes were grafted using synthetic calcium phosphate bone substitutes, and graft volume was measured in cubic centimeters for each case. Cone beam computed tomography (CBCT) examination was conducted preoperatively in all patients and for each grafted sinus at 1 day (n = 8), 2 days (n = 9), 3 days (n = 8), or 7 days (n = 7) after surgery. Control CBCT was then performed for all patients at 3, 6, and 12 months after surgery. Sinus membrane thickness was measured on cross-sectional CBCT images at nine standardized points per sinus, before lateral sinus floor elevation and at all postoperative examinations. Mean sinus membrane thickness was 0.73 mm before surgery, and 5 mm, 4.1 mm, 5.9 mm, and 7 mm, respectively, at 1, 2, 3, and 7 days after surgery. First week combined postoperative CBCT measurements of membrane thickness was 5.4 mm, then 1.3, 0.68, and 0.39 mm at 3, 6, and 12 months, respectively, after surgery. Membrane thickness significantly increased the first week after surgery and gradually decreased significantly at 3, 6, and 12 months in all groups (P < .001). First-week postoperative measurements showed a significant increase in membrane thickness at 3 days compared with the 1- and 2-day results (P < .001) and at 7 days compared with all other time points (P < .001). Membrane thickness at 2 days did not change significantly compared with 1-day measurements. Larger graft volume was positively correlated with an increase in membrane thickness after surgery at all time points (n = 32; r = 0.527; P < .001). After lateral sinus floor elevation surgery, transient swelling of sinus membrane is observed. It reaches a peak value 7 days after surgery and completely resolves over months. This swelling is correlated to the extent of sinus floor elevation.

Case report: a branchial cleft anomaly presenting as an oropharyngeal mass.

PubMed

Mullin, David; Merz, Meredith

2011-12-01

Branchial anomalies are common cervical pathologic entities encountered in the field of otolaryngology and are typical in the pediatric and young adult populations. In most cases, these anomalies present as a cyst, sinus, or fistula in a rather stereotypical fashion. When a branchial anomaly deviates from the classic presentation, an improper diagnosis and inadequate management are more likely to occur, leading to an increased recurrence rate. We present a case of a 6-year-old girl with an incidental finding of a right posterior oropharyngeal wall mass, distinctly separate from the tonsillar fossa, which was found on pathologic analysis to be a branchial cleft anomaly. The theories regarding the pathogenesis of branchial anomalies are presented, along with other cases of atypical branchial anomalies.

A rare coexistence of aspergillosis with actinomycosis.

PubMed

Vinay, B Hari; Mohan, Aditya; Haritha, P; Lakshmi, K Roja

2017-01-01

Aspergillosis is a common systemic mycosis which affects immunocompromised and immunocompetent hosts. Aspergillus spp. is wide spread in the environment in most countries, which renders an invasive form of disease. The presence conidial heads are pathognomic to aspergillosis in diagnosis. Actinomycosis is a subacute-to-chronic infection that causes sinus fistula, tract or abscess due to the invasion surrounding the soft tissue. Cervicofacial infection accounts for 50%-60% of all actinomycosis cases. The mandible and nasopharynx are the sites of predilection, but maxillary infection is rare. Aspergillosis and Actinomycosis each of them was reported in case, but mixed infection of both organisms is rare, only one case has been reported. This paper discussed about a case report of coexistence of aspergillosis with actinomycosis in 38-year-old male.

Koch's Disease Presenting as an Isolated Testicular Mass- An Unusual Occurance.

PubMed

Lamichaney, Rachna; Das, Deepak; Sherpa, Mingma

2014-09-01

Isolated testicular tuberculosis (TB) is rarely seen. A 72-year-old, farmer presented with complaints of discharging sinus from scrotum along with pain and swelling. The patient had no sign of tuberculosis. On examination a hard mass arising from the left testis was noted along with a discharging fistula on the overlying scrotal skin. Chest x-ray and ultrasound examination of the abdomen were within normal limits. After assessing the testicular mass, an informed consent was taken thereafter left orchiectomy and fistulectomy performed. Histopathological examination revealed caseating granulomas along with numerous Langhan's giant cells consistent with tuberculous orchitis. The patient received anti-TB treatment for six months. The rare involvement of testis by tuberculosis needs to be mentioned.

Koch’s Disease Presenting as an Isolated Testicular Mass- An Unusual Occurance

PubMed Central

Das, Deepak; Sherpa, Mingma

2014-01-01

Isolated testicular tuberculosis (TB) is rarely seen. A 72-year-old, farmer presented with complaints of discharging sinus from scrotum along with pain and swelling. The patient had no sign of tuberculosis. On examination a hard mass arising from the left testis was noted along with a discharging fistula on the overlying scrotal skin. Chest x-ray and ultrasound examination of the abdomen were within normal limits. After assessing the testicular mass, an informed consent was taken thereafter left orchiectomy and fistulectomy performed. Histopathological examination revealed caseating granulomas along with numerous Langhan’s giant cells consistent with tuberculous orchitis. The patient received anti-TB treatment for six months. The rare involvement of testis by tuberculosis needs to be mentioned. PMID:25386448

Vascular Complications of Intercavernous Sinuses during Transsphenoidal Surgery: An Anatomical Analysis Based on Autopsy and Magnetic Resonance Venography.

PubMed

Deng, Xuefei; Chen, Shijun; Bai, Ya; Song, Wen; Chen, Yongchao; Li, Dongxue; Han, Hui; Liu, Bin

2015-01-01

Vascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV). Eighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV. Through dissection of the cadavers and CE-MRV, the location, shape, number, diameter and type of intercavernous sinuses were measured and compared. Different intercavernous sinuses were identified by their location and shape in all the cadavers and CE-MRV. Compared to the cadavers, CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus. The smaller intercavernous sinuses were not seen in the neuro-images. According to the presence of the anterior and inferior intercavernous sinus, four types of the intercavernous sinuses were identified in cadavers and CE-MRV, and the corresponding operative space in the transsphenoidal surgical approach was implemented. The morphology and classification of the cavernous sinus can be identified by CE-MRV, especially for the larger vessels, which cause bleeding more easily. Therefore, CE-MRV provides a reliable measure for individualized preoperative planning during transsphenoidal surgery.

Skull base trauma: diagnosis and management.

PubMed

Samii, Madjid; Tatagiba, Marcos

2002-03-01

The singular anatomical relationship of the base of the skull is responsible for the particular problems that may arise after injury. Extensive dural laceration and severe neurovascular damage may accompany skull base injuries. Trauma to the anterior skull base is frequently related to the paranasal sinuses, and trauma to the middle and the posterior skull base usually affects the petrous bone. Injury to the anterior fossa including the paranasal sinuses may produce CSF leakage, damage the olfactory nerves, optic nerves, and orbita contents. Fractures may affect the carotid canal, injure the internal carotid artery and result in carotid-cavernous fistula. Trauma to the petrous bone may cause facial palsy and deafness, and CSF leakage with otorrhoea or paradoxal rhinoliquorrhoea. Trauma to the posterior fossa may lacerate the major venous sinuses, and affect the cranio-cervical stability. Each one of these injuries will need a particular strategy. Decision making for management as a whole must consider all aspects, including the fact that these injuries frequently involve polytraumatized patients. Decisions regarding the timing of surgery and the sequence of the surgical procedures must be made with great care. Modern surgical techniques and recent technologies including functional preservation of the olfactory nerves in frontobasal trauma, visual evoked potentials, assisted optic nerve decompression, facial nerve reconstruction, interventional technique for intravascular repair of vascular injuries, and recent developments in cochlea implants and brain stem implants, all contributed significantly to improve outcome and enhance the quality of life of patients. This article reviews basic principles of management of skull base trauma stressing the role of these advanced techniques.

Case series: Endoscopic management of fourth branchial arch anomalies.

PubMed

Watson, G J; Nichani, J R; Rothera, M P; Bruce, I A

2013-05-01

Fourth branchial arch anomalies represent <1% of all branchial anomalies and present as recurrent neck infections or suppurative thyroiditis. Traditionally, management has consisted of treatment of the acute infection followed by hemithyroidectomy, surgical excision of the tract and obliteration of the opening in the pyriform fossa. Recently, it has been suggested that endoscopic obliteration of the sinus tract alone using laser, chemo or electrocautery is a viable alternative to open surgery. To determine the results of endoscopic obliteration of fourth branchial arch fistulae in children in our institute. Retrospective case note review of all children undergoing endoscopic treatment of fourth branchial arch anomalies in the last 7 years at the Royal Manchester Children's Hospital. Patient demographics, presenting symptoms, investigations and surgical technique were analysed. The primary and secondary outcome measures were resolution of recurrent infections and incidence of surgical complications, respectively. In total 5 cases were identified (4 females and 1 male) aged between 3 and 12 years. All presented with recurrent left sided neck abscesses. All children underwent a diagnostic laryngo-tracheo-bronchoscopy which identified a sinus in the apex of the left pyriform fossa. This was obliterated using electrocautery in 1 patient, CO₂ laser/Silver Nitrate chemocautery in 2 patients and Silver Nitrate chemocautery in a further 2 patients. There were no complications and no recurrences over a mean follow-up period of 25 months (range 11-41 months). Endoscopic obliteration of pyriform fossa sinus is a safe method for treating fourth branchial arch anomalies with no recurrence. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Relationship between BMI and Postoperative Complications with Free Flap in Anterolateral Craniofacial Reconstruction

PubMed Central

Yagi, Shunjiro; Toriyama, Kazuhiro; Takanari, Keisuke; Fujimoto, Yasushi; Nishio, Naoki; Fujii, Masazumi; Saito, Kiyoshi; Takahashi, Masakatsu; Kamei, Yuzuru

2016-01-01

Background: Although we have seen tremendous advancement in microsurgery over the last 2 decades and free tissue transfer has become standard for head and neck reconstruction, surgeons still struggle to prevent postoperative complications. We examined the relationship between body mass index (BMI) and postoperative complications in patients undergoing rectus abdominis free flap transfer after anterolateral craniofacial resection. Methods: This was a retrospective review of reconstructive surgery using rectus abdominis musculocutaneous free flap in patients with locally advanced maxillary sinus carcinoma from 2003 to 2014 (n = 35, 27 men and 8 women; average age, 60.9 ± 7.8 years). All patients underwent craniofacial reconstruction after anterior and middle cranial fossa skull base resection and maxillectomy (class IV, subtype a) with palatal resection. Patients were categorized based on sex, BMI, and other parameters. Results: Recipient-site infection occurred in 11 patients (31.4%), cerebrospinal fluid leakage in 6 (17.1%), partial flap necrosis in 2 (5.7%), total flap necrosis in 1 (2.9%), and facial fistula in 4 (11.4%). Women showed partial flap necrosis significantly more frequently (P = 0.047), probably owing to poor vascular supply of the subcutaneous fat layer. Patients with low BMI (<20 kg/m2) showed recipient-site infection (P = 0.02) and facial fistula (P = 0.01) significantly more frequently owing to insufficient tissue volume and poor vascular supply. Conclusion: Postoperative recipient-site infection and facial fistula occurred mainly in low-BMI patients. Surgeons should take care to achieve sufficient donor tissue on low-BMI patients. Using a prosthetic obturator in low-BMI patients for craniofacial reconstruction can be a good alternative option to reduce postoperative complications due to insufficient donor tissue volume. PMID:27257566

Detachable-Tip Microcatheters for Liquid Embolization of Brain Arteriovenous Malformations and Fistulas: A United States Single-Center Experience.

PubMed

Herial, Nabeel A; Khan, Asif A; Sherr, Gregory T; Qureshi, Mushtaq H; Suri, M Fareed K; Qureshi, Adnan I

2015-09-01

The US Food and Drug Administration recently approved a detachable-tip microcatheter, the Apollo microcatheter (eV3, Inc, Irvine, California), to prevent catheter entrapment during embolization of brain arteriovenous malformations (AVMs) using liquid embolic systems. To report technical aspects and clinical results of cerebral embolizations with the Apollo microcatheter in 7 embolizations in 3 adult patients. A 62-year-old man presented with an AVM in the parieto-occipital region measuring 3.6 × 1.6 cm with major cortical feeders from the right middle cerebral artery (MCA) and minor contribution from the distal right anterior cerebral artery. Two pedicles originating from the MCA were embolized. A 48-year-old woman presented with a left frontal AVM measuring 3.3 × 1.8 cm with arterial feeders from the left MCA, left middle meningeal artery, and contralateral anterior cerebral artery. Three pedicles originating from the left MCA were embolized. A 76-year-old man presented with an arteriovenous fistula with multiple fistulous connections and feeders from both vertebral and occipital arteries and the left posterior cerebral artery draining into the left transverse, torcula, and left sigmoid sinus. Two major occipital artery feeders were embolized. Seven Apollo microcatheters were used with the Onyx 18 liquid embolic system. The length of the detachable tip was 15 mm in 2 and 30 mm in 5 embolizations. The mean microcatheter in-position time within the pedicle was 20 minutes. Detachment of tip occurred in 3 instances. No limitations in accessing target arterial feeders and safe tip disengagement were noted despite prolonged injection times. Our initial experience supports the feasibility, safety, and effectiveness of detachable-tip microcatheters in treating brain AVMs and arteriovenous fistulas.

Treatment of oroantral fistulas using bony press-fit technique.

PubMed

Er, Nuray; Tuncer, Hakan Yusuf; Karaca, Ciğdem; Copuroğlu, Seçil

2013-04-01

The objective of this study was to determine the effectiveness of the bony press-fit technique in closing oroantral communications (OACs) and oroantral fistulas (OAFs) and in identifying potential intraoral donor sites. Ten patients, 4 with OACs and 6 with OAFs, were treated with autogenous bone grafts using the bony press-fit technique. In 9 patients, dental extractions caused OACs or OAFs; in 1 patient, an OAC appeared after cyst enucleation. Donor sites included the chin (3 patients), buccal exostosis (1 patient), maxillary tuberosity (2 patients), ramus (1 patient), and the lateral wall of the maxillary sinus (3 patients). The preoperative evaluation of the patients, surgical technique, and postoperative management were examined. In all 10 patients, a stable press fit of the graft was achieved. Additional fixation methods were not needed. In 2 patients, mucosal dehiscence developed, but healed spontaneously. In 2 patients, dental implant surgery was performed in the grafted area. Treatment of 10 patients with OACs or OAFs was performed, with a 100% success rate. The bony press-fit technique can be used to safely close OACs or OAFs, and it presents some advantages compared with other techniques. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Screen for intracranial dural arteriovenous fistulae with carotid duplex sonography.

PubMed

Tsai, L-K; Yeh, S-J; Chen, Y-C; Liu, H-M; Jeng, J-S

2009-11-01

Early diagnosis and management of intracranial dural arteriovenous fistulae (DAVF) may prevent the occurrence of stroke. This study aimed to identify the best carotid duplex sonography (CDS) parameters for screening DAVF. 63 DAVF patients and 170 non-DAVF patients received both CDS and conventional angiography. The use of seven CDS haemodynamic parameter sets related to the resistance index (RI) of the external carotid artery (ECA) for the diagnosis of DAVF was validated and the applicability of the best CDS parameter set in 20 400 patients was tested. The CDS parameter set (ECA RI (cut-off point = 0.7) and internal carotid artery (ICA) to ECA RI ratio (cut-off point = 0.9)) had the highest specificity (99%) for diagnosis of DAVF with moderate sensitivity (51%). Location of the DAVF was a significant determinant of sensitivity of detection, which was 70% for non-cavernous DAVF and 0% for cavernous sinus DAVF (p<0.001). The above parameter set detected abnormality in 92 of 20 400 patients. These abnormalities included DAVF (n = 25), carotid stenosis (n = 32), vertebral artery stenosis (n = 7), intracranial arterial stenosis (n = 6), head and neck tumour (n = 3) and unknown aetiology (n = 19). Combined CDS parameters of ECA RI and ICA to ECA RI ratio can be used as a screening tool for the diagnosis of DAVF.

Pulsatile tinnitus: imaging and differential diagnosis.

PubMed

Hofmann, Erich; Behr, Robert; Neumann-Haefelin, Tobias; Schwager, Konrad

2013-06-01

Pulsatile tinnitus, unlike idiopathic tinnitus, usually has a specific, identifiable cause. Nonetheless, uncertainty often arises in clinical practice about the findings to be sought and the strategy for work-up. Selective literature review and evaluation of our own series of patients. Pulsatile tinnitus can have many causes. No prospective studies on this subject are available to date. Pulsatile tinnitus requires both a functional organ of hearing and a genuine, physical source of sound, which can, under certain conditions, even be objectified by an examiner. Pulsatile tinnitus can be classified by its site of generation as arterial, arteriovenous, or venous. Typical arterial causes are arteriosclerosis, dissection, and fibromuscular dysplasia. Common causes at the arteriovenous junction include arteriovenous fistulae and highly vascularized skull base tumors. Common venous causes are intracranial hypertension and, as predisposing factors, anomalies and normal variants of the basal veins and sinuses. In our own series of patients, pulsatile tinnitus was most often due to highly vascularized tumors of the temporal bone (16%), followed by venous normal variants and anomalies (14%) and vascular stenoses (9%). Dural arteriovenous fistulae, inflammatory hyperemia, and intracranial hypertension were tied for fourth place (8% each). The clinical findings and imaging studies must always be evaluated together. Thorough history-taking and clinical examination are the basis for the efficient use of imaging studies to reveal the cause of pulsatile tinnitus.

Volumetric computed tomography analysis of the olfactory cleft in patients with chronic rhinosinusitis.

PubMed

Soler, Zachary M; Pallanch, John F; Sansoni, Eugene Ritter; Jones, Cameron S; Lawrence, Lauren A; Schlosser, Rodney J; Mace, Jess C; Smith, Timothy L

2015-09-01

Commonly used computed tomography (CT) staging systems for chronic rhinosinusitis (CRS) focus on the sinuses and do not quantify disease in the olfactory cleft. The goal of the current study was to determine whether precise measurements of olfactory cleft opacification better correlate with olfaction in patients with CRS. Olfaction was assessed using the 40-item Smell Identification Test (SIT-40) before and after sinus surgery in adult patients. Olfactory cleft opacification was quantified precisely using three-dimensional (3D), computerized volumetric analysis, as well as via semiquantitative Likert scale estimations at predetermined anatomic sites. Sinus opacification was also quantified using the Lund-Mackay staging system. The overall cohort (n = 199) included 89 (44.7%) patients with CRS with nasal polyposis (CRSwNP) and 110 (55.3%) with CRS without nasal polyposis (CRSsNP). The olfactory cleft opacified volume correlated with objective olfaction as determined by the SIT-40 (Spearman's rank correlation coefficient [Rs ] = -0.461; p < 0.001). The correlation was significantly stronger in the CRSwNP subgroup (Rs = -0.573; p < 0.001), whereas no appreciable correlation was found in the CRSsNP group (Rs = -0.141; p = 0.141). Correlations between sinus-specific Lund-Mackay CT scoring and SIT-40 scores were weaker in the CRSwNP (Rs = -0.377; p < 0.001) subgroup but stronger in the CRSsNP (Rs = -0.225; p = 0.018) group when compared to olfactory cleft correlations. Greater intraclass correlations (ICCs) were found between quantitative volumetric measures of olfactory cleft opacification (ICC = 0.844; p < 0.001) as compared with semiquantitative Likert grading (ICC = 0.627; p < 0.001). Quantitative measures of olfactory cleft opacification correlate with objective olfaction, with the strongest correlations seen in patients with nasal polyps. © 2015 ARS-AAOA, LLC.

Sigmoid Sinus Diverticulum, Dehiscence, and Venous Sinus Stenosis: Potential Causes of Pulsatile Tinnitus in Patients with Idiopathic Intracranial Hypertension?

PubMed

Lansley, J A; Tucker, W; Eriksen, M R; Riordan-Eva, P; Connor, S E J

2017-09-01

Pulsatile tinnitus is experienced by most patients with idiopathic intracranial hypertension. The pathophysiology remains uncertain; however, transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence have been proposed as potential etiologies. We aimed to determine whether the prevalence of transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence was increased in patients with idiopathic intracranial hypertension and pulsatile tinnitus relative to those without pulsatile tinnitus and a control group. CT vascular studies of patients with idiopathic intracranial hypertension with pulsatile tinnitus ( n = 42), without pulsatile tinnitus ( n = 37), and controls ( n = 75) were independently reviewed for the presence of severe transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence according to published criteria. The prevalence of transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence in patients with idiopathic intracranial hypertension with pulsatile tinnitus was compared with that in the nonpulsatile tinnitus idiopathic intracranial hypertension group and the control group. Further comparisons included differing degrees of transverse sinus stenosis (50% and 75%), laterality of transverse sinus stenosis/sigmoid sinus diverticulum/dehiscence, and ipsilateral transverse sinus stenosis combined with sigmoid sinus diverticulum/dehiscence. Severe bilateral transverse sinus stenoses were more frequent in patients with idiopathic intracranial hypertension than in controls ( P < .001), but there was no significant association between transverse sinus stenosis and pulsatile tinnitus within the idiopathic intracranial hypertension group. Sigmoid sinus dehiscence (right- or left-sided) was also more common in patients with idiopathic intracranial hypertension compared with controls ( P = .01), but there was no significant association with pulsatile tinnitus within the idiopathic intracranial hypertension group. While our data corroborate previous studies demonstrating increased prevalence of sigmoid sinus diverticulum/dehiscence and transverse sinus stenosis in idiopathic intracranial hypertension, we did not establish an increased prevalence in patients with idiopathic intracranial hypertension with pulsatile tinnitus compared with those without. It is therefore unlikely that these entities represent a direct structural correlate of pulsatile tinnitus in patients with idiopathic intracranial hypertension. © 2017 by American Journal of Neuroradiology.

Sjögren's syndrome with multiple cystic lesions and pulmonary arteriovenous fistulae.

PubMed

Taniguchi, Hirokazu; Miwa, Atsuo; Abo, Hitoshi; Demachi, Hiroshi; Izumi, Saburo

2008-01-01

A patient presented with Sjögren's syndrome associated with pulmonary multiple cystic lesions and a pulmonary arteriovenous fistulae. A histological examination of the lungs during the autopsy revealed the stenosis of the bronchiole lumens with hyperplasia of goblet cells, proliferation of smooth muscles in the inner wall of the bronchioli and retention of mucus in the airway lumens. These small airway changes were accompanied with chronic inflammatory changes of the airways in Sjögren's syndrome and led to the formation of cystic lesions via a ball-valve mechanism. Arteriovenous fistulae were situated around the cystic lesions. There may have been a correlation between the formation of the fistulae and cysts, but no mechanism was indicated in the histological findings. This report reveals that chronic inflammatory changes of the airways in Sjögren's syndrome are sufficient to cause the formation of cystic lesions.

Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting

PubMed Central

Sikkema, Kathleen J.; Watt, Melissa H.; Masenga, Gileard G.; Mosha, Mary V.

2016-01-01

Objectives Obstetric fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical fistula repair, discharge and reintegration home. Methods Women admitted for surgical repair of obstetric fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients' homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with paired t tests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed with t tests and Pearson correlations. Results Participants (N = 28) had been living with fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress. Conclusions Fistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies. PMID:27010550

[Management and classification of first branchial cleft anomalies].

PubMed

Zhong, Zhen; Zhao, Enmin; Liu, Yuhe; Liu, Ping; Wang, Quangui; Xiao, Shuifang

2013-07-01

We aimed to identify the different courses of first branchial cleft anomalies and to discuss the management and classification of these anomalies. Twenty-four patients with first branchial cleft anomalies were reviewed. The courses of first branchial cleft anomalies and their corresponding managements were analyzed. Each case was classified according to Olsen's criteria and Works criteria. According to Olsen's criteria, 3 types of first branchial cleft anomalies are identified: cysts (n = 4), sinuses (n = 13), and fistulas (n = 7). The internal opening was in the external auditory meatus in 16 cases. Two fistulas were parallel to the external auditory canal and the Eustachian tube, with the internal openings on the Eustachian tube. Fourteen cases had close relations to the parotid gland and dissection of the facial nerve had to be done in the operation. Temporary weakness of the mandibular branch of facial nerve occurred in 2 cases. Salivary fistula of the parotid gland occurred in one patient, which was managed by pressure dressing for two weeks. Canal stenosis occurred in one patient, who underwent canalplasty after three months. The presence of squamous epithelium was reported in all cases, adnexal skin structures in 6 cases, and cartilage in 14 cases. The specimens of the fistula which extended to the nasopharynx were reported as tracts lined with squamous epithelium (the external part) and ciliated columnar epithelium (the internal part). According to Work's criteria, 9 cases were classified as Type I lesions, 13 cases were classified as Type II lesions, and two special cases could not be classified. The average follow-up was 83 months (ranging from 12 to 152 months). No recurrence was found. First branchial cleft anomalies have high variability in the courses. If a patient is suspected to have first branchial anomalies, the external auditory canal must be examined for the internal opening. CT should be done to understand the extension of the lesion. For cases without internal openings in the external auditory canal, CT fistulography should be done to demonstrate the courses, followed by corresponding treatment. Two special cases might be classified as a new type of lesions.

Recurrent branchial sinus tract with aberrant extension.

PubMed

Barret, J P

2004-01-01

Second branchial cysts are the commonest lesions among congenital lateral neck anomalies. Good knowledge of anatomy and embryology are necessary for proper treatment. Surgical treatment involves resection of all branchial remnants, which extend laterally in the neck, medial to the sternocleidomastoid muscle with cranial extension to the pharynx and ipsilateral tonsillar fosa. However, infections and previous surgery can distort anatomy, making the approach to branchial anomalies more difficult. We present a case of a 17-year-old patient who presented with a second branchial tract anomaly with an aberrant extension to the midline and part of the contralateral neck. Previous surgical interventions and chronic infections may have been the primary cause for this aberrant tract. All head and neck surgeons should bear in mind that aberrant presentations may exist when reoperating on chronic branchial cysts fistulas.

Second branchial cleft anomaly with an ectopic tooth: a case report.

PubMed

Alyono, Jennifer C; Hong, Paul; Page, Nathan C; Malicki, Denise; Bothwell, Marcella R

2014-09-01

Branchial cleft cysts, sinuses, and fistulas are the most common congenital lateral neck lesions in children. They arise as a result of an abnormal development of the branchial arches and their corresponding ectoderm-lined branchial clefts. Of these diverse anomalies, second branchial cleft lesions are the most common, accounting for approximately 95% of all branchial arch pathologies. We describe what is to the best of our knowledge the first reported case of an ectopic tooth in a branchial cleft anomaly. The patient was a young girl who had other congenital abnormalities and syndromic features and who was eventually diagnosed with Townes-Brocks syndrome. We describe the clinical presentation, management, pathologic analysis, and postoperative outcomes of this case, and we present a brief review of Townes-Brocks syndrome.

Odontogenic sinus tracts: a cohort study.

PubMed

Slutzky-Goldberg, Iris; Tsesis, Igor; Slutzky, Hagay; Heling, Ilana

2009-01-01

To determine the prevalence,location, and distribution of sinus tracts in patients referred for endodontic consultation. This cohort study included 1,119 subjects referred for endodontic consultation, 108 of whom presented with sinus tracts. Following clinical and radiographic examination, the diameter of the rarifying osteitis lesion on the radiograph was measured and the path and origin of the sinus tracts determined. Signs and symptoms, tooth site,buccal/lingual location, and diameter were recorded. Data were statistically analyzed using Pearson chi-square test. Sinus tracts originated mainly from maxillary teeth (63.1%); only 38.9% originated from mandibular teeth. Chronic periapical abscess was the most prevalent diagnosed origin (71.0%). Broken restorations were highly associated with the presence of sinus tracts (53.0%). The most frequent site of orifices was buccal(82.4%), followed by lingual or palatal (12.0%). Orifices on the lingual aspect of the gingiva were observed in mandibularmolars. There was an 86.8% correlation between the occurrence of an apically located sinus tract and apical rarifying osteitis(P<.01). Sinus tract in the lingual or palatal aspect of the gingiva is relatively common. Practitioners should look for signs of sinus tract during routine examination

Diagnosis of Vein of Galen aneurysmal malformation using fetal MRI.

PubMed

Zhou, Li-Xia; Dong, Su-Zhen; Zhang, Ming-Feng

2017-11-01

To present three fetal vein of Galen aneurysmal malformations (VGAMs), which were diagnosed through magnetic resonance imaging (MRI), and highlight these cardiovascular findings. We retrospectively reviewed three fetuses with VGAM at 31, 32, and 33 weeks of gestation. Feeding arteries and draining veins were observed by MRI. Secondary changes in the brain and high-output heart failure caused by high blood flow in the lesion were evaluated. Two fetuses were born, and neonatal MRI was performed. One fetus was terminated. A characteristic dilated structure in the midline of the brain presented in each fetus. The arteriovenous fistula led to anatomical brain changes such as in the hydrocephalus, dilated feeding vessels (one or more), jugular vein, and/or superior vena cava. Substantial brachiocephalic vessel dilation was observed in two fetuses. Following parturition, one baby had neonatal asphyxia and sinus thrombosis, and MRI revealed hypoxic-ischemic encephalopathy. Cardiomegaly was detected in all three cases. With a large field of view, fetal MRI can observe brain VGAM, as well as the heart and affected large vessels. It can determine hydrocephalus, ischemia, intracranial hemorrhage, and sinus thrombosis. Providing such information on the infant's entire body can aid clinicians in determining the most appropriate treatment. 4 J. Magn. Reson. Imaging 2017;46:1535-1539. © 2016 International Society for Magnetic Resonance in Medicine.

Image analysis of oronasal fistulas in cleft palate patients acquired with an intraoral camera.

PubMed

Murphy, Tania C; Willmot, Derrick R

2005-01-01

The aim of this study was to examine the clinical technique of using an intraoral camera to monitor the size of residual oronasal fistulas in cleft lip-cleft palate patients, to assess its repeatability on study casts and patients, and to compare its use with other methods. Seventeen plaster study casts of cleft palate patients with oronasal fistulas obtained from a 5-year series of 160 patients were used. For the clinical study, 13 patients presenting in a clinic prospectively over a 1-year period were imaged twice by the camera. The area of each fistula on each study cast was measured in the laboratory first using a previously described graph paper and caliper technique and second with the intraoral camera. Images were imported into a computer and subjected to image enhancement and area measurement. The camera was calibrated by imaging a standard periodontal probe within the fistula area. The measurements were repeated using a double-blind technique on randomly renumbered casts to assess the repeatability of measurement of the methods. The clinical images were randomly and blindly numbered and subjected to image enhancement and processing in the same way as for the study casts. Area measurements were computed. Statistical analysis of repeatability of measurement using a paired sample t test showed no significant difference between measurements, indicating a lack of systematic error. An intraclass correlation coefficient of 0.97 for the graph paper and 0.84 for the camera method showed acceptable random error between the repeated records for each of the two methods. The graph paper method remained slightly more repeatable. The mean fistula area of the study casts between each method was not statistically different when compared with a paired samples t test (p = 0.08). The methods were compared using the limits of agreement technique, which showed clinically acceptable repeatability. The clinical study of repeated measures showed no systematic differences when subjected to a t test (p = 0.109) and little random error with an intraclass correlation coefficient of 0.98. The fistula size seen in the clinical study ranged from 18.54 to 271.55 mm. Direct measurements subsequently taken on 13 patients in the clinic without study models showed a wide variation in the size of residual fistulas presenting in a multidisciplinary clinic. It was concluded that an intraoral camera method could be used in place of the previous graph paper method and could be developed for clinical and scientific purposes. This technique may offer advantages over the graph paper method, as it facilitates easy visualization of oronasal fistulas and objective fistulas size determination and permits easy storage of data in clinical records.

Autonomic reactivity during viewing of an unpleasant film.

PubMed

Baldaro, B; Mazzetti, M; Codispoti, M; Tuozzi, G; Bolzani, R; Trombini, G

2001-12-01

The effect of an aversive, high-arousing film on heart rate, respiratory sinus arrhythmia, and electrogastrographic activity (EGG) was investigated. Previous studies have indicated a larger heart-rate deceleration for visual stimuli depicting surgery or blood compared to neutral content, and this phenomenon is similar to the bradycardia observed in animals in response to fear. The heart-rate deceleration is clearly parasympathetically driven, and it is considered a general index of attention. An accurate index of cardiac vagal tone can be obtained by means of quantification of the amplitude of respiratory sinus arrhythmia. The relationship between cardiac vagal tone and EGG is complex, but animal research has shown that suppressing vagal activity dampens gastric motility. We have investigated whether a movie depicting surgery is associated with greater heart-rate deceleration, larger increase in respiratory sinus arrhythmia, and greater increase in EGG activity compared to a neutral movie. In addition, if both respiratory sinus arrhythmia and EGG are indices of vagal tone, a positive correlation between these physiological responses was expected. Analysis indicated an effect of the surgery movie on heart rate and respiratory sinus arrhythmia, but not on EGG activity. Moreover, the expected correlation was not found. Implications for future studies are discussed.

[Investigation of fat in the dural sinus].

PubMed

Tokiguchi, S

1991-08-25

Detection of fat in the cranium usually indicates the presence of a fat-containing tumor such as lipoma, dermoid cyst or teratoma. However, since 1982, Hasso et al demonstrated with CT the presence of normal adipose tissue in the cavernous sinus, the mere existence of fat in the cranium does not necessarily mean the presence of a fatty tumor. The author first described fat deposition in the superior sagittal sinus and torcular Herophili following a CT study performed in 1986. The purpose of this study was to investigate the distribution, frequency, and anatomical correlations of fat in the dural sinus as demonstrated on CT. Fat was detected in the cavernous sinus in 20% of all cases (492/2408), and occurred more frequently (25%) in those older than 50 years. Fat was less frequent in the other dural sinuses (3%; 75/2296). The most common location was the torcular Herophili, followed in decreasing order of frequency by the straight sinus, inferior sagittal sinus, superior sagittal sinus and transverse sinus. Pathological examination was performed in three cases. Fat deposition was composed of normal adipose tissue and was devoid of fibrous encapsulation or infiltration. In one case, the fat seemed to be partly exposed to the subarachnoid space on CT, whereas on autopsy, thin dura mater covering the fat nodule was confirmed. Fat in the dural sinus must be differentiated from cavernous nodule or sinus thrombosis. The Hounsfield unit may be helpful in making a definitive diagnosis.

Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting.

PubMed

Wilson, Sarah M; Sikkema, Kathleen J; Watt, Melissa H; Masenga, Gileard G; Mosha, Mary V

2016-05-01

Objectives Obstetric fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical fistula repair, discharge and reintegration home. Methods Women admitted for surgical repair of obstetric fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients' homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with paired t tests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed with t tests and Pearson correlations. Results Participants (N = 28) had been living with fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress. Conclusions Fistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies.

Design and Psychometric Evaluation of the Quality of Life in Patients With Anal Fistula Questionnaire.

PubMed

Ferrer-Márquez, Manuel; Espínola-Cortés, Natalia; Reina-Duarte, Angel; Granero-Molina, José; Fernández-Sola, Cayetano; Hernández-Padilla, José Manuel

2017-10-01

Quality of life is often considered when deciding and evaluating the treatment strategy for patients diagnosed with anal fistula. The purpose of this study was to develop and psychometrically test the Quality of Life in Patients with Anal Fistula Questionnaire. This was an observational cross-sectional study for the development and validation of a psychometric tool. The study was conducted at a general hospital in the southeast of Spain. A convenience sample included 54 patients diagnosed with anal fistula. The reliability of the tool was assessed through its internal consistency (Cronbach α) and temporal stability (Spearman correlation coefficient (r) between test-retest). The content validity index of the items and the scale was calculated. Correlation analysis and an ordinal regression analysis between the developed tool and the Short Form 12 Health Survey examined its concurrent validity. Principal component analysis and known-group analysis using the Kruskal-Wallis test examined its construct validity. The reliability of the developed questionnaire was very high (α = 0.908; r = 0.861; p < 0.01). Its content validity was excellent (all-item content validity index = 0.79-1.00; scale validity index = 0.92). Evidence of its concurrent validity included strong correlation between the developed tool and Short Form 12 Health Survey (r = 0.734; p < 0.001), and participant scores on the developed tool explained ≈46.2% of the between-subject variation for the participant scores on Short Form 12 Health Survey (Nagelkerke R = 0.462). Confirming its construct validity, principal component analysis revealed that 2 factors explained 81.63% of the total variance found. Known-group analysis evidenced the ability of the questionnaire to detect expected differences in patients presenting with different symptomatology. The major limitations of this study were the use of a small sample of Spanish-speaking patients, not including patients in the initial development of the questionnaire, and developing the scoring system using a summation method. The Quality of Life in Patients with Anal Fistula Questionnaire has proven to be a valid, reliable, and concise tool that could contribute to the evaluation of quality of life among patients with an anal fistula. See Video Abstract at http://links.lww.com/DCR/A368.

Beyond the sniffer: frontal sinuses in Carnivora.

PubMed

Curtis, Abigail A; Van Valkenburgh, Blaire

2014-11-01

Paranasal sinuses are some of the most poorly understood features of mammalian cranial anatomy. They are highly variable in presence and form among species, but their function is not well understood. The best-supported explanations for the function of sinuses is that they opportunistically fill mechanically unnecessary space, but that in some cases, sinuses in combination with the configuration of the frontal bone may improve skull performance by increasing skull strength and dissipating stresses more evenly. We used CT technology to investigate patterns in frontal sinus size and shape disparity among three families of carnivores: Canidae, Felidae, and Hyaenidae. We provide some of the first quantitative data on sinus morphology for these three families, and employ a novel method to quantify the relationship between three-dimensional sinus shape and skull shape. As expected, frontal sinus size and shape were more strongly correlated with frontal bone size and shape than with the morphology of the skull as a whole. However, sinus morphology was also related to allometric differences among families that are linked to biomechanical function. Our results support the hypothesis that frontal sinuses most often opportunistically fill space that is mechanically unnecessary, and they can facilitate cranial shape changes that reduce stress during feeding. Moreover, we suggest that the ability to form frontal sinuses allows species to modify skull function without compromising the performance of more functionally constrained regions such as the nasal chamber (heat/water conservation, olfaction), and braincase (housing the brain and sensory structures). © 2014 Wiley Periodicals, Inc.

Enterocutaneous Fistulae: Etiology, Treatment, and Outcome – A Study from South India

PubMed Central

Kumar, Prakash; Maroju, Nanda K.; Kate, Vikram

2011-01-01

Background/Aim: Enterocutaneous fistula (ECF) is a difficult condition managed in the surgical wards and is associated with significant morbidity and mortality. Sepsis, malnutrition, and electrolyte abnormality is the classical triad of complications of ECF. Sepsis with malnutrition is the leading cause of death in cases of ECF. Although it is a common condition, no recent report in literature on the profile of patients with ECF has been documented from the southern part of India. Materials and Methods: All consecutive patients who developed or presented with ECF during the study period were included in the study. The etiology, anatomic distribution, fistula output, clinical course, complications, predictive factors for spontaneous closure, and outcomes for patients with ECF were studied. Results: A total of 41 patients were included in this prospective observational study, of which 34 were males and 7 were females. About 95% of ECF were postoperative. Ileum was found to be the most common site of ECF. Also, 49% of fistulas were high output and 51% were low output. Serum albumin levels correlated significantly with fistula healing and mortality. Surgical intervention was required in 41% of patients. Conclusion: Most of the ECF are encountered in the postoperative period. Serum albumin levels can predict fistula healing and mortality. Conservative management should be the first line of treatment. Mortality in patients with ECF continues to be significant and is commonly related to malnutrition and sepsis. PMID:22064337

[Orbito-palpebral vascular pathology].

PubMed

Heran Dreyfus, F; Galatoire, O; Koskas, P; Lafitte, F; Nau, E; Bergès, O

2016-11-01

Orbito-palpebral vascular pathology represents 10% of all the diseases of this area. The lesion may be discovered during a brain CT scan or MRI, or because it causes clinical symptoms such as orbital mass, visual or oculomotor alteration, pain, proptosis, or acute bleeding due to a complication of the lesion (hemorrhage, thrombosis). We present these lesions using an anatomical, clinical, imaging and therapeutic approach. We distinguish four different entities. Vascular tumors have common imaging characteristics (hypersignal on T2 sequence, contrast enhancement, abnormal vascularization well depicted with ultrasound and Doppler, and possible bleeding). The main lesions are cavernous hemangiomas, the most frequent lesion of that type during adulthood; infantile hemangiomas, the most frequent vascular tumor in children; and more seldomly, hemangioperitcytomas. True vascular malformations are divided according to their flow. Low flow lesions are venous (orbital varix), capillarovenous or lymphatic (lymphangioma). High flow malformations, more rare, are either arteriovenous or arterial malformations (aneurisms). Complex malformations include both low and high flow elements. Lesions leading to modifications of the orbito-palpebral blood flow are mainly due to cavernous sinus abnormalities, either direct carotid-cavernous fistula affecting young adults after severe head trauma, or dural fistula, more insidious, found in older adults. The last section is devoted to congenital syndromic vascular malformations (Sturge-Weber, Rendu-Olser…). This classification allows for a better understanding of these pathologies and their specific imaging features. Copyright © 2016. Published by Elsevier Masson SAS.

The morphological interaction between the nasal cavity and maxillary sinuses in living humans.

PubMed

Holton, Nathan; Yokley, Todd; Butaric, Lauren

2013-03-01

To understand how variation in nasal architecture accommodates the need for effective conditioning of respired air, it is necessary to assess the morphological interaction between the nasal cavity and other aspects of the nasofacial skeleton. Previous studies indicate that the maxillary sinuses may play a key role in accommodating climatically induced nasal variation such that a decrease in nasal cavity volume is associated with a concomitant increase in maxillary sinus volume. However, due to conflicting results in previous studies, the precise interaction of the nasal cavity and maxillary sinuses, in humans, is unclear. This is likely due to the prior emphasis on nasal cavity size, whereas arguably, nasal cavity shape is more important with regard to the interaction with the maxillary sinuses. Using computed tomography scans of living human subjects (N=40), the goal of this study is to assess the interaction between nasal cavity form and maxillary sinus volume in European- and African-derived individuals with differences in nasal cavity morphology. First, we assessed whether there is an inverse relationship between nasal cavity and maxillary sinus volumes. Next, we examined the relationship between maxillary sinus volume and nasal cavity shape using multivariate regression. Our results show that there is a positive relationship between nasal cavity and maxillary sinus volume, indicating that the maxillary sinuses do not accommodate variation in nasal cavity size. However, maxillary sinus volume is significantly correlated with variation in relative internal nasal breadth. Thus, the maxillary sinuses appear to be important for accommodating nasal cavity shape rather than size. Copyright © 2013 Wiley Periodicals, Inc.

Interventions for treating oro-antral communications and fistulae due to dental procedures.

PubMed

Kiran Kumar Krishanappa, Salian; Prashanti, Eachempati; Sumanth, Kumbargere N; Naresh, Shetty; Moe, Soe; Aggarwal, Himanshi; Mathew, Rebecca J

2016-05-27

An oro-antral communication is an unnatural opening between the oral cavity and maxillary sinus. When it fails to close spontaneously, it remains patent and is epithelialized to develop into an oro-antral fistula. Various surgical and non-surgical techniques have been used for treating the condition. Surgical procedures include flaps, grafts and other techniques like re-implantation of third molars. Non-surgical techniques include allogenic materials and xenografts. To assess the effectiveness and safety of various interventions for the treatment of oro-antral communications and fistulae due to dental procedures. We searched the Cochrane Oral Health Group's Trials Register (whole database, to 3 July 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2015, Issue 6), MEDLINE via OVID (1946 to 3 July 2015), EMBASE via OVID (1980 to 3 July 2015), US National Institutes of Health Trials Registry (http://clinicaltrials.gov) (whole database, to 3 July 2015) and the World Health Organization (WHO) International Clinical Trials Registry Platform (http://www.who.int/ictrp/en/) (whole database, to 3 July 2015). We also searched the reference lists of included and excluded trials for any randomised controlled trials (RCTs). We included RCTs evaluating any intervention for treating oro-antral communications or oro-antral fistulae due to dental procedures. We excluded quasi-RCTs and cross-over trials. We excluded studies on participants who had oro-antral communications, fistulae or both related to Caldwell-Luc procedure or surgical excision of tumours. Two review authors independently selected trials. Two review authors assessed trial risk of bias and extracted data independently. We estimated risk ratios (RR) for dichotomous data, with 95% confidence intervals (CI). We assessed the overall quality of the evidence using the GRADE approach. We included only one study in this review, which compared two surgical interventions: pedicled buccal fat pad flap and buccal flap for the treatment of oro-antral communications. The study involved 20 participants. The risk of bias was unclear. The relevant outcome reported in this trial was successful (complete) closure of oro-antral communication.The quality of the evidence for the primary outcome was very low. The study did not find evidence of a difference between interventions for the successful (complete) closure of an oro-antral communication (RR 1.00, 95% Cl 0.83 to 1.20) one month after the surgery. All oro-antral communications in both groups were successfully closed so there were no adverse effects due to treatment failure.We did not find trials evaluating any other intervention for treating oro-antral communications or fistulae due to dental procedures. We found very low quality evidence from a single small study that compared pedicled buccal fat pad and buccal flap. The evidence was insufficient to judge whether there is a difference in the effectiveness of these interventions as all oro-antral communications in the study were successfully closed by one month after surgery. Large, well-conducted RCTs investigating different interventions for the treatment of oro-antral communications and fistulae caused by dental procedures are needed to inform clinical practice.

Assessing the impact of a fistula after a pancreaticoduodenectomy using the Post-operative Morbidity Index.

PubMed

Miller, Benjamin C; Christein, John D; Behrman, Stephen W; Callery, Mark P; Drebin, Jeffrey A; Kent, Tara S; Pratt, Wande B; Lewis, Russell S; Vollmer, Charles M

2013-10-01

The Post-operative Morbidity Index (PMI) is a quantitative utility measure of a complication burden created by severity weighting. The Fistula Risk Score (FRS) is a validated model that predicts whether a patient will develop a post-operative pancreatic fistula (POPF). These novel tools might provide further discrimination of the ISGPF grading system. From 2001 to 2012, 1021 pancreaticoduodenectomies were performed at four institutions. POPFs were categorized by ISGPF standards. PMI scores were calculated based on the Modified Accordion Severity Grading System. FRS scores were assigned according to the relative influence of four recognized factors for developing a clinically relevant POPF (CR-POPF). In total, 231 patients (22.6%) developed a POPF, of which 54.1% were CR-POPFs. The PMI differed significantly between the ISGPF grades and patients with no or non-fistulous complications (P < 0.001). 64.9% of POPFs and 84.0% of CR-POPFs contributed the highest Accordion grade to the PMI. Overall, the FRS correlated well with PMI (R(2) = 0.81, P < 0.001). These data quantitatively reinforce the ISGPF grades that were developed qualitatively around the concept of clinical severity. CR-POPFs usually reflect the patient's highest Accordion score whereas biochemical POPFs are often superseded. The correlation between FRS and PMI indicates that risk factors for a fistula contribute to overall pancreaticoduodenectomy morbidity. © 2013 International Hepato-Pancreato-Biliary Association.

Branchial Cleft Anomalies

PubMed Central

McPhail, Neil; Mustard, Robert A.

1966-01-01

The embryology, anatomy and pathology of branchial cleft anomalies are discussed and 87 cases reviewed. The most frequent anomaly was branchial cleft cyst, of which there were 77 cases. Treatment in all cases consisted of complete excision. There were five cases of external branchial sinus and five cases of complete branchial fistula. Sinograms were helpful in demonstrating these lesions. Excision presented little difficulty. No proved case of branchiogenic carcinoma has been found in the Toronto General Hospital. Five cases are described in which the original diagnosis was branchiogenic carcinoma—in four of these a primary tumour has already been found. The authors believe that the diagnosis of branchiogenic carcinoma should never be accepted until repeated examinations over a period of at least five years have failed to reveal a primary tumour. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5 PMID:5901161

Analysis of the Agger nasi cell and frontal sinus ostium sizes using computed tomography of the paranasal sinuses.

PubMed

Angélico, Fernando Veiga; Rapoport, Priscila Bogar

2013-01-01

The Agger nasi cell (ANC) and the frontal sinus ostium (FO) are important structures that can influence the anatomy and physiology of the frontal recess. The aim of this study was to evaluate the presence and size of ANC and the FO and correlate them according to gender, race and among themselves. A prospective study with 40 patients who underwent CT of the paranasal sinuses with sagittal reconstruction. ANC (APAN) anteroposterior diameter, ANC (CCAN) craniocaudal diameter, ANC (LLAN) side-to-side diameter, anteroposterior diameter of the FO (APFO) and side-to-side diameter of the FO (LLFO). Twenty-two patients were male and 18 females, mean age 33.7 years. Most patients were white (45%), followed by browns (32.5%), blacks (20%) and asians (2.5%). The ANC was present in 98.7% of patients. There was statistical difference for APAN on females and LLAN on females and on the total sample. There were no differences for all measurements regarding gender, as well as the race. ANC and FO measurements showed positive correlation, but poor or very poor. The prevalence of ANC in our sample was high and did not show a statistically significant difference for most measurements. The correlation between measurements of ANC and the FO was poor or very poor.

Non-invasive diagnostics of the maxillary and frontal sinuses based on diode laser gas spectroscopy.

PubMed

Lewander, Märta; Lindberg, Sven; Svensson, Tomas; Siemund, Roger; Svanberg, Katarina; Svanberg, Sune

2012-03-01

Suspected, but objectively absent, rhinosinusitis constitutes a major cause of visits to the doctor, high health care costs, and the over-prescription of antibiotics, contributing to the serious problem of resistant bacteria. This situation is largely due to a lack of reliable and widely applicable diagnostic methods. A novel method for the diagnosis of rhinosinusitis based on non-intrusive diode laser gas spectroscopy is presented. The technique is based on light absorption by free gas (oxygen and water vapour) inside the sinuses, and has the potential to be a complementary diagnostic tool in primary health care. The method was evaluated on 40 patients with suspected sinus problems, referred to the diagnostic radiology clinic for low-dose computed tomography (CT), which was used as the reference technique. The data obtained with the new laser-based method correlated well with the grading of opacification and ventilation using CT. The sensitivity and specificity were estimated to be 93% and 61%, respectively, for the maxillary sinuses, and 94% and 86%, respectively, for the frontal sinuses. Good reproducibility was shown. The laser-based technique presents real-time clinical data that correlate well to CT findings, while being non-intrusive and avoiding the use of ionizing radiation.

Respiratory sinus arrhythmia is a limited measure of cardiac parasympathetic control in man.

PubMed Central

Kollai, M; Mizsei, G

1990-01-01

1. Respiratory modulation of cardiac parasympathetic activity and the relationship between respiratory sinus arrhythmia and parasympathetic control has been studied in twenty-nine conscious, healthy young adult subjects. 2. Changes in heart period in propranolol-treated subjects were taken as the measure of changes in cardiac parasympathetic activity; respiratory sinus arrhythmia was quantified as the difference between maximum and minimum heart periods in a given respiratory cycle; cardiac parasympathetic control was defined as the change in heart period after administration of a full dose of atropine. 3. During normal quiet breathing the inspiratory level of cardiac parasympathetic activity was not reduced to zero. The expiratory level was influenced by excitatory inputs whose activation was related to respiratory cycle length. 4. Slow breathing was associated with augmented sinus arrhythmia, but in different individuals the influence on minimum and maximum heart periods varied so that mean heart period was increased in some subjects but decreased in others. This occurred both in control conditions and after administration of a full dose of propranolol. 5. During normal breathing the correlation across subjects between respiratory sinus arrhythmia and parasympathetic control, although significant, was not close (r = 0.61). The relationship was not affected by beta-adrenergic blockade (r = 0.63). The strength of the correlation improved when multiple regression of respiratory sinus arrhythmia was performed on three variables: parasympathetic control, respiratory cycle length and tidal volume (R = 0.93). 6. It is concluded that in conscious human subjects the respiratory modulation of cardiac parasympathetic activity is different from that observed in the anaesthetized dog, and that variations in the amplitude of respiratory sinus arrhythmia do not necessarily reflect proportional changes in cardiac parasympathetic control. PMID:2391653

Coronary sinus signal amplitude predicts left atrial scarring.

PubMed

Attanasio, Philipp; Qaiyumi, Daniel; Röhle, Robert; Wutzler, Alexander; Safak, Erdal; Muntean, Bogdan; Boldt, Leif-Hendrik; Pieske, Burkert; Haverkamp, Wilhelm; Huemer, Martin

2017-12-22

Left atrial scarring is recognised as a critical component in the maintenance of atrial fibrillation and is associated with the failure of interventional treatment. Diminished bipolar voltage (LV) has been proposed as a useful tool for left atrial scar quantification. We hypothesised that, due to its anatomic location, signals on the coronary sinus catheter might be used to predict the amount of left atrial low voltage. A total of 124 patients (42% women, average age 66 ± 9 years) were included. Forty-one with paroxysmal and 83 with persistent atrial fibrillation. Left atrial low-voltage (<0.5 mV, measured during sinus rhythm) area size and distribution varied considerably among the included patients (mean: 34.9%; maximum: 94.6%; minimum: 0.4%). Spearman correlation revealed a strong negative correlation between bipolar voltage of the signals on the coronary sinus catheter and the amount of left atrial scarring (R = -0.778, p < .0001). The optimal CS voltage cut off for prediction of left atrial low-voltage size of ≥50% was 1.9 mV with an area-under-the receiver-operating-characteristic (ROC) curve of 0.982, a sensitivity of 97% and a specificity of 98%. There is a strong negative correlation between the size of left atrial low-voltage areas (LVA) and coronary sinus signal amplitude. With increasing left atrial LVA size, CS signal amplitudes decrease, and vice versa. On the basis of these findings, average CS signal amplitudes of ≤1.9 mV can be used as a predictor for a left atrial low-voltage size of ≥50%.

Microbiology of intracranial abscesses associated with sinusitis of odontogenic origin.

PubMed

Brook, Itzhak

2006-12-01

The unique microbiology of sinusitis of dental origin that is associated with intracranial abscesses (IAs) and the correlation between the organisms at the two sites has not been reported before. This report describes the author's experience during a 30-year period in studying the microbiology of 8 IAs and their corresponding sinusitis of dental origin. Aspirates of pus from 8 infected sinuses associated with odontogenic infections and their corresponding IAs were studied for aerobic and anaerobic bacteria. Polymicrobial flora was found in all 8 sinuses and 7 IAs, and the number of isolates varied from 1 to 5. Anaerobic bacteria were isolated from all sinuses and IAs. A total of 28 isolates (3.5 isolates per site; 25 strict anaerobic, 1 aerobic or facultative, and 2 microaerophilic) were recovered from the sinuses, and 20 isolates (2.5 isolates per site; 16 strict anaerobic, 1 aerobic or facultative, and 3 microaerophilic) were found in the IAs. The bacterial isolates were Fusobacterium spp (14), Prevotella spp (11), Peptostreptococcus spp (13), microaerophilic streptococci (5), Veillonella parvula (3), and beta-hemolytic streptococci group F(2). Concordance in the microbiological findings between the sinus and the IA was found in all instances; however, certain organisms were only present at one site. These data illustrate the concordance in the organisms recovered from sinusitis of dental origin and their associated IAs and confirm the importance of anaerobic bacteria in sinusitis and IAs of dental origin.

Paranasal sinus pathogens in children with cystic fibrosis: do they relate to lower respiratory tract pathogens and is eradication successful?

PubMed

Wilson, P; Lambert, C; Carr, S B; Pao, C

2014-07-01

The study aims were to assess the association of microflora between the paranasal sinus and the lower airways of children attending a regional paediatric cystic fibrosis centre and to determine the performance of an eradication treatment protocol for positive paranasal sinus samples. Paired nasal lavage and lower airway samples (cough swabs or sputum) were taken from 54 children with cystic fibrosis (median age 11 years). Positive paranasal sinus samples received eradication treatment, using oral and sinonasal nebulised antibiotics. A correlation between paranasal sinus and lower airways was detected in 33/54 paired timed samples (p<0.02). Of 4/54 children who reported sinus symptoms, only 2 had paranasal sinus positive samples. 28 positive nasal lavage samples cultured 8 Pseudomonas aeruginosa (PA), 8 Staphylococcus aureus (SA) and 12 other bacterial pathogens. Eradication using sinonasal nebulised antibiotics and oral antibiotics showed a success of 14/21 (67%) treated paranasal sinus positive samples at 1 month & 3 months after treatment. Success rate was 75% in the PA group and 71% in the SA group. Ongoing monitoring with nasal lavage will continue. There was agreement between pathogens or lack of them found in the paranasal sinus and lower airways. Paranasal infection is often asymptomatic in children with cystic fibrosis. The eradication protocol for paranasal sinus pathogens had a good success rate. Copyright © 2014 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Adiponectin downregulation is associated with volume overload-induced myocyte dysfunction in rats

PubMed Central

Wang, Li-li; Miller, Dori; Wanders, Desiree; Nanayakkara, Gayani; Amin, Rajesh; Judd, Robert; Morrison, Edward E; Zhong, Ju-ming

2016-01-01

Aim: Adiponectin has been reported to exert protective effects during pathological ventricular remodeling, but the role of adiponectin in volume overload-induced heart failure remains unclear. In this study we investigated the effect of adiponectin on cardiac myocyte contractile dysfunction following volume overload in rats. Methods: Volume overload was surgically induced in rats by infrarenal aorta-vena cava fistula. The rats were intravenously administered adenoviral adiponectin at 2-, 6- and 9-weeks following fistula. The protein expression of adiponectin, adiponectin receptors (AdipoR1/R2 and T-cadherin) and AMPK activity were measured using Western blot analyses. Isolated ventricular myocytes were prepared at 12 weeks post-fistula to examine the contractile performance of myocytes and intracellular Ca2+ transient. Results: A-V fistula resulted in significant reductions in serum and myocardial adiponectin levels, myocardial adiponectin receptor (AdipoR1/R2 and T-cadherin) levels, as well as myocardial AMPK activity. Consistent with these changes, the isolated myocytes exhibited significant depression in cell shortening and intracellular Ca2+ transient. Administration of adenoviral adiponectin significantly increased serum adiponectin levels and prevented myocyte contractile dysfunction in fistula rats. Furthermore, pretreatment of isolated myocytes with recombinant adiponectin (2.5 μg/mL) significantly improved their contractile performance in fistula rats, but had no effects in control or adenoviral adiponectin-administered rats. Conclusion: These results demonstrate a positive correlation between adiponectin downregulation and volume overload-induced ventricular remodeling. Adiponectin plays a protective role in volume overload-induced heart failure. PMID:26616727

Cribriform carcinoma mimicking breast abscess - case report. Diagnostic and therapeutic management.

PubMed

Dobruch-Sobczak, Katarzyna; Roszkowska-Purska, Katarzyna; Chrapowicki, Eryk

2013-06-01

The authors presents a case of cribriform breast carcinoma in a cyst that clinically imitated an abscess. The case concerns a 71-year-old female patient treated for ankylosing spondylitis, with a positive family history of breast cancer. The patient presented at the surgical clinic for incision of an abscess of the mammary gland localized in the lower inner quadrant that was a consequence of previous trauma to the right breast. The abscess was incised and the serosanguineous contents were evacuated. The wound was drained and antibiotics (Dalacin with Metronidazol) were administered for the period of 10 days. During the treatment, a cutaneous fistula was formed. At the incision site, a hard thickening was palpable (tumor). Core needle biopsy of the clinically palpable tumor was performed and the purulent material from the fistula was collected for a culture test. Complete blood count did not reveal leucocytosis. In accordance with the obtained sensitivity report, the patient was started on antibiotics again. Breast ultrasound performed upon the completion of the antibiotic therapy, in the right breast, revealed two solidcystic oval lesions with thick echogenic walls and blurred margins. Both masses contained dense levels of fluid material and solid polycyclic structures. On sonoelastography, the lesions were heterogeneous with a high Young's modulus. In the right axillary fossa, ultrasound examination revealed three abnormal lymph nodes enlarged to 31 mm length, which were rounded, hypoechoic and without visible sinuses. Histopathology of the core needle biopsy performed at admittance and after the antibiotic therapy indicated a breast abscess (presence of fibrinous and partly fibrinopurulent material). The mass was finally resected to confirm histopathology. The resected material revealed the presence of an invasive, moderately differentiated cribriform carcinoma, which developed within a cyst, with a 40% necrotic component. Eighteen months after the commencement of treatment, the patient remains under oncological supervision and continues hormonal therapy. There are no signs of relapse or foci of distant metastases. The occurrence of breast carcinoma within an abscess emphasises the need for comprehensive assessment and correlation of the clinical picture with imaging and histopathological findings. It also highlights the necessity to include breast abscess in the differential diagnosis of rare forms of carcinomas.

Complex perirectal sepsis: clinical classification and imaging.

PubMed

Zbar, A P; Armitage, N C

2006-07-01

The use of specialized imaging to assess cryptogenic fistula-in-ano is selective, aimed at delineation of the site of the internal fistula opening and the relationship of the primary and secondary tracks and collections to the main levator plate. Advanced imaging also permits definition of the destructive effects of perirectal sepsis (e.g. internal or external anal sphincter damage, perineal body destruction and an ano- or rectovaginal fistula), which may require secondary reconstructive surgery. We performed a PubMed search of outcomes for fistula management in the English and non-English literature, and summarized results regarding the accuracy of internal opening and horseshoe detection as well as the operative correlation for cryptogenic and non-cryptogenic fistula-in-ano using endoanal ultrasound (EAUS) and magnetic resonance (MR) imaging. Only literature defining these characteristics was included. The advantages and limitations of the main forms of imaging are discussed in this review with emphasis on EAUS and endoanal or pelvic phased-array MR fistulography. The new technique of transperineal sonography is highlighted. A small but important group of patients with complex fistula-in-ano require specialized imaging. There are specific limitations of endoanal ultrasound (EAUS) which necessitate pelvic phased-array MR imaging. Initial work suggests that EAUS may have a role in intraoperative use for image-guided drainage of recurrent abscesses where operative interpretation can be difficult. The coloproctologist in a tertiary referral center must acquire the skills of ultrasound performance in order to successfully treat fistulous disease, suggesting a role for formal imaging accreditation as part of coloproctological training. Future studies should determine both what sequential imaging algorithms for imaging are cost-effective as well as predictive of fistula cure.

Validation of computational fluid dynamics-based analysis to evaluate hemodynamic significance of access stenosis.

PubMed

Hoganson, David M; Hinkel, Cameron J; Chen, Xiaomin; Agarwal, Ramesh K; Shenoy, Surendra

2014-01-01

Stenosis in a vascular access circuit is the predominant cause of access dysfunction. Hemodynamic significance of a stenosis identified by angiography in an access circuit is uncertain. This study utilizes computational fluid dynamics (CFD) to model flow through arteriovenous fistula to predict the functional significance of stenosis in vascular access circuits. Three-dimensional models of fistulas were created with a range of clinically relevant stenoses using SolidWorks. Stenoses diameters ranged from 1.0 to 3.0 mm and lengths from 5 to 60 mm within a fistula diameter of 7 mm. CFD analyses were performed using a blood model over a range of blood pressures. Eight patient-specific stenoses were also modeled and analyzed with CFD and the resulting blood flow calculations were validated by comparison with brachial artery flow measured by duplex ultrasound. Predicted flow rates were derived from CFD analysis of a range of stenoses. These stenoses were modeled by CFD and correlated with the ultrasound measured flow rate through the fistula of eight patients. The calculated flow rate using CFD correlated within 20% of ultrasound measured flow for five of eight patients. The mean difference was 17.2% (ranged from 1.3% to 30.1%). CFD analysis-generated flow rate tables provide valuable information to assess the functional significance of stenosis detected during imaging studies. The CFD study can help in determining the clinical relevance of a stenosis in access dysfunction and guide the need for intervention.

Magnetic resonance imaging of the nose and paranasal sinuses.

PubMed Central

Lloyd, G A

1989-01-01

Seventy-five patients with a wide range of sinus disease have been investigated by magnetic resonance (MR): these included congenital conditions, allergic and inflammatory sinus disease, fungus infections, and the necrotizing granulomata. In addition, a variety of benign and malignant tumours have been examined, and in the more recent sinus malignancies the paramagnetic contrast agent, Gadolinium (Gd) DTPA (Schering Health Care) has been used. This experience of magnetic resonance scanning has shown that it is superior to computed tomography in demonstrating the extent of malignant disease in the nose and sinuses; most especially when Gd DTPA is used, reaching an accuracy of over 96% by biopsy correlation. An additional advantage of this technique is the wide coverage of the head and neck for the assessment of malignant disease, provided by direct 3 plane imaging and the multislice facility. The main disadvantage of magnetic resonance of the sinuses is the poor demonstration of calcification and bone. For this reason the MR scans may need to be augmented by high resolution CT performed specifically to show bone detail. Images Figure 2. Figure 3. PMID:2926770

Sex Determination of Adult Human Maxillary Sinuses on Panoramic Radiographs

PubMed Central

Leao de Queiroz, Cristhiane; Terada, Andrea Sayuri Silveira Dias; Dezem, Thais Uenoyama; Gomes de Araújo, Lais; Galo, Rodrigo; Oliveira-Santos, Christiano

2016-01-01

Absract The purpose of this study was to evaluate dimensions of adult human maxillary sinuses on panoramic radiographs and their possible application on the sex determination for forensic purposes. The sample comprised 64 database panoramic radiographs from individuals aged 20 years or older (32 male and 32 female subjects), with complete permanent dentition (or absence of third molars). One examiner measured the width and height of the right and left maxillary sinuses using the software Image J 1.47v (National Institutes of Health, Bethesda, USA). Measurements were repeated to calculate intra-observer agreement. Chi-Square test, Kappa, ANOVA and T-Student were used for results analysis for p≤ 0.05. Intra-observer agreement with correlation Kappa ranged between 0.38 and 0.96. For female subjects, the mean height and width of the left maxillary sinus were 28.7856mm and 44.6178mm, respectively. And right maxillary sinus was 27.7163mm for height and 45.1850mm for width. Male subjects were found to have the mean height and width of the left maxillary sinus 30.9981mm and 48.7753mm, respectively. And right maxillary sinus was 30.7403mm for height and 48.5753mm for width. There was a statistically significant difference in the height and width of maxillary sinuses between males and females. It can be concluded that maxillary sinuses height and width on panoramic radiographs can be used to determine the gender of adult human subjects. PMID:27847394

Variations in paranasal sinus anatomy: implications for the pathophysiology of chronic rhinosinusitis and safety of endoscopic sinus surgery.

PubMed

Nouraei, S A R; Elisay, A R; Dimarco, A; Abdi, R; Majidi, H; Madani, S A; Andrews, P J

2009-02-01

To study the radiologic anatomy of the paranasal sinuses in patients with and without chronic rhinosinusitis to assess whether anatomic variations are associated with disease pathology, and to identify those variants that may impact operative safety. Tertiary referral otolaryngology unit. Incidence and nature of anatomic variants with potential impact on operative safety, and the presence or absence of sinus mucosal disease and its correlation with anatomic variants with a potential impact on mucociliary clearance. We reviewed 278 computed tomographic scans from patients with rhinosinusitis symptoms to investigate anatomic variations that may predispose to sinusitis or impact on operative safety. The incidence of variants with potential impact on sinus drainage was compared between patients with and without sinus mucosal disease with logistic regression. A closed osteomeatal complex was identified in 148 patients (53%), followed by concha bullosa in 98 patients (35%). Closed osteomeatal complex and nasal polyposis were independent risk factors for sinus mucosal disease. Anatomic variants with a potential impact on operative safety included anterior clinoid process pneumatization (18%), infraorbital ethmoid cell (12%), sphenomaxillary plate (11%), and supraorbital recess (6%). In 92% of patients, the level difference between the roof of the ethmoid cavity and the cribriform plate was Keros I. Bony anatomic variants do not increase the risk of sinus mucosal disease. However, anatomic variants with a potential impact on operative safety occur frequently and need to be specifically sought as part of preoperative evaluation.

Dens invaginatus with necrotic pulp in a right maxillary lateral incisor with preserved vitality.

PubMed

Alessandro, Lanza; Fabrizio, Di Francesco; Gennaro, De Marco; Dario, Di Stasio; Eugenio, Guidetti; Letizia, Perillo; Luigi, Femiano; Felice, Femiano

2018-01-01

Dens invaginatus (DI) is a dental malformation occurring in several morphologic types. Consequently, treatment of teeth affected by DI can get complicated because of the complex root canal anatomy. The aim is to describe how to manage a rare report of a DI with necrotic pulp held within the vital pulp of a maxillary lateral incisor. Oral fistula was found on the buccal mucosa of the apex of the vital maxillary lateral incisor with a DI having necrotic pulp. Endodontic treatment of the maxillary lateral incisor and of the tract canal of DI was realized. Clinical disappearance of oral sinus tract was observed after 10 days. On the contrary, the disappearance of radiolucent area occurred after 6 months. A proper and prompt diagnosis is necessary to carry out effective prevention protocols or prevent consequences generating nonrecoverable endo-perio diseases.

Sclerotherapy for congenital lesions in the head and neck.

PubMed

Kim, Kwang Hyun; Sung, Myung-Whun; Roh, Jong-Lyel; Han, Moon Hee

2004-09-01

This study retrospectively reviews the results of sclerotherapy using several sclerosants for congenital lesions of the head and neck. Between May 1990 and May 2002, patients with lymphatic malformations were treated by sclerotherapy; 10 with bleomycin, and 25 with OK-432. OK-432 sclerotherapy was also applied in 9 patients with plunging ranula and in 1 patient with branchial anomaly. Percutaneous sclerotherapy with ethanolamine oleate was used in 29 patients with venous malformations, and 28 patients with pyriform sinus fistula were treated by trichloroacetic acid chemocauterization. Overall, two thirds of patients with these lesions showed marked to complete response. One case of mortality occurred in the bleomycin sclerotherapy group. However, no major complications by other sclerosants were found. In lymphatic malformations, history of excision before sclerotherapy was a poor prognostic factor. Sclerotherapy using these sclerosants is a safe and effective primary treatment for congenital lesions in the head and neck.

Investigation of atrial vulnerability by analysis of the sinus node EG from atrial fibrillation models using a phase synchronization method.

PubMed

Chen, Ying; Wu, Zhong; Yang, Cuiwei; Shao, Jun; Wong, Kelvin Kian Loong; Abbott, Derek

2012-09-01

Atrial fibrillation (AF) can result in life-threatening arrhythmia, and a clinically convenient means for detecting vulnerability remains elusive. We investigated atrial vulnerability by analyzing the sinus electrogram (EG) from AF animal models using a phase synchronization method. Using acetylcholine (ACh)-induced acute canine AF models (n= 4), a total of 128 electrical leads were attached to the surface of the anterior and posterior atria, and the pulmonary veins to form an electrocardiological mapping system. ACh was injected at varying concentrations with ladder-type adjustments. Sinus EGs and induced AF EGs that pertain to specific ACh concentrations were recorded.We hypothesize that the atrial vulnerability may be correlated with the Shannon entropy (SE) of the phase difference matrix that is extracted from the sinus EG. Our research suggests that the combination of SE with the synchronization method enables the sinus node EG to be analyzed and used to estimate atrial vulnerability.

Effect of environmental factors on Internet searches related to sinusitis.

PubMed

Willson, Thomas J; Lospinoso, Joshua; Weitzel, Erik K; McMains, Kevin C

2015-11-01

Sinusitis significantly affects the population of the United States, exacting direct cost and lost productivity. Patients are likely to search the Internet for information related to their health before seeking care by a healthcare professional. Utilizing data generated from these searches may serve as an epidemiologic surrogate. A retrospective time series analysis was performed. Google search trend data from the Dallas-Fort Worth metro region for the years 2012 and 2013 were collected from www.google.com/trends for terms related to sinusitis based on literature outlining the most important symptoms for diagnosis. Additional terms were selected based on common English language terms used to describe the disease. Twelve months of data from the same time period and location for common pollutants (nitrogen dioxide, ozone, sulfur dioxide, and particulates), pollen and mold counts, and influenza-like illness were also collected. Statistical analysis was performed using Pearson correlation coefficients, and potential search activity predictors were assessed using autoregressive integrated moving average. Pearson correlation was strongest between the terms congestion and influenza-like illness (r=0.615), and sinus and influenza-like illness (r=0.534) and nitrogen dioxide (r=0.487). Autoregressive integrated moving average analysis revealed ozone, influenza-like illness, and nitrogen dioxide levels to be potential predictors for sinus pressure searches, with estimates of 0.118, 0.349, and 0.438, respectively. Nitrogen dioxide was also a potential predictor for the terms congestion and sinus, with estimates of 0.191 and 0.272, respectively. Google search activity for related terms follow the pattern of seasonal influenza-like illness and nitrogen dioxide. These data highlight the epidemiologic potential of this novel surveillance method. NA. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

The morphology of the coronary sinus in patients with congenitally corrected transposition: implications for cardiac catheterisation and re-synchronisation therapy.

PubMed

Aiello, Vera D; Ferreira, Flávia C N; Scanavacca, Mauricio I; Anderson, Robert H; D'Avila, André

2016-02-01

Patients with congenitally corrected transposition frequently benefit from re-synchronisation therapy or ablation procedures. This is likely to require catheterisation of the coronary sinus. Its anatomy, however, is not always appreciated, despite being well-described. With this caveat in mind, we have evaluated its location and structure in hearts with congenitally corrected transposition in order to reinforce the guidance needed by the cardiac interventionist. We dissected and inspected the coronary sinus, the oblique vein of the left atrium, and the left-sided-circumflex venous channel in eight heart specimens with corrected transposition and eight controls, measuring the orifice and length of the sinus and the atrioventricular valves. In two-thirds of the malformed hearts, the sinus deviated from its anticipated course in the atrioventricular groove, ascending obliquely on the left atrial inferior wall to meet the left oblique vein. The maximal deviation coincided in all hearts with the point where the left oblique vein joined the left-sided-circumflex vein to form the coronary sinus. We describe a circumflex vein, rather than the great cardiac vein, as the latter venous channel is right-sided in the setting of corrected transposition. The length of the sinus correlated positively with the diameter of the tricuspid valve (p=0.02). Compared with controls, the left oblique vein in the malformed hearts joined the circumflex venous channel significantly closer to the mouth of the sinus. The unexpected course of the coronary sinus in corrected transposition and the naming of the cardiac veins have important implications for venous cannulation and interpretation of images.

CT of Anatomic Variants of the Paranasal Sinuses and Nasal Cavity: Poor Correlation With Radiologically Significant Rhinosinusitis but Importance in Surgical Planning.

PubMed

Shpilberg, Katya A; Daniel, Simon C; Doshi, Amish H; Lawson, William; Som, Peter M

2015-06-01

The purpose of this study was to determine the incidence of sinonasal anatomic variants and to assess their relation to sinonasal mucosal disease. A retrospective evaluation of 192 sinus CT examinations of patients with a clinical history of rhinosinusitis was conducted. The CT scans were evaluated for the presence of several anatomic variants of the sinonasal cavities, and the prevalence of each variant was calculated. Prevalences of all sinonasal anatomic variants were compared between patients who had minimal to no apparent imaging evidence of rhinosinusitis and those who had radiologic evidence of clinically significant rhinosinusitis. The most common normal variants were nasal septal deviation, Agger nasi cells, and extension of the sphenoid sinuses into the posterior nasal septum. We found no statistically significant difference in the prevalence of any of the studied anatomic variants between patients with minimal and those with clinically significant paranasal sinus or nasal cavity disease. Analysis of every routine CT scan of the paranasal sinuses obtained for sinusitis or rhinitis for the presence of different anatomic variants is of questionable value unless surgery is planned.

Mucoceles of the sphenoid sinus.

PubMed

Weaver, R G; Gates, G A

1979-01-01

Mucoceles of the sphenoid sinuses are uncommon; 60 cases have been reported in the world literature to date. Signs and symptoms are caused by local expansion of the mucocele and include headache (the most common symptom), ocular field deficits, external ophthalmoplegia (particularly the sixth cranial nerve), and proptosis. Radiologic correlation in the form of plain films and polytomorgraphy is the most reliable guide in the diagnosis of sphenoid sinus disease. Therapy of these lesions is surgical, and drainage can be achieved via the external ethmoid or sublabial transseptal route. Three cases are presented: two had classical findings and the third was conspicuous by the presence of aseptic meningitis in the absence of local findings.

Further analysis of the Glans-Urethral Meatus-Shaft (GMS) hypospadias score: correlation with postoperative complications.

PubMed

Arlen, Angela M; Kirsch, Andrew J; Leong, Traci; Broecker, Bruce H; Smith, Edwin A; Elmore, James M

2015-04-01

The Glans-Urethral Meatus-Shaft (GMS) score is a concise and reproducible way to describe hypospadias severity. We classified boys undergoing primary hypospadias repair to determine the correlation between GMS score and postoperative complications. Between February 2011 and August 2013, patients undergoing primary hypospadias repair were prospectively scored using the GMS classification. GMS scoring included a 1-4 scale for each component: G - glans size/urethral plate quality, M - meatal location, and S - degree of shaft curvature, with more unfavorable characteristics assigned higher scores [Figure]. Demographics, repair type, and complications (urethrocutaneous fistula, meatal stenosis, glans dehiscence, phimosis, recurrent chordee and stricture) were assessed. Total and individual component scores were tested in uni- and multivariate analysis. Two-hundred and sixty-two boys (mean age 12.3 ± 13.7 months) undergoing primary hypospadias repair had a GMS score assigned. Mean GMS score was 7 ± 2.5 (G 2.1 ± 0.9, M 2.4 ± 1, S 2.4 ± 1). Mean clinical follow-up was 17.7 ± 9.3 months. Thirty-seven children (14.1%) had 45 complications. A significant relationship between the total GMS score and presence of any complication (p < 0.001) was observed; for every unit increase in GMS score the odds of any postoperative complication increased 1.44 times (95% CI, 1.24-1.68). Urethrocutaneuous fistula was the most common complication, occurring in 21 of 239 (8.8%) of single-stage repairs. Patients with mild hypospadias (GMS 3-6) had a 2.4% fistula rate vs. 11.1% for moderate (GMS 7-9) and 22.6% for severe (GMS 10-12) hypospadias (p < 0.001). Degree of chordee was an independent predictor of fistula on multivariate analysis; S4 (>60° ventral curvature) patients were 27 times more likely to develop a fistula than S1 (no curvature) boys (95% CI, 3.2-229). The GMS score is based on anatomic features (i.e. glans size/urethral plate quality, location of meatus, and degree of chordee) felt to most likely impact functional and cosmetic outcomes following hypospadias repair. We demonstrated a statistically significant increase in the likelihood of any postoperative complication with every unit increase in total GMS score. The concept that factors aside from meatal location affect hypospadias repair and outcomes is not novel, and degree of ventral curvature and urethral plate quality are often cited as important factors. In our series, boys with greater than 60° of ventral curvature undergoing a single-stage repair were 27 times more likely to develop a fistula than those without chordee on multivariate analysis, making severe curvature an independent predictor of urethrocutaneous fistula formation. That meatal location did not retain significance on multivariate analysis highlights the importance of considering the entire hypospadias complex when determining severity, rather than just evaluating the position of the meatus. Our study has several limitations that warrant consideration. While GMS scores were assigned prospectively, the data was collected retrospectively, subjecting it to flaws inherent with such study design. Furthermore, type of repair is influenced by surgeon preference and subjective assessment of hypospadias characteristics not incorporated in our scoring system (i.e. tissue quality, urethral hypoplasia, penoscrotal transposition). Despite these limitations, our study demonstrates a strong correlation between the GMS classification and surgical complications, furthering supporting its potential as a tool to standardize hypospadias severity and gauge postoperative complications. The Glans-Urethral Meatus-Shaft (GMS) classification provides a means by which hypospadias severity and reporting can be standardized, which may improve inter-study comparison of reconstructive outcomes. There is a strong correlation between complication risk and total GMS score. Degree of chordee (S score) is independently predictive of fistula rate. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Volumetric analysis of chronic maxillary atelectasis.

PubMed

Lin, Giant C; Sedaghat, Ahmad R; Bleier, Benjamin S; Holbrook, Eric H; Busaba, Nicolas Y; Yoon, Michael K; Gray, Stacey T

2015-01-01

The relationship between orbit and maxillary sinus volumes in patients with chronic maxillary atelectasis (CMA), commonly known as silent sinus syndrome if enophthalmos is present, is poorly understood. A retrospective review of 22 patients who underwent endoscopic sinus surgery (ESS) for CMA from 2005 to 2013 was performed. Computed tomography (CT) images were analyzed using OsiriX 5.8.2 software for volumetric analysis of the orbit and maxillary sinus at presentation and after surgical treatment with ESS. Pretreatment mean orbit volumes on the diseased side (DS) and the contralateral side (CS) were 29.22 and 26.50 mL, respectively (p < 0.001); mean sinus volumes on the DS and CS were 8.51 and 17.20 mL, respectively (p < 0.001); and pretreatment mean midorbit heights (MOHs) on the DS and CS were 3.39 cm and 3.07 cm, respectively (p < 0.001). The percent decrease in sinus volume on the DS compared to that on the CS did not correlate significantly with the percent orbit-volume increase. Enophthalmos was present in nine (41%) patients, and diplopia was present in three (14%) patients. The measured degree of increased orbit volume and decreased sinus volume secondary to CMA did not significantly predict the presence of enophthalmos at presentation. Seven patients underwent sinus CT more than 6 months after ESS. In these patients, orbit volume on the DS decreased from 29.67 to 27.52 mL (p = 0.005), and sinus volume on the DS increased from 9.78 to 11.84 mL (p = 0.08). Volumetric analysis is a powerful and novel method for objectively demonstrating the degree of orbit expansion and maxillary sinus contraction seen with CMA. Spontaneous maxillary sinus expansion and a decrease in orbit volume can occur after ESS, but post-ESS volumes do not return to the normal volume of the CS.

[Recurrent urinary tract infection due to enterovesical fistula secondary to colon diverticular disease: a case report].

PubMed

Cavalcanti, Natália Silva; da Silva, Lorena Luryann Cartaxo; da Silva, Leonardo Sales; da Fonseca, Luiz Antonio Cavalcante; Alexandre, Cristianne da Silva

2013-01-01

Enterovesical fistula are pathological connections between the bladder and pelvic intestinal segments. It consists of a rare complication of neoplastic and inflammatory pelvic disorders, in addition to iatrogenic or traumatic injuries, and correlates with both high morbidity and mortality indexes. Male patient, 61 years old, admitted at the hospital clinics featuring abdominal pain and distension, vomiting and fecal retention. Patient's pathological precedents include high blood pressure, diabetes mellitus, vesical dysfunction and recurrent urinary tract infection on the past three years. Magnetic resonance imaging of abdomen and pelvis revealed enterovesical fistula in association with colon diverticular disease of the sigmoid. Management of choice consisted of partial colectomy with bowel lowering and partial cystectomy with surgical double-J stent insertion. Although consisting of a gastrointestinal primary affection, patients with enterovesical fistula usually search for medical help charging urinary tract features. In this particular case, our patient was admitted with gastrointestinal symptoms, reasoned by diagnostic delay, as the patient had already attended at multiple centers with urinary symptoms. Despite being an unusual affection, recurrent urinary tract infection associated with colon diverticular disease must always be considered at differential diagnosis of recurrent urinary tract infection as it concurs with high morbidity and mortality.

Cure and prevention strategy for postoperative gastrointestinal fistula after esophageal and gastric cardiac cancer surgery.

PubMed

Han, Youkui; Zhao, Hui; Xu, HongRui; Liu, Shuzhong; Li, Li; Jiang, Chunyang; Yang, Bingjun

2014-01-01

Gastrointestinal fistula is the most serious complication of esophageal and gastric cardiac cancer surgery. According to occurrence of organ, gastrointestinal fistula can be divided into anastomotic fistula, gastric fistula; According to occurrence site, fistula can be divided into cervical fistula, thoracic fistula; According to time of occurrence, can be divided into early, middle and late fistula. There are special types of fistula including ‘thoracic cavity’-stomach-bronchial fistula, ‘thoracic cavity’-stomach-aortic fistula. Early diagnosis needs familiarity with various types of clinical gastrointestinal fistulas. However, Prevention of gastrointestinal fistula is better than cure, including perioperative nutritional support, respiratory tract management, and acid suppression, positive treatment of complications, antibiotic prophylaxis, and gastrointestinal decompression and eating timing. Prevention can effectively reduce the incidence of postoperative gastrointestinal fistula. Collectively, early diagnosis and treatment, nutritional supports are key to reducing mortality of gastrointestinal fistula.

Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women.

PubMed

El Ayadi, Alison; Nalubwama, Hadija; Barageine, Justus; Neilands, Torsten B; Obore, Susan; Byamugisha, Josaphat; Kakaire, Othman; Mwanje, Haruna; Korn, Abner; Lester, Felicia; Miller, Suellen

2017-09-02

Obstetric fistula is a debilitating and traumatic birth injury affecting 2-3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov's ρ and Pearson's correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs. Themes central to women's experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled 'Mobility and social engagement', 'Meeting family needs', 'Comfort with relationships', and 'General life satisfaction', and goodness of fit statistics supported a higher-order latent variable of 'Reintegration.' Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions. As more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.

Correlations between symptoms, nasal endoscopy, and in-office computed tomography in post-surgical chronic rhinosinusitis patients.

PubMed

Ryan, William R; Ramachandra, Tara; Hwang, Peter H

2011-03-01

To determine correlations between symptoms, nasal endoscopy findings, and computed tomography (CT) scan findings in post-surgical chronic rhinosinusitis (CRS) patients. Cross-sectional. A total of 51 CRS patients who had undergone endoscopic sinus surgery (ESS) completed symptom questionnaires, underwent endoscopy, and received an in-office sinus CT scan during one clinic visit. For metrics, we used the Sinonasal Outcomes Test-20 (SNOT-20) questionnaire, visual analog symptom scale (VAS), Lund-Kennedy endoscopy scoring scale, and Lund-MacKay (LM) CT scoring scale. We determined Pearson correlation coefficients, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) between scores for symptoms, endoscopy, and CT. The SNOT-20 score and most VAS symptoms had poor correlation coefficients with both endoscopy and CT scores (0.03-0.24). Nasal drainage of pus, nasal congestion, and impaired sense of smell had moderate correlation coefficients with endoscopy and CT (0.24-0.42). Endoscopy had a strong correlation coefficient with CT (0.76). Drainage, edema, and polyps had strong correlation coefficients with CT (0.80, 0.69, and 0.49, respectively). Endoscopy had a PPV of 92.5% and NPV of 45.5% for detecting an abnormal sinus CT (LM score ≥1). In post-ESS CRS patients, most symptoms do not correlate well with either endoscopy or CT findings. Endoscopy and CT scores correlate well. Abnormal endoscopy findings have the ability to confidently rule in the presence of CT opacification, thus validating the importance of endoscopy in clinical decision making. However, a normal endoscopy cannot assure a normal CT. Thus, symptoms, endoscopy, and CT are complementary in the evaluation of the post-ESS CRS patient. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc., Rhinological, and Otological Society, Inc.

Endoscopic and computed tomographic evaluation of influence of nasal septal deviation on lateral wall of nose and its relation to sinus diseases.

PubMed

Poorey, V K; Gupta, Neha

2014-09-01

To correlate symptoms of deviated nasal septum (DNS) and chronic rhinosinusitis with the findings of nasal endoscopy and computed tomographic (CT) imaging. To evaluate the influence of degree of septal angle deviation on the severity of lateral nasal wall abnormalities. A prospective study was conducted on 67 patients with clinical evidence of DNS and chronic sinusitis attending ENT OPD between January 2012 and September 2013. All these patients underwent nasal endoscopy and CT scan PNS coronal sections. Direction and degree of DNS was recorded. Range of sinus mucosal thickening on CT scan films was also recorded. Chronic sinusitis is common in the age group between 21 and 40 years (50.74 %) with male preponderance (55.22 %), chief symptoms being nasal obstruction (86.56 %), headache (73.13 %) and nasal discharge (52.23 %). Left sided DNS is more common (64.17 %). Most of the patients have moderate DNS, i.e. 6°-10° (56.7 %), followed by severe (22.4 %) and then mild (20.9 %). DNS results in compensatory structural changes in the turbinates and/or lateral nasal wall which causes ostiomeatal complex (OMC) obstruction resulting in sinusitis. Contralateral concha bullosa and ethmoid bulla prominence was noted. Maxillary sinus is most commonly affected sinus (73.13 %). Patients with increasing septal angles were associated with a higher incidence of maxillary sinus mucosal changes (p < 0.05). Present study reemphasized the concept that septal deviation causes obstruction at OMC which results in an increased incidence and severity of bilateral chronic sinus disease.

Impact of beta thalassemia on maxillary sinuses and sino-nasal passages: A case control study.

PubMed

Ragab, Ahmed; Ragab, Seham Mohammed; Shawki, Mohammed

2015-12-01

Skeletal changes among beta (β) thalassemia children are well documented, but without available data regarding sino-nasal passages alterations. The authors investigated the maxillary sinuses and sino-nasal passages changes in β-thalassemia children and correlated such changes with the amount of transfused red cells and the erythroid marrow activity. Clinical analyses including otorhinolaryngical examination (ORL) were obtained in twenty β-thalassemia children and 20 matched healthy controls. Hemoglobin (Hb), serum ferritin, soluble transferrin receptor (sTfR) levels and bone mineral density of the lumbar spine (BMD ls) were assayed. The two groups were analyzed for the CT image parameters: bone thickness, anterior and posterior choanae diameters, extramedullary hematopoiesis and chronic rhinosinusitis (CRS) RESULTS: Nasal congestion/obstruction was identified in 14 (70%) children. Eight patients (40%) had criteria of chronic rhinosinusitis. In comparison with the normal controls, the increase in the roof, floor, medial, anterior, lateral and posterior maxillary bony walls thickness was significantly higher (1.26, 2.46, 2.6, 2.9, 3.23 and 5.34-folds, respectively). The mean posterior choanae horizontal, vertical diameters and their surface area were significantly reduced in the patients compared to the controls. The mean anterior maxillary wall bone thickness directly correlated with sTfR (P=0.047) while that of the posterior wall correlated inversely with Hb level (P=0.013). The mean vertical posterior choanae diameter had positive correlation with the amount of transfused red cells (P=0.001) and negative correlation with sTfR (P=0.001). The Hounsfield unit of maxillary sinus wall had direct relation with BMDls (P=0.003) CONCLUSIONS: Thalassemia children are at risk of different folds increase of maxillary sinuses walls thicknesses utmost at posterior and lateral walls. Other sino-nasal morbidities include diminished posterior choanal diameter, nasal obstruction and CRS. Certain morbidities had relations to the erythroid marrow activity and the transfusion adequacy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Magnetic Resonance Imaging (MRI) Characterization of Perianal Fistulous Disease in a Rural Based Tertiary Hospital of North India.

PubMed

Chauhan, Narvir Singh; Sood, Dinesh; Shukla, Anurag

2016-01-01

To diagnose and characterize the perianal fistulous disease using Magnetic resonance imaging (MRI) in a hilly and rural area of North India. This prospective hospital based study was conducted for a period of one year from April 2014 to April 2015 in the departments of Radiodiagnosis and Surgery of our institute. A total of 50 consecutive patients presenting with perianal fistulous disease fulfilling the inclusion and exclusion criteria were included in the study and taken up for MRI. The perianal fistulae were classified according to St James University hospital classification and tracks were assessed with regard to anatomical plane, length, ramifications, abscess formation, enteric communication, external cutaneous opening, enhancement and suprasphincteric extension. Surgical correlation was done in 31 patients who opted for surgical treatment. Rest of the 19 patients preferred alternative medicine for treatment or chose to postpone their surgery. The disease was much more prevalent in males in comparison to females with male to female ratio of 24:1. Grade 4 was the most common type of fistula (34%) while Grade 5 was the least common type (4%).MRI showed a high sensitivity of 93.7% and positive predictive value (PPV) of 96.7% when correlated with surgical findings. A substantial number of patients (38%) preferred alternative medicine or non surgical form of treatment. MRI is a very sensitive modality for the evaluation of perianal fistula. In our study group, the disease predominantly affected middle aged men. Ramifications and abscesses were commonly seen, affecting nearly half of the patients and majority of the patients had active fistulous tracks with posteriorly located enteric opening. Overall, transsphincteric fistulae were most common. Significant number of patients avoided surgery or showed preference for non surgical treatment.

Monte Carlo modeling of light propagation in the human head for applications in sinus imaging

PubMed Central

Cerussi, Albert E.; Mishra, Nikhil; You, Joon; Bhandarkar, Naveen; Wong, Brian

2015-01-01

Abstract. Sinus blockages are a common reason for physician visits, affecting one out of seven people in the United States, and often require medical treatment. Diagnosis in the primary care setting is challenging because symptom criteria (via detailed clinical history) plus objective imaging [computed tomography (CT) or endoscopy] are recommended. Unfortunately, neither option is routinely available in primary care. We previously demonstrated that low-cost near-infrared (NIR) transillumination correlates with the bulk findings of sinus opacity measured by CT. We have upgraded the technology, but questions of source optimization, anatomical influence, and detection limits remain. In order to begin addressing these questions, we have modeled NIR light propagation inside a three-dimensional adult human head constructed via CT images using a mesh-based Monte Carlo algorithm (MMCLAB). In this application, the sinus itself, which when healthy is a void region (e.g., nonscattering), is the region of interest. We characterize the changes in detected intensity due to clear (i.e., healthy) versus blocked sinuses and the effect of illumination patterns. We ran simulations for two clinical cases and compared simulations with measurements. The simulations presented herein serve as a proof of concept that this approach could be used to understand contrast mechanisms and limitations of NIR sinus imaging. PMID:25781310

Monte Carlo modeling of light propagation in the human head for applications in sinus imaging

NASA Astrophysics Data System (ADS)

Cerussi, Albert E.; Mishra, Nikhil; You, Joon; Bhandarkar, Naveen; Wong, Brian

2015-03-01

Sinus blockages are a common reason for physician visits, affecting one out of seven people in the United States, and often require medical treatment. Diagnosis in the primary care setting is challenging because symptom criteria (via detailed clinical history) plus objective imaging [computed tomography (CT) or endoscopy] are recommended. Unfortunately, neither option is routinely available in primary care. We previously demonstrated that low-cost near-infrared (NIR) transillumination correlates with the bulk findings of sinus opacity measured by CT. We have upgraded the technology, but questions of source optimization, anatomical influence, and detection limits remain. In order to begin addressing these questions, we have modeled NIR light propagation inside a three-dimensional adult human head constructed via CT images using a mesh-based Monte Carlo algorithm (MMCLAB). In this application, the sinus itself, which when healthy is a void region (e.g., nonscattering), is the region of interest. We characterize the changes in detected intensity due to clear (i.e., healthy) versus blocked sinuses and the effect of illumination patterns. We ran simulations for two clinical cases and compared simulations with measurements. The simulations presented herein serve as a proof of concept that this approach could be used to understand contrast mechanisms and limitations of NIR sinus imaging.

Orbital complications associated with paranasal sinus infections - A 10-year experience in Israel.

PubMed

Segal, Nili; Nissani, Roni; Kordeluk, Sofia; Holcberg, Meni; Hertz, Shay; Kassem, Firas; Mansour, Anwar; Segal, Avichai; Gluck, Ofer; Roth, Yehudah; Honigman, Tal; Ephros, Moshe; Cohen Kerem, Ranan

2016-07-01

Orbital involvement is the most common complication of sinus infections. The epidemiology of the disease is continuously changing in the antibiotic era. Data on patients who were hospitalized due to acute sinusitis and orbital complications were retrospectively collected and analyzed from four medical centers in Israel during the years 2002-2012. 288 patients were included in the study, the average age was 14.4 years, 180 were males, and 220 were children. No significant annual increase in the number of patients was noted. The lowest number of patients was found during the summer 19.4%. A linear direct correlation was found between older age and prolonged hospital stay. Children were presented with a significantly higher Chandler score than adults. No patient had cavernous sinus thrombosis. 101 (35%) patients received antibiotics before hospital admission. Their average hospital stay was similar to those who were not treated prior to admission. 106 patients (39.8%) had fever. A direct correlation was found between older age and the presence of fever. 102 (35.4%) patients had leukocytosis. The difference in white blood cell count between patients younger than two years of age to the other groups was statistically significant. Forty four (15.3%) patients underwent surgical intervention. A direct correlation was found between leukocytosis and older age to surgery. Periorbital cellulitis occurs mainly in children and males and is less frequent in the summer. Children tend to have worse orbital involvement with lower temperatures than adults. Older age and leukocytosis are associated with surgical intervention. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

ONYX versus n-BCA for embolization of cranial dural arteriovenous fistulas.

PubMed

Rabinov, James David; Yoo, Albert J; Ogilvy, Christopher S; Carter, Bob S; Hirsch, Joshua A

2013-07-01

To evaluate the efficacy of n-butyl-2-cyanoacrylate (Trufill n-BCA) versus ethylene vinyl alcohol copolymer (ONYX) for the embolization of cranial dural arteriovenous fistulas (DAVF). Fifty-three consecutive patients with cranial dural AVF were treated with liquid embolic agents from November, 2003 to November, 2008. These 53 patients had 56 lesions treated with arterial embolization. Patients embolized to completion underwent follow-up angiography at 3 months to assess for durable occlusion. Twenty-one lesions were treated with n-BCA. Seven patients treated with n-BCA had initial angiographic occlusion of their DAVF, which were durable at 3 months. Six patients had adjunctive treatment with coils and/or polyvinyl alcohol particles, but none of these were occluded by endovascular treatment alone. Eleven patients underwent post-embolization surgery for closure of their DAVF. There was one death related to intractable status epilepticus at presentation. One patient developed a major stroke from venous sinus thrombosis after embolization. Thirty-five lesions were treated with ONYX in 34 patients. Twenty-nine patients treated with ONYX had initial angiographic occlusion of their DAVF by embolization alone. One patient had recurrence at 3 months and was re-treated out of 27 total follow-ups. Four patients underwent post-embolization surgical obliteration of their lesions. No deaths or major strokes occurred in this cohort. Initial angiographic occlusion (p=0.0004) and durable angiographic occlusion (p=0.0018) rates for embolization of cranial DAVF show a statistically significant higher efficacy with ONYX compared with n-BCA. Patients embolized with ONYX underwent surgery less frequently compared with those treated with n-BCA (p=0.0015).

Gastrointestinal Fistulas in Acute Pancreatitis With Infected Pancreatic or Peripancreatic Necrosis

PubMed Central

Jiang, Wei; Tong, Zhihui; Yang, Dongliang; Ke, Lu; Shen, Xiao; Zhou, Jing; Li, Gang; Li, Weiqin; Li, Jieshou

2016-01-01

Abstract Gastrointestinal (GI) fistula is a well-recognized complication of acute pancreatitis (AP). However, it has been reported in limited literature. This study aimed to evaluate the incidence and outcome of GI fistulas in AP patients complicated with infected pancreatic or peripancreatic necrosis (IPN). Between 2010 and 2013 AP patients with IPN who diagnosed with GI fistula in our center were analyzed in this retrospective study. And we also conducted a comparison between patients with and without GI fistula regarding the baseline characteristics and outcomes. Over 4 years, a total of 928 AP patients were admitted into our center, of whom 119 patients with IPN were diagnosed with GI fistula and they developed 160 GI fistulas in total. Colonic fistula found in 72 patients was the most common form of GI fistula followed with duodenal fistula. All duodenal fistulas were managed by nonsurgical management. Ileostomy or colostomy was performed for 44 (61.1%) of 72 colonic fistulas. Twenty-one (29.2%) colonic fistulas were successfully treated by percutaneous drainage or continuous negative pressure irrigation. Mortality of patients with GI fistula did not differ significantly from those without GI fistula (28.6% vs 21.9%, P = 0.22). However, a significantly higher mortality (34.7%) was observed in those with colonic fistula. GI fistula is a common finding in patients of AP with IPN. Most of these fistulas can be successfully managed with different procedures depending on their sites of origin. Colonic fistula is related with higher mortality than those without GI fistula. PMID:27057908

Diagnosis and treatment of branchial cleft anomalies in UKMMC: a 10-year retrospective study.

PubMed

Zaifullah, Syed; Yunus, Mohd Razif Mohamad; See, Goh Bee

2013-03-01

Branchial cleft anomalies result from abnormal persistence of branchial apparatus, which is located at the lateral part of the neck. These occur due to failure of obliteration of the branchial apparatus during embryonic development. Differential diagnoses of lateral neck mass are salivary gland or neurogenic neoplasms, paragangliomas, adenopathies, cystic hygroma or cystic metastasis from squamous cell carcinoma or thyroid papillary carcinoma. Clinically, a branchial cyst is smooth, round, fluctuant and non-tender, and usually occurs over the upper part of the neck, anterior to the sternocleidomastoid muscle. Sometimes, it may present as infected cyst (or abscess), a sinus or fistula. Surgical excision is the definitive treatment for branchial anomalies. The objective of the work was to study the demographic data, clinical presentation, definite diagnostic workup and treatment of patients diagnosed with branchial anomalies. This is a retrospective study of 26 patients who were diagnosed with branchial anomalies (branchial cyst and fistula), of which only 12 patients had data available between July 1999 and June 2009 at the Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre. Twelve cases of branchial anomalies were seen, in which 10 patients had second branchial cyst anomalies, 1 had third branchial fistula and 1 had bilateral branchial lesion. There were seven females and five males. The age of the patients varied over a wide range (4-44 years), but the majority of the patients were in their second and third decade of life. All branchial anomalies occurred at the classical site; eight patients had left-sided neck lesion. Correct clinical diagnosis was made only in five patients (41.6 %). All patients underwent surgical excision with no reported recurrence. Branchial anomalies are frequently forgotten in the differential diagnosis of lateral neck swelling. Diagnosis is usually delayed, leading to improper treatment. The diagnosis of patients who present with lateral neck cystic swelling with or without episodes of recurrent neck abscess should be considered with a high suspicion for branchial anomalies. FNA cytology is a good investigative tool in reaching toward a diagnosis of branchial lesion, with the concurrent assistance of radiological modalities. Surgical excision is the gold standard treatment of lesions of branchial anomalies.

Surgical Outcomes of Cavernous Sinus Syndrome in Pituitary Adenomas.

PubMed

Fu, Weilun; Duan, Lian; Geng, Sumin

2017-11-01

The type of pituitary adenoma with a manifestation that includes cavernous sinus syndrome is rare. Based on the clinical data of 70 patients, this study investigated the pathogenesis, imaging characteristics, and prognostic factors of pituitary adenoma with cavernous sinus syndrome. We conducted a retrospective analysis of the characteristics of patients with pituitary adenoma with cavernous sinus syndrome who received surgical treatment. The patients were classified into different prognosis groups according to the time required for them to recover from the cavernous sinus syndrome. Univariate analyses were conducted for the correlations between the prognosis and factors. Of the 3598 cases of pituitary adenomas, 70 (1.95%) presented cavernous sinus syndrome. Of the patients, 55.7% recovered within 2 weeks of surgery, 24.3% recovered from 2 weeks to 1 year after surgery, and 20% had not returned to normal after more than 1 year after surgery. Univariate analyses showed that shorter disease duration (P < 0.001), lower Knosp grade (P = 0.045), a transsphenoidal approach (P < 0.001), and associated pituitary apoplexy (P = 0.012) were predictive factors of early postoperative recovery. The prognosis of cavernous sinus syndrome differs depending on the mechanism of the syndrome. There was no significant difference in the prognosis between patients with total pituitary adenoma resection and subtotal resection. Timely surgery within 100 days of symptom occurrence, Knosp grade 0-2, and associated pituitary apoplexy are predictive factors of good prognosis. Copyright © 2017 Elsevier Inc. All rights reserved.

Spectral analysis of sinus arrhythmia - A measure of mental effort

NASA Technical Reports Server (NTRS)

Vicente, Kim J.; Craig Thornton, D.; Moray, Neville

1987-01-01

The validity of the spectral analysis of sinus arrhythmia as a measure of mental effort was investigated using a computer simulation of a hovercraft piloted along a river as the experimental task. Strong correlation was observed between the subjective effort-ratings and the heart-rate variability (HRV) power spectrum between 0.06 and 0.14 Hz. Significant correlations were observed not only between subjects but, more importantly, within subjects as well, indicating that the spectral analysis of HRV is an accurate measure of the amount of effort being invested by a subject. Results also indicate that the intensity of effort invested by subjects cannot be inferred from the objective ratings of task difficulty or from performance.

Computerized tomography-assisted calculation of sinus augmentation volume.

PubMed

Krennmair, Gerald; Krainhöfner, Martin; Maier, Harald; Weinländer, Michael; Piehslinger, Eva

2006-01-01

This study was intended to calculate the augmentation volume for a sinus lift procedure based on cross-sectional computerized tomography (CT) scans for 2 different augmentation heights. Based on area calculations of cross-sectional CT scans, the volume of additional bone needed was calculated for 44 sinus lift procedures. The amount of bone volume needed to raise the sinus floor to heights of both 12 and 17 mm was calculated. To achieve a sinus floor height of 12 mm, it was necessary to increase the height by a mean of 7.2+/-2.1 mm (range, 3.0 to 10.5 mm), depending on the residual ridge height; to achieve a height of 17 mm, a mean of 12.4+/-2.0 mm (range, 8.5 to 15.5 mm) was required (P < .01). The calculated augmentation volume for an augmentation height of 12 mm was 1.7+/-.9 cm3; for an augmentation height of 17 mm, the volume required was 3.6+/-1.5 cm3. Increasing the height of the sinus lift by 5 mm, ie, from 12 mm to 17 mm augmentation height, increased the augmentation volume by 100%. A significant correlation was found between augmentation height and the calculated sinus lift augmentation volume (r = 0. 78, P < .01). Detailed preoperative knowledge of sinus lift augmentation volume is helpful as a predictive value in deciding on a donor site for harvesting autogenous bone and on the ratio of bone to bone substitute to use. Calculation of the augmentation size can help determine the surgical approach and thus perioperative treatment and the costs of the surgery for both patients and clinicians.

Delayed closure of the palatal defect using buccal inversion and palatal rotation flaps after maxillectomy.

PubMed

Jung, Seunggon; Kook, Min-Suk; Park, Hong-Ju; Oh, Hee-Kyun

2013-03-01

Maxillectomy leaves oronasal and oroantral defects that result in functional impairment of mastication, deglutition, and speech. Many treatment options are suggested and tried including the palatal flap as local flap. Although palatal flaps have been used to repair various oral cavity defects, they have certain limitations due to the dimensions. The amount and location of the palatal tissues available are important for palatal repair. Secondary intentional healing after maxillectomy will allow the epithelialization of the defect margin adjacent to remained palate, and there will be more mucosa that is available for closure of the defect. We delayed the closure of the palatal defect, while the patient underwent prosthetic treatment for functional recovery in 5 maxillectomy patients. Delayed closure of palatal defect with local flap was done at 10.8 ± 7.9 months after the maxillectomy. While delayed closure in hemimaxillectomy patients left postoperative fistula, it provided separation of the oral cavity and nasal/sinus cavity and adequate surface for prosthesis in partial maxillectomy patients.

Cardiac veins: collateral venous drainage pathways in chronic hemodialysis patients.

PubMed

Ozmen, Evrim; Algin, Oktay

2016-07-12

Venous anomalies are diagnostic and therapeutic challenges. Subclavian or superior vena cava stenosis can be developed and venous return can be achieved via cardiac veins and coronary sinus in patients with central venous catheter for long-term hemodialysis. These types of abnormalities are not extremely rare especially in patients with a history of central venous catheter placement. Detection of these anomalies and subclavian vein stenosis before the surgical creation of hemodialysis fistulae or tunneled central venous catheter placement may prevent unnecessary interventions in those patients. Multidetector computed tomography (MDCT) technique can give further information when compared with fluoroscopy or digital subtraction angiography in the management of these patients. This case report describes interesting aspects of central vein complications in hemodialysis patients. As a conclusion, there are limited data about thoracic venous return, and further prospective studies with large patient number are required. MDCT with 3D reconstruction is particularly useful for the accurate evaluation of venous patency, variations, and collateral circulation. Also it is an excellent tool for choosing and planning treatment.

77-year-old female with syncope.

PubMed

Abdelsalam, Mahmoud A; Geske, Jeffrey B

2017-02-15

A 77-year-old female was referred for evaluation of an episode of syncope while eating breakfast. There was no history of fall, syncope, prodrome, dyspnoea, chest discomfort or palpitations. Medical history was notable for hyperlipidaemia and treated hypertension. Blood pressure was 140/90 mm Hg, pulse 85  beats per minute (BPM). No murmurs were present on cardiac examination. ECG revealed normal sinus rhythm with left ventricular (LV) hypertrophy (see online supplementary figure S1). Holter monitor demonstrated rare premature ventricular complexes (<1% of beats), without heart block or ventricular tachycardia. Transthoracic echocardiogram is shown in figure 1. Which of the following is the explanation for the flow indicated by the yellow arrow? Aortic stenosisCoronary artery flow, indicative of coronary fistulaHypertrophic cardiomyopathy with apical pouchHypertensive heart diseaseMitral stenosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Effect of Hemoconcentration on Dural Sinus Computed Tomography Density in a Pediatric Population.

PubMed

Yurttutan, Nursel; Kizildag, Betul; Sarica, Mehmet Akif; Baykara, Murat

2016-10-01

Unenhanced brain computed tomography (CT) is inexpensive, easily available, and the first-choice imaging modality for patients presenting with various neurologic symptoms. Venous thrombosis is not rare in childhood, but diagnosis can be difficult. In some cases, only denser vessels can be used to highlight an issue. The aim of this study was to retrospectively evaluate the relationship between X-ray attenuation and hemoconcentration in a pediatric population. This study enrolled 99 pediatric patients who had been referred radiology department for unenhanced brain CT. Images were retrospectively evaluated for measurement of dural sinus densities from four distinct dural sinus locations. Correlation between mean Hounsfield unit (HU) values and hemoglobin/hematocrit (Hb/Htc) levels, as well as age and gender were further analyzed. There was a strong correlation between mean HU and Hb levels (r = 0.411; standard deviation: 0.001) and also between mean HU and Htc levels (r = 0.393; p < 0.001). According to the results of this study, the mean sinus density and H:H (HU:Htc) values were 44.06 HU and 1.19, respectively, in a normal pediatric group. In conclusion, before deciding between a diagnosis of thrombosis and a determination of normal findings during an evaluation of unenhanced CT in a pediatric population, radiologists should consider complete blood count results as well as H:H ratios. Georg Thieme Verlag KG Stuttgart · New York.

Predictors and outcome of surgical repair of obstetric fistula at a regional referral hospital, Mbarara, western Uganda

PubMed Central

2011-01-01

Background Obstetric fistula although virtually eliminated in high income countries, still remains a prevalent and debilitating condition in many parts of the developing world. It occurs in areas where access to care at childbirth is limited, or of poor quality and where few hospitals offer the necessary corrective surgery. Methods This was a prospective observational study where all women who attended Mbarara Regional Referral Hospital in western Uganda with obstetric fistula during the study period were assessed pre-operatively for social demographics, fistula characteristics, classification and outcomes after surgery. Assessment for fistula closure and stress incontinence after surgery was done using a dye test before discharge Results Of the 77 women who were recruited in this study, 60 (77.9%) had successful closure of their fistulae. Unsuccessful fistula closure was significantly associated with large fistula size (Odds Ratio 6 95% Confidential interval 1.46-24.63), circumferential fistulae (Odds ratio 9.33 95% Confidential interval 2.23-39.12) and moderate to severe vaginal scarring (Odds ratio 12.24 95% Confidential interval 1.52-98.30). Vaginal scarring was the only factor independently associated with unsuccessful fistula repair (Odds ratio 10 95% confidential interval 1.12-100.57). Residual stress incontinence after successful fistula closure was associated with type IIb fistulae (Odds ratio 5.56 95% Confidential interval 1.34-23.02), circumferential fistulae (Odds ratio 10.5 95% Confidential interval 1.39-79.13) and previous unsuccessful fistula repair (Odds ratio 4.8 95% Confidential interval 1.27-18.11). Independent predictors for residual stress incontinence after successful fistula closure were urethral involvement (Odds Ratio 4.024 95% Confidential interval 2.77-5.83) and previous unsuccessful fistula repair (Odds ratio 38.69 95% Confidential interval 2.13-703.88). Conclusions This study demonstrated that large fistula size, circumferential fistulae and marked vaginal scarring are predictors for unsuccessful fistula repair while predictors for residual stress incontinence after successful fistula closure were urethral involvement, circumferential fistulae and previous unsuccessful fistula repair. PMID:22151960

Predictors and outcome of surgical repair of obstetric fistula at a regional referral hospital, Mbarara, western Uganda.

PubMed

Kayondo, Musa; Wasswa, Ssalongo; Kabakyenga, Jerome; Mukiibi, Nozmo; Senkungu, Jude; Stenson, Amy; Mukasa, Peter

2011-12-07

Obstetric fistula although virtually eliminated in high income countries, still remains a prevalent and debilitating condition in many parts of the developing world. It occurs in areas where access to care at childbirth is limited, or of poor quality and where few hospitals offer the necessary corrective surgery. This was a prospective observational study where all women who attended Mbarara Regional Referral Hospital in western Uganda with obstetric fistula during the study period were assessed pre-operatively for social demographics, fistula characteristics, classification and outcomes after surgery. Assessment for fistula closure and stress incontinence after surgery was done using a dye test before discharge Of the 77 women who were recruited in this study, 60 (77.9%) had successful closure of their fistulae. Unsuccessful fistula closure was significantly associated with large fistula size (Odds Ratio 6 95% Confidential interval 1.46-24.63), circumferential fistulae (Odds ratio 9.33 95% Confidential interval 2.23-39.12) and moderate to severe vaginal scarring (Odds ratio 12.24 95% Confidential interval 1.52-98.30). Vaginal scarring was the only factor independently associated with unsuccessful fistula repair (Odds ratio 10 95% confidential interval 1.12-100.57). Residual stress incontinence after successful fistula closure was associated with type IIb fistulae (Odds ratio 5.56 95% Confidential interval 1.34-23.02), circumferential fistulae (Odds ratio 10.5 95% Confidential interval 1.39-79.13) and previous unsuccessful fistula repair (Odds ratio 4.8 95% Confidential interval 1.27-18.11). Independent predictors for residual stress incontinence after successful fistula closure were urethral involvement (Odds Ratio 4.024 95% Confidential interval 2.77-5.83) and previous unsuccessful fistula repair (Odds ratio 38.69 95% Confidential interval 2.13-703.88). This study demonstrated that large fistula size, circumferential fistulae and marked vaginal scarring are predictors for unsuccessful fistula repair while predictors for residual stress incontinence after successful fistula closure were urethral involvement, circumferential fistulae and previous unsuccessful fistula repair.

Respiratory viral detection in the paranasal sinuses of patients with cystic fibrosis.

PubMed

Rowan, Nicholas R; Wang, Eric W; Kanaan, Alyssa; Sahu, Nivedita; Williams, John V; Phillips, Caleb D; Lee, Stella E

2017-03-01

Pulmonary colonization with antibiotic-resistant organisms in patients with cystic fibrosis (CF) is often preceded by upper-airway infections. Although there is a well-described relationship between pulmonary respiratory viral infections and overall disease progression of CF, the pathogenicity of respiratory viral infections in the paranasal sinuses of patients with CF remains unknown. With recent advances in respiratory virus detection techniques, this study sought to detect the presence of respiratory viruses in the paranasal sinuses of patients with CF in comparison with healthy controls and to correlate the viral presence with clinical measures of sinonasal disease. This prospective individual cohort study compared 24 patients with CF with 14 healthy controls. Basic demographics, clinical measures of disease and respiratory viral screens (commercial multiplex) obtained directly from the paranasal sinuses were compared between the two groups. Respiratory viruses were detected in 33% of patients with CF (8/24) compared with 0% of the healthy controls (0/14) (p = 0.017). Respiratory viruses were only detected during the winter months, and the most commonly identified were influenza A and human rhinovirus strains. There was no statistical difference in the 22-Item Sino-Nasal Outcome Test (SNOT-22) scores (p = 0.93) or modified Lund-Kennedy scores (p = 0.74) between patients with CF with a positive viral test and those without a positive result. Respiratory viral detection is more commonly detected in the paranasal sinuses of patients with CF compared with healthy controls. Although respiratory viral presence did not correlate with a worse clinical severity of sinonasal disease, these findings may provide insight into the pathophysiology of CF and open new avenues for potential targeted therapy.

Bacterial Biofilms in Chronic Rhinosinusitis and Their Implications for Clinical Management.

PubMed

Karunasagar, Abhilasha; Garag, Santosh S; Appannavar, Suma B; Kulkarni, Raghavendra D; Naik, Ashok S

2018-03-01

To study the microbiological profile in patients with chronic rhino-sinusitis. To correlate disease severity with the presence of biofilms and host risk factors. To assess outcome of Sinus Surgery 2 weeks post operatively in terms of presence of bacteria and their ability to form biofilm. Prospective study. 50 cases of chronic rhino-sinusitis requiring Functional Endoscopic Sinus Surgery admitted in SDM Hospital, Dharwad, Karnataka were studied using intra-operative mucosal samples for microbiological analysis. The organisms isolated were tested for biofilm forming ability using three in vitro tests. Severity of disease was assessed using SNOT 22 scoring system. Of 50 cases studied, 66% showed presence of chronic rhino-sinusitis with polyposis and had higher SNOT scores compared to those without polyps. Bacterial isolates were obtained from only 17 samples. Staphylococcus species was isolated from 16 samples and Klebsiella pneumoniae from one. 11 Staph spp. isolates showed biofilm forming ability in vitro. Postoperative events in 3 cases yielded biofilm-forming Staphylococcus. Staphylococcus was the most dominant organism isolated and 11 isolates were biofilm formers. Thus the detection of biofilm forming organisms can be considered as a negative prognostic indicator and should forewarn the surgeon about the risk of recurrence.

Successful closure of gastrocutaneous fistulas using the Surgisis® anal fistula plug

PubMed Central

Kasem, H

2014-01-01

Introduction Gastrocutaneous fistulas remain an uncommon complication of upper gastrointestinal surgery. Less common but equally problematic are gastrocutaneous fistulas secondary to non-healing gastrostomies. Both are associated with considerable morbidity and mortality. Surgical repair remains the gold standard of care. For those unfit for surgical intervention, results from conservative management can be disappointing. We describe a case series of seven patients with gastrocutaneous fistulas who were unfit for surgical intervention. These patients were managed successfully in a minimally invasive manner using the Surgisis® (Cook Surgical, Bloomington, IN, US) anal fistula plug. Methods Between September 2008 and January 2009, seven patients with gastrocutaneous fistulas presented to Wishaw General Hospital. Four gastrocutaneous fistulas represented non-healing gastrostomies, two followed an anastomotic leak after an oesophagectomy and one following an anastomotic leak after a distal gastrectomy. All patients had poor nutritional reserve with no other identifiable reason for failure to heal. All were deemed unfit for surgical intervention. Five gastrocutaneous fistulas were closed successfully using the Surgisis® anal fistula plug positioned directly into the fistula tract under local anaesthesia and two gastrocutaneous fistulas were closed successfully using the Surgisis® anal fistula positioned endoscopically using a rendezvous technique. Results For the five patients with gastrocutaneous fistulas closed directly under local anaesthesia, oral alimentation was reinstated immediately. Fistula output ceased on day 12 with complete epithelialisation occurring at a median of day 26. For the two gastrocutaneous fistulas closed endoscopically using the rendezvous technique, oral alimentation was reinstated on day 5 with immediate cessation of fistula output. Follow-up upper gastrointestinal endoscopy confirmed re-epithelialisation at eight weeks. In none of the cases has there been fistula recurrence (range of follow-up duration: 30–59 months). Conclusions Surgisis® anal fistula plugs can be used safely and effectively to close gastrocutaneous fistulas in a minimally invasive manner in patients unfit for surgical intervention. PMID:24780017

Successful closure of gastrocutaneous fistulas using the Surgisis(®) anal fistula plug.

PubMed

Darrien, J H; Kasem, H

2014-05-01

Gastrocutaneous fistulas remain an uncommon complication of upper gastrointestinal surgery. Less common but equally problematic are gastrocutaneous fistulas secondary to non-healing gastrostomies. Both are associated with considerable morbidity and mortality. Surgical repair remains the gold standard of care. For those unfit for surgical intervention, results from conservative management can be disappointing. We describe a case series of seven patients with gastrocutaneous fistulas who were unfit for surgical intervention. These patients were managed successfully in a minimally invasive manner using the Surgisis(®) (Cook Surgical, Bloomington, IN, US) anal fistula plug. Between September 2008 and January 2009, seven patients with gastrocutaneous fistulas presented to Wishaw General Hospital. Four gastrocutaneous fistulas represented non-healing gastrostomies, two followed an anastomotic leak after an oesophagectomy and one following an anastomotic leak after a distal gastrectomy. All patients had poor nutritional reserve with no other identifiable reason for failure to heal. All were deemed unfit for surgical intervention. Five gastrocutaneous fistulas were closed successfully using the Surgisis(®) anal fistula plug positioned directly into the fistula tract under local anaesthesia and two gastrocutaneous fistulas were closed successfully using the Surgisis(®) anal fistula positioned endoscopically using a rendezvous technique. For the five patients with gastrocutaneous fistulas closed directly under local anaesthesia, oral alimentation was reinstated immediately. Fistula output ceased on day 12 with complete epithelialisation occurring at a median of day 26. For the two gastrocutaneous fistulas closed endoscopically using the rendezvous technique, oral alimentation was reinstated on day 5 with immediate cessation of fistula output. Follow-up upper gastrointestinal endoscopy confirmed re-epithelialisation at eight weeks. In none of the cases has there been fistula recurrence (range of follow-up duration: 30-59 months). Surgisis(®) anal fistula plugs can be used safely and effectively to close gastrocutaneous fistulas in a minimally invasive manner in patients unfit for surgical intervention.

Diagnostic Delay in Romanian Patients with Inflammatory Bowel Disease: Risk Factors and Impact on the Disease Course and Need for Surgery

PubMed Central

Zaharie, Roxana; Zaharie, Florin; Tantau, Marcel; Gheorghe, Liana; Gheorghe, Cristian; Gologan, Serban; Cijevschi, Cristina; Trifan, Anca; Dobru, Daniela; Goldis, Adrian; Constantinescu, Gabriel; Iacob, Razvan; Diculescu, Mircea

2016-01-01

Background: The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, particularly with regard to diagnostic delay. Here we investigated the factors leading to delayed diagnosis and the effect of the delay on several disease progression and outcome measures. Methods: A total of 1196 IBD cases [682 ulcerative colitis [UC], 478 Crohn’s disease [CD], 36 indeterminate colitis] from the Romanian national registry IBDPROSPECT were reviewed. Standard clinical and demographic factors were evaluated as predictors of a long diagnostic delay in both CD and UC. Diagnostic delay was subsequently evaluated as a potential risk factor for bowel stenoses, bowel fistulas, perianal fistulas, perianal surgery, and intestinal surgery in CD patients. Results: The median diagnostic delay was significantly longer in CD [5 months] than in UC [1 month] patients [p < 0.001]. Compared with 5 months for UC patients, 75% of CD patients were diagnosed within 18 months of symptom onset. In CD patients, extra-ileal location was a protective factor (odds ratio [OR], 0.5; p = 0.03), whereas being an active smoker [OR, 2.09; p = 0.01] and symptom onset during summer [OR, 3.35; p < 0.001] were independent risk factors for a long diagnostic delay [> 18 months]. In UC patients, an age > 40 years was a protective factor [OR, 0.68; p = 0.04] for a long delay. Regarding outcomes, a long diagnostic delay in CD patients positively correlated with bowel stenoses [OR, 3.38; p < 0.01] and any IBD-related surgery [OR, 1.95; p = 0.03] and had a positive trend for intestinal fistulas [OR, 2.64; p = 0.08] and perianal fistulas [OR, 2.9; p = 0.07]. Disease duration since diagnosis positively correlated with bowel stenoses [OR, 1.04; p = 0.04], any IBD-related surgery [OR, 1.04; p = 0.02], and intestinal surgery [OR, 1.07; p < 0.01]. Conclusions: A long diagnostic delay in IBD correlates with an increased frequency of bowel stenoses and need for IBD-related surgery. PMID:26589956

Surgical intervention of pilonidal sinus: impact on patients' postoperative satisfaction and return to work time.

PubMed

Gaiser, Maria Rita; Lee, Sophia Boyoung; Enk, Alexander; Schrott, Peter; Weisser, Heiko

2013-01-01

Pilonidal sinus (PS) is a chronic inflammatory process accompanied by psychological strain and a high rate of work incapacity. To analyze the impact of PS surgery on individual patients' satisfaction (SAT) and economic impacts on work capability. We retrospectively analyzed 40 PS patients regarding SAT and return to work time (RTW) in relation to various factors, using multivariate analysis and Pearson's correlation test. We found a significant negative correlation between SAT and RTW (p<0.01), both correlated equally strongly with duration between first diagnosis and surgery (p<0.01) and with loss of weight (p<0.05). RTW correlated with duration of painkiller intake (p<0.01). SAT correlated with gender (p<0.01), smoking cessation (p<0.05) and quantity of painkiller intake (p<0.01). Satisfaction correlated with gender (p<0.01), smoking cessation (p<0.05), and quantity of painkiller intake (p<0.05). RTW after PS surgery is influenced by factors that can be influenced prior to surgery, leading to better economic results for patients and employers as well as society.

Evaluating the sinus and Nasal Quality of Life Survey in the pediatric cystic fibrosis patient population.

PubMed

Xie, Deborah X; Wu, Jeffanie; Kelly, Katherine; Brown, Rebekah F; Shannon, Chevis; Virgin, Frank W

2017-11-01

The Sinus and Nasal Quality of Life Survey (SN-5) is a validated quality of life (QOL) questionnaire for chronic rhinosinusitis in patients age 2-12. Its utility in the cystic fibrosis (CF) has been studied, but not yet validated. The purpose of this study is to determine the effectiveness of the SN-5 for evaluation of sinonasal symptoms in the pediatric CF population. This retrospective study analyzed SN-5 surveys completed between 2012 and 2015 by pediatric CF patients and caregivers. Baseline and follow-up overall QOL scores and specific symptom scores were obtained from surveys completed in the three-year span. Non-parametric statistics were conducted to identify differences in survey data. A total of 165 patients completed baseline and follow-up surveys. The overall QOL of the patient cohort did not change over the duration of the study (p = 0.660). Thirty-seven patients indicated higher overall QOL, with all five symptom scores showing significant improvement. Analysis by age group showed that QOL was significantly correlated with all five symptoms for children ages 0-4. In patients 5-12 years, overall QOL was only correlated with sinus infection (r = -0.3090, p = 0.01). QOL was significantly correlated with sinus infection (r = -0.2903, p = 0.04) and allergy symptoms (r = -0.5644, p < 0.01) in patients >12 years of age. There remains a need for a validated CRS QOL tool for children with CF. Though the SN-5 has previously been described as a potential instrument, our data suggest that it may be more valuable in children ages 0-4. Copyright © 2017 Elsevier B.V. All rights reserved.

Patterns of Failure After Combined-Modality Approaches Incorporating Radiotherapy for Sinonasal Undifferentiated Carcinoma of the Head and Neck

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Allen M.; Daly, Megan E.; El-Sayed, Ivan

2008-02-01

Purpose: To report the clinical outcome of patients treated with combined-modality approaches for sinonasal undifferentiated carcinoma (SNUC) of the head and neck. Methods and Materials: The records of 21 patients with SNUC treated with curative intent at University of California, San Francisco between 1990 and 2004 were analyzed. Patient age ranged from 33 to 71 years (median, 47 years). Primary tumor sites included the nasal cavity (11 patients), maxillary sinus (5 patients), and ethmoid sinus (5 patients). All patients had T3 (4 patients) or T4 (17 patients) tumors. Local-regional treatment included surgery followed by postoperative radiotherapy (PORT) with or withoutmore » adjuvant chemotherapy for 17 patients; neoadjuvant chemoradiotherapy followed by surgery for 2 patients; and definitive chemoradiotherapy for 2 patients. Median follow-up among surviving patients was 58 months (range, 12-70 months). Results: The 2- and 5-year estimates of local control were 60% and 56%, respectively. There was no difference in local control according to initial treatment approach, but among the 19 patients who underwent surgery the 5-year local control rate was 74% for those with gross tumor resection, compared with 24% for those with subtotal tumor resection (p = 0.001). The 5-year rates of overall and distant metastasis-free survival were 43% and 64%, respectively. Late complications included cataracts (2 patients), lacrimal stenosis (1 patient), and sino-cutaneous fistula (1 patient). Conclusion: The suboptimal outcomes suggest a need for more effective therapies. Gross total resection should be the goal of all treatments whenever possible.« less

Sexual violence-related fistulas in the Democratic Republic of Congo.

PubMed

Onsrud, Mathias; Sjøveian, Solbjørg; Luhiriri, Roger; Mukwege, Dennis

2008-12-01

To determine the magnitude of traumatic gynecologic fistulas caused by sexual violence in the Democratic Republic of Congo. A retrospective analysis of hospital records from 604 consecutive patients who received treatment for gynecologic fistulas at Panzi Hospital between November 2005 and November 2007. Of the 604 patients, 24 (4%) reported that their fistulas had been caused by sexual violence; of these, 5 (0.8%) had developed fistulas as a direct result of forced penetration with foreign objects and/or gang rapes. Of the remaining patients, 6 had a fistula before they were raped, 9 developed iatrogenic fistulas following inappropriate instrumentation to manage rape-induced spontaneous abortion or stillbirth, or after abdominal hysterectomy, and 4 developed fistulas after prolonged and obstructed labor. Traumatic fistulas are rare compared to obstetric fistulas. Fistulas indirectly related to sexual violence are likely to be more common than those directly related. All fistulas resulting from sexual violence, whether direct or indirect, should be considered traumatic and special care should be given to these women.

Glucose pump test can be used to measure blood flow rate of native arteriovenous fistula in chronic hemodialysis.

PubMed

Yavuz, Y C; Selcuk, N Y; Altıntepe, L; Güney, I; Yavuz, S

2018-01-01

In chronic hemodialysis patients, the low flow of vascular access may leads to inadequate dialysis, increased rate of hospitalization, morbidity, and mortality. It was found that surveillance should be performed for native arteriovenous (AV) should not be performed for AV graft in various studies. However, surveillance was done in graft AV fistulas in most studies. Doppler ultrasonography (US) was suggested for surveillance of AV fistulas by the last vascular access guideline of National Kidney Foundation Disease Outcomes Quality Initiative (NKF KDOQI). The aim of study is to determine whether glucose pump test (GPT) is used for surveillance of native AV fistulas by using Doppler US as reference. In 93 chronic hemodialysis patients with native AV fistula, blood flow rates were measured by Doppler US and GPT. For GPT, glucose was infused to 16 mL/min by pump and was measured at basal before the infusion and 11 s after the start of the infusion by glucometer. Doppler US was done by an expert radiologist. Used statistical tests were Mann-Whitney U test, Friedman test, regression analysis, and multiple regression analysis. Median values of blood flow rates measured by GPT (707 mL/min) and by Doppler US (700 mL/min) were not different (Z = 0.414, P = 0.678). Results of GPT and Doppler US measurements were positive correlate by regression analysis. The mean GPT value of diabetic patients (n = 39; 908 mL/min) was similar to that of nondiabetic patients (n = 54; 751 mL/min; Z = 1.31, P = 0.188). GPT values measured at three different dialysis session did not differ from each other that by Friedman test (F = 0.92, P = 0.39). This showed that GPT was stable and reliable. Glucose pump test can be used to measure blood flow rate of native AV fistula. GPT is an accurate and reliable test.

Assessment and classification of fistula-in-ano in patients with Crohn's disease by hydrogen peroxide enhanced transanal ultrasound.

PubMed

Sloots, C E; Felt-Bersma, R J; Poen, A C; Cuesta, M A; Meuwissen, S G

2001-09-01

Crohn's disease is well known for its perianal complications, among which fistulas-in-ano are the most common abnormalities. Fistulas-in-ano in Crohn's disease tend to be complex and have a high recurrence rate. Therefore the role of surgery is generally more conservative. Hydrogen peroxide enhanced transanal ultrasound has proven superior to physical examination, fistulography, computed tomography, and conventional ultrasound in demonstrating the fistula tract. This study examined the fistula tracks in patients with Crohn's disease. Forty-one patients with Crohn's disease and fistula-in-ano were investigated using physical examination, sondage of the fistula, proctoscopy and transanal ultrasound. Hydrogen peroxide was infused via a small catheter into the fistula. The main track and the ramification of the fistula were classified according to the anatomical Parks' classification. Only 9 (22%) patients had a single inter- or transsphincteric fistula. In 5 (12%) patients a single supra- or extrasphincteric fistula (high fistula) was found, in 14 (34%) more than one fistula track (ramified), and in 13 (32%) an anovaginal fistula. Thus 78% of patients had a surgically difficult to treat fistula. In the ramified fistula the main track follows the Parks' classification, but ramifications can have a bizarre pattern which is not in agreement with this classification. Optimal documentation by means of hydrogen peroxide enhanced transanal ultrasound is therefore mandatory before surgery or before other therapies such as anti-tumor necrosis factor treatment.

Monte Carlo modeling of light propagation in the human head for applications in sinus imaging

NASA Astrophysics Data System (ADS)

Cerussi, Albert E.; Mishra, Nikhil; You, Joon; Bhandarkar, Naveen; Wong, Brian J. F.

2015-02-01

Sinus blockages are a common reason for physician visits, affecting 1 out of 7 in the United States. Over 20 million cases of acute bacterial sinusitis become chronic and require medical treatment. Diagnosis in the primary care setting is challenging because symptom criteria (via detailed clinical history) plus objective imaging (CT or endoscopy) is recommended. Unfortunately, neither option is routinely available in primary care. Our previous work demonstrated that low-cost near infrared (NIR) transillumination instruments produced signals that correlated with the bulk findings of sinus opacity measured by CT. We have upgraded the technology, but questions remain such as finding the optimal arrangement of light sources, measuring the influence of specific anatomical structures, and determining detection limits. In order to begin addressing these questions, we have modeled NIR light propagation inside the adult human head using a mesh-based Monte Carlo algorithm (MMCLab) applied to a detailed anatomical head model constructed from CT images. In this application the sinus itself, which under healthy conditions is a void region (e.g., non-scattering), is the region of interest instead of an obstacle to other contrast mechanisms. We report preliminary simulations that characterize the changes in detected intensity due to clear (i.e., healthy) versus blocked sinuses. We also ran simulations for two of our clinical cases and compared results with the measurements. The simulations presented herein serve as a proof of concept that this approach could be used to understand contrast mechanisms and limitations of NIR imaging of the sinus cavities.

Enterohepatic fistula in a Crohn's disease patient: A case report.

PubMed

Van Backer, Justin T; Lee, Edward C

2017-01-01

Fistulous tracts are a hallmark of Crohn's Disease. However, solid organ to intestinal fistulas are rare with previously few case reports of colosplenic fistulas and one case report of an enterohepatic fistula. We review the available literature and present the first case report of an enterohepatic fistula in a female with Crohn's Disease to be treated operatively. The patient did well postoperatively with complete resolution of her fistula. Crohn's Disease is an inflammatory bowel disease that can present with fistulas. However, a fistula between the liver and bowel is exceedingly rare with only one previous case report. This is the first report of an enteroheptic fistula that has been managed successfully with an operation. Not all enteroenteric fistulas are apparent preoperatively. When discovered, laparoscopic enterohepatic fistula takedown is feasible for this rare disease process manifestation. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

An Annotated Bibliography of the Literature Dealing with the Physiological Correlates of Cognitive Performance

DTIC Science & Technology

1978-06-01

responses (AER) with a photo-optico-electronic method. Habituation was obtained by binaural stimulation with monotonously repeated clicki of a constant...Bonsper, D. E. The effect of increased information processing on sinus arrhythmia and heart beat Monti-y,7UalTfrniaITNaval Postgraduate School...September 1970. (NTIS No. ’’A’’A f śS4) This experiment investigated the eflt of increased information processing on heart beat and sinus arrhythmia. A

Intermediate-term patency of upper arm arteriovenous fistulae for hemodialysis access in children.

PubMed

Haricharan, Ramanath N; Aprahamian, Charles J; Morgan, Traci L; Harmon, Carroll M; Barnhart, Douglas C

2008-01-01

The goal of this study was to estimate the 2-year cumulative thrombosis-free survival of basilic vein transposition (BVT) and brachiocephalic fistulae in children. All children who underwent BVT or brachiocephalic fistula construction at a tertiary care children's hospital from June 2001 to July 2006 were reviewed. Kaplan-Meier analysis, log-rank test, and proportional hazards regression were done. Sixteen children (7 girls) with inadequate forearm veins underwent creation of 18 fistulae (12 BVT, 6 brachiocephalic). Median age was 14 (9-19) years. Mean (+/-SE) operative times for BVT and brachiocephalic fistulae were 3.4 (+/- 0.6) hours and 1.9 (+/-0.4) hours, respectively. The overall 2-year cumulative survival rate was 74% (BVT, 66%; brachiocephalic fistula, 83%). Four fistulae failed (1 brachiocephalic, 3 BVT) and 14 fistulae were censored (5, patent fistula; 4, renal transplantation; 2, unrelated death; 1, elective conversion to peritoneal dialysis; 1, surgical ligation of fistula; 1, lost to follow-up). Of 18 fistulae, 6 underwent additional interventions (4, percutaneous angioplasty; 2, surgical thrombectomy). There were no significant differences in survival times based on fistula type, prior transplant status, age, or operative time. Brachiocephalic and BVT fistulae create reliable hemodialysis access for children who have inadequate forearm veins to allow construction of more distal fistulae.

Cleft Palate Fistula Closure Utilizing Acellular Dermal Matrix.

PubMed

Emodi, Omri; Ginini, Jiriys George; van Aalst, John A; Shilo, Dekel; Naddaf, Raja; Aizenbud, Dror; Rachmiel, Adi

2018-03-01

Fistulas represent failure of cleft palate repair. Secondary and tertiary fistula repair is challenging, with high recurrence rates. In the present retrospective study, we review the efficacy of using acellular dermal matrix as an interposition layer for cleft palate fistula closure in 20 consecutive patients between 2013 and 2016. Complete fistula closure was obtained in 16 patients; 1 patient had asymptomatic recurrent fistula; 2 patients had partial closure with reduction of fistula size and minimal nasal regurgitation; 1 patient developed a recurrent fistula without changes in symptoms (success rate of 85%). We conclude that utilizing acellular dermal matrix for cleft palate fistula repair is safe and simple with a high success rate.

Cleft Palate Fistula Closure Utilizing Acellular Dermal Matrix

PubMed Central

Emodi, Omri; van Aalst, John A.; Shilo, Dekel; Naddaf, Raja; Aizenbud, Dror; Rachmiel, Adi

2018-01-01

Summary: Fistulas represent failure of cleft palate repair. Secondary and tertiary fistula repair is challenging, with high recurrence rates. In the present retrospective study, we review the efficacy of using acellular dermal matrix as an interposition layer for cleft palate fistula closure in 20 consecutive patients between 2013 and 2016. Complete fistula closure was obtained in 16 patients; 1 patient had asymptomatic recurrent fistula; 2 patients had partial closure with reduction of fistula size and minimal nasal regurgitation; 1 patient developed a recurrent fistula without changes in symptoms (success rate of 85%). We conclude that utilizing acellular dermal matrix for cleft palate fistula repair is safe and simple with a high success rate. PMID:29707449

The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After.

PubMed

Bassi, Claudio; Marchegiani, Giovanni; Dervenis, Christos; Sarr, Micheal; Abu Hilal, Mohammad; Adham, Mustapha; Allen, Peter; Andersson, Roland; Asbun, Horacio J; Besselink, Marc G; Conlon, Kevin; Del Chiaro, Marco; Falconi, Massimo; Fernandez-Cruz, Laureano; Fernandez-Del Castillo, Carlos; Fingerhut, Abe; Friess, Helmut; Gouma, Dirk J; Hackert, Thilo; Izbicki, Jakob; Lillemoe, Keith D; Neoptolemos, John P; Olah, Attila; Schulick, Richard; Shrikhande, Shailesh V; Takada, Tadahiro; Takaori, Kyoichi; Traverso, William; Vollmer, Charles R; Wolfgang, Christopher L; Yeo, Charles J; Salvia, Roberto; Buchler, Marcus

2017-03-01

In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of the present report is to verify the value of the International Study Group of Pancreatic Fistula definition and grading of postoperative pancreatic fistula and to update the International Study Group of Pancreatic Fistula classification in light of recent evidence that has emerged, as well as to address the lingering controversies about the original definition and grading of postoperative pancreatic fistula. The International Study Group of Pancreatic Fistula reconvened as the International Study Group in Pancreatic Surgery in order to perform a review of the recent literature and consequently to update and revise the grading system of postoperative pancreatic fistula. Based on the literature since 2005 investigating the validity and clinical use of the original International Study Group of Pancreatic Fistula classification, a clinically relevant postoperative pancreatic fistula is now redefined as a drain output of any measurable volume of fluid with an amylase level >3 times the upper limit of institutional normal serum amylase activity, associated with a clinically relevant development/condition related directly to the postoperative pancreatic fistula. Consequently, the former "grade A postoperative pancreatic fistula" is now redefined and called a "biochemical leak," because it has no clinical importance and is no longer referred to a true pancreatic fistula. Postoperative pancreatic fistula grades B and C are confirmed but defined more strictly. In particular, grade B requires a change in the postoperative management; drains are either left in place >3 weeks or repositioned through endoscopic or percutaneous procedures. Grade C postoperative pancreatic fistula refers to those postoperative pancreatic fistula that require reoperation or lead to single or multiple organ failure and/or mortality attributable to the pancreatic fistula. This new definition and grading system of postoperative pancreatic fistula should lead to a more universally consistent evaluation of operative outcomes after pancreatic operation and will allow for a better comparison of techniques used to mitigate the rate and clinical impact of a pancreatic fistula. Use of this updated classification will also allow for more precise comparisons of surgical quality between surgeons and units who perform pancreatic surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical role of a modified seton technique for the treatment of trans-sphincteric and supra-sphincteric anal fistulas.

PubMed

Tokunaga, Yukihiko; Sasaki, Hirokazu; Saito, Tohru

2013-03-01

We have devised a modified seton technique that resects the external fistula tract while preserving the anal sphincter muscle. This study assessed the technique when used for the management of complex anal fistulas. Between January 2006 and December 2007, 239 patients (208 males and 31 females, median age: 41 years) underwent surgery for complex anal fistulas using the technique. Of the 239 patients, 198 patients had trans-sphincteric fistula and 41 patients had supra-sphincteric fistula. The durations of the surgeries were 17 min (47, 13) [median (range, interquartile range)] for trans-sphincteric fistulas and 38 (44, 16) for supra-sphincteric fistulas. The durations of the surgeries were significantly (P < 0.05) longer for supra-sphincteric fistula than trans-sphincteric fistula. The hospital stays were 4 (13, 2) days and 5 (14, 3) days, respectively, for trans- and supra-sphincteric fistulas. The durations of seton placement until the spontaneous dropping of the seton were 42 (121, 48) and 141 (171, 55) days respectively. The recurrence rate was 0 % in patients with trans-sphincteric fistulas and 4.9 % (2 of 41) in patients with supra-sphincteric fistulas (P < 0.01). Serious incontinence was not observed. The technique provided favorable results for the treatment of complex anal fistulas and could be safely applied while preserving the sphincter function and conserving fecal continence.

Missile war injuries of the face.

PubMed

Kummoona, Raja K

2011-11-01

In a society struggling to rebuild its country after 3 decades of years of dictatorships and wars, Iraqi maxillofacial and craniofacial surgeons play a critical role in treatment of many most serious terrorist missile injuries of the face by ongoing conflict in Iraq. This study reflects our surgical techniques of treating explosive missile injuries and other combat- and terrorism-related injuries and also evaluates the immediate and secondary phase managements of patients with missile injuries. This study includes 235 patients with missile war injuries of the face during a period of 4 years; all injured patients were treated in the Maxillofacial Unit of Surgical Specialties Hospital, Medical City, Baghdad. There were 195 men and 40 women; their ages ranged from 1 to 70 years (mean, 39.5 years). Posttraumatic missile facial deformities were classified as follows: 95 patients (40.43%) had bone loss; 72 patients (30.64%) had soft tissue loss; 33 patients (14.05%) had orbital injuries; and 35 patients (14.90%) had other deformities of scar contracture, fistula, and sinus formation. Two techniques were used for reconstruction of the bony defect, either by bone chips carried by osteomesh tray harvested from the iliac crest or by free block of corticocancellous bone graft from the iliac crest. Soft tissue reconstruction was done by local flaps and regional flaps such as lateral cervical and cervicofacial flaps, and the orbit was reconstructed by bone graft, lyophilized dura, and sialastic implant. Scar contracture was treated by scar revision and sinus tract excised at the same time of scar revision. In conclusion, the primary phase required an urgent airway management, controlling an active bleeding by surgical intervention; most entrance and exit wounds as well as retained missiles were located in the cheek, chin, and mandibular body, with few cases of mortality due to complications related to head injuries. The secondary phase management of deformities of the face as a complication of missile injuries was classified as bone loss, soft tissue loss, combined bone and soft tissue loss, and others (sinus tracts and poor scars).

Management of surgical and radiation induced rectourethral fistulas with an interposition muscle flap and selective buccal mucosal onlay graft.

PubMed

Vanni, Alex J; Buckley, Jill C; Zinman, Leonard N

2010-12-01

Rectourethral fistulas are a rare but devastating complication of pelvic surgery and radiation. We review, analyze and describe the management and outcomes of nonradiated and radiation/ablation induced rectourethral fistulas during a consecutive 12-year period. We performed a retrospective review of patients undergoing rectourethral fistula repair between January 1, 1998 and December 31, 2009. Patient demographics as well as preoperative, operative and postoperative data were obtained. All rectourethral fistulas were repaired using an anterior transperineal approach with a muscle interposition flap and selective use of a buccal mucosal graft urethral patch onlay. A total of 74 patients with rectourethral fistulas underwent repair with an anterior perineal approach and muscle interposition flap (68 gracilis muscle interposition flaps, 6 other muscle interposition flaps). We compared 35 nonradiated and 39 radiated/ablation induced rectourethral fistulas. Concurrent urethral strictures were present in 11% of nonradiated and 28% of radiated/ablation rectourethral fistulas. At a mean followup of 20 months 100% of nonradiated rectourethral fistulas were closed with 1 procedure while 84% of radiated/ablation rectourethral fistulas were closed in a single stage. Of the patients with nonradiated rectourethral fistulas 97% had the bowel undiverted. Of those undiverted cases 100% were without bowel complication. Of the patients with radiated/ablation rectourethral fistulas 31% required permanent fecal diversion. Successful rectourethral fistula closure can be achieved for nonradiated (100%) and radiation/ablation (84%) rectourethral fistulas using a standard anterior perineal approach with an interposition muscle flap and selective use of buccal mucosal graft, providing a standard for rectourethral fistula repair. Even the most complex radiation/ablation rectourethral fistula can be repaired avoiding permanent urinary and fecal diversion. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Acute bithalamic infarct manifesting as sleep-like coma: A diagnostic challenge.

PubMed

Honig, Asaf; Eliahou, Ruth; Eichel, Roni; Shemesh, Ari Aharon; Ben-Hur, Tamir; Auriel, Eitan

2016-12-01

Bilateral thalamic infarction (BTI) typically presents as a sleep-like coma (SLC) without localizing signs, posing a diagnostic challenge that may lead the treating physician to search for toxic or metabolic causes and delay treatment. We review our experience with BTI of different etiologies, and emphasize the critical role of timely imaging, diagnosis, and management in a series of 12 patients with a presentation of SLC and acute BTI who were managed in our Medical Centers from 2006-2015. In 11/12, urgent head CT scans showed normal brain tissue, while diffusion-weighted (DWI) MRI revealed symmetric bilateral thalamic hyperintense lesions with variable degrees of brainstem involvement. In 1/12, CT scans revealed a contralateral subacute stroke from a thalamic infarct 1month earlier with a unilateral hyperintense lesion on DWI-MRI. From clinical and imaging findings (DWI-MRI, CT angiography and venography), etiology was attributed to embolic causes (cardio-embolism, artery-to-artery mechanism), small vessel disease, or deep sinus vein thrombosis secondary to dural arteriovenous (AV) fistula. Three patients had good outcomes after prompt diagnosis and optimal treatment in <3hours (intravenous tissue plasminogen activator in two patients cardio-embolic etiology and neuro-endovascular repair in one patient with venous infarction due to a dural AV fistula). The diagnosis was made beyond the therapeutic window in seven patients, who were left with significant neurological sequelae. Higher awareness of BTI presenting as SLC is warranted. Optimal patient management includes urgent DWI-MRI. In cases of BTI, further imaging workup is indicated to provide a comprehensive assessment for etiology. Early diagnosis and prompt, targeted intervention are crucial. Copyright © 2016 Elsevier Ltd. All rights reserved.

Enterocutaneous fistulas: an overview.

PubMed

Whelan, J F; Ivatury, R R

2011-06-01

Enterocutaneous fistulas remain a difficult management problem. The basis of management centers on the prevention and treatment of sepsis, control of fistula effluent, and fluid and nutritional support. Early surgery should be limited to abscess drainage and proximal defunctioning stoma formation. Definitive procedures for a persistent fistula are indicated in the late postoperative period, with resection of the fistula segment and reanastomosis of healthy bowel. Even more complex are the enteroatmospheric fistulas in the open abdomen. These enteric fistulas require the highest level of multidisciplinary approach for optimal outcomes.

[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.

Cranial dural arteriovenous shunts. Part 4. Clinical presentation of the shunts with leptomeningeal venous drainage.

PubMed

Baltsavias, Gerasimos; Spiessberger, Alex; Hothorn, Torsten; Valavanis, Anton

2015-04-01

Cranial dural arteriovenous fistulae have been classified into high- and low-risk lesions mainly based on the pattern of venous drainage. Those with leptomeningeal venous drainage carry a higher risk of an aggressive clinical presentation. Recently, it has been proposed that the clinical presentation should be considered as an additional independent factor determining the clinical course of these lesions. However, dural shunts with leptomeningeal venous drainage include a very wide spectrum of inhomogeneous lesions. In the current study, we correlated the clinical presentation of 107 consecutive patients harboring cranial dural arteriovenous shunts with leptomeningeal venous drainage, with their distinct anatomic and angiographic features categorized into eight groups based on the "DES" (Directness and Exclusivity of leptomeningeal venous drainage and features of venous Strain) concept. We found that among these groups, there are significant angioarchitectural differences, which are reflected by considerable differences in clinical presentation. Leptomeningeal venous drainage of dural sinus shunts that is neither direct nor exclusive and without venous strain manifested only benign symptoms (aggressive presentation 0%). On the other end of the spectrum, the bridging vein shunts with direct and exclusive leptomeningeal venous drainage and venous strain are expected to present aggressive symptoms almost always and most likely with bleeding (aggressive presentation 91.5%). Important aspects of the above correlations are discussed. Therefore, the consideration of leptomeningeal venous drainage alone, for prediction of the clinical presentation of these shunts appears insufficient. Angiographic analysis based on the above concept, offers the possibility to distinguish the higher- from the lower-risk types of leptomeningeal venous drainage. In this context, consideration of the clinical presentation as an additional independent factor for the prediction of their clinical course seems superfluous and possibly misleading. Topography is connected to the clinical presentation of the dural shunts inasmuch as the former determines the venous anatomy and the angioarchitectural features of the lesions.

Effectiveness of collateral vein embolization for salvage of immature native arteriovenous fistulas.

PubMed

Ahmed, Osman; Patel, Mikin; Ginsburg, Michael; Jilani, Danial; Funaki, Brian

2014-12-01

To investigate the value of collateral vein embolization (CVE) as a salvage treatment for nonmaturing native arteriovenous fistulae (AVFs) in patients requiring hemodialysis. A total of 49 patients undergoing CVE (N = 65) for immature native AVFs at a single institution were reviewed. The study included 42 patients treated by 56 embolizations. Average fistula age at time of intervention was 18.2 weeks. Each patient underwent angiographic evaluation for fistula immaturity, with clinical success defined by initiation of single-session hemodialysis through the native fistula. Fistula maturity was achieved in 32 of 42 patients (76.2%). No major complications occurred. Average time from CVE to fistula maturity was 38.4 days. Angioplasty done with CVE was found in a statistically higher percentage of patients with fistula success versus failure (31.3% vs 8.3%; P = .039). Radiocephalic fistulae were seen in a higher percentage of fistula failures compared with successes, but the results were not statistically significant (83.3% vs 59.4%; P = .054). Thirty-four patients underwent CVE without angioplasty, which resulted in successful fistula maturation in 22 cases (64.7%). Radiocephalic fistulae were again seen in a higher percentage of fistula failures compared with successes, but the findings did not meet statistical significance (81.8% vs 54.5%; P = .052). Coil embolization of competing collateral vessels as a salvage treatment for nonfunctioning autologous AVFs is a viable treatment option in the majority of patients. Patients with radiocephalic fistulae may be at higher risk for primary fistula failure, but the present data are inconclusive. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Durham Smith Vest-Over-Pant Technique: Simple Procedure for a Complex Problem (Post-Hypospadias Repair Fistula).

PubMed

Gite, Venkat A; Patil, Saurabh R; Bote, Sachin M; Siddiqui, Mohd Ayub Karam Nabi; Nikose, Jayant V; Kandi, Anitha J

2017-01-01

Urethrocutaneous fistula, which occurs after hypospadias surgery, is often a baffling problem and its treatment is challenging. The study aimed to evaluate the results of the simple procedure (Durham Smith vest-over-pant technique) for this complex problem (post-hypospadias repair fistula). During the period from 2011 to 2015, 20 patients with post-hypospadias repair fistulas underwent Durham Smith repair. Common age group was between 5 and 12 years. Site wise distribution of fistula was coronal 2 (10%), distal penile 7 (35%), mid-penile 7 (35%), and proximal-penile 4 (20%). Out of 20 patients, 15 had fistula of size <5 mm (75%) and 5 patients had fistula of size >5 mm (25%). All cases were repaired with Durham Smith vest-over-pant technique by a single surgeon. In case of multiple fistulas adjacent to each other, all fistulas were joined to form single fistula and repaired. We have successfully repaired all post-hypospadias surgery urethrocutaneous fistulas using the technique described by Durham Smith with 100% success rate. Durham Smith vest-over-pant technique is a simple solution for a complex problem (post hypospadias surgery penile fistulas) in properly selected patients. © 2017 S. Karger AG, Basel.

Radiographic identification of the equine ventral conchal bulla.

PubMed

Finnegan, C M; Townsend, N B; Barnett, T P; Barakzai, S Z

Involvement of the ventral conchal sinus (VCS) is an important diagnostic and prognostic feature in cases of the equine sinus disease. The authors aimed to ascertain if the caudo-dorsal extension of the VCS, the ventral conchal bulla (VCB) is identifiable on plain radiographs of cadaver skulls without sinus disease. Bilateral frontonasal sinus flaps were made in 10 equine cadaver skulls. Plain lateral, lateral oblique and dorso-ventral radiographs were then obtained followed by the same views taken with stainless steel wire outlining the caudal border of the VCB. Plain radiographs were randomised and blindly evaluated by two observers who marked where they believed the VCB to be positioned. This was then correlated with the true position of the VCB using radiographs with wires in place. The ease of identification of the VCB was classified as 'easy' or 'difficult'. The VCB was correctly identified in 70 per cent of lateral radiographs, but only 45 per cent of lateral oblique radiographs and 17 per cent of dorso-ventral radiographs. If a clinician was confident that he or she could identify the VCB, they were usually correct. Conversely if the clinician judged VCB identification as 'difficult', they usually identified it incorrectly. In the authors' clinical experience, the VCB of horses with sinusitis involving this compartment is more radiologically evident than in clinically normal horses. Knowledge of the normal radiographic anatomy of this structure should aid clinicians in identifying horses with sinusitis affecting the VCS.

The sensitivity and specificity of touch preparation for rapid diagnosis of invasive fungal sinusitis: A pilot study.

PubMed

Schuman, Theodore A; Nguyen, Josephine H; Yelverton, Joshua C; Almenara, Jorge A; Powers, Celeste N

2018-01-01

Invasive fungal sinusitis is a morbid pathology that typically affects immunocompromised patients and may quickly progress to fulminant disease. The purpose of this study was to measure the sensitivity and specificity of touch preparation of nasal debridement specimens as a rapid diagnostic tool for invasive fungal sinusitis. A retrospective chart review was performed of 22 patients undergoing nasal debridement due to suspicion for invasive fungal sinusitis over a 10-year period. Thirteen patients had touch preparation of nasal specimens followed by routine histologic processing; 2 of these patients underwent two and 1 patient had three separate debridements, for a total of 17 touch preparations performed. The sensitivity and specificity of touch preparation were calculated by correlating the initial results with the presence of fungal invasion on final pathologic analysis. The sensitivity of touch preparation was 56% (95% confidence interval [CI]: 0.23 to 0.85), specificity was 100% (95% CI: 0.60 to 1.00), positive predictive value was 100% (95% CI: 0.46 to 1.00), and negative predictive value was 67% (95% CI: 0.35 to 0.89). This procedure may be a useful adjunct in situations requiring rapid diagnosis of invasive fungal sinusitis but should not be used as the sole criterion for determining the need for surgical intervention.

Autogenous forearm loop arteriovenous fistula creation.

PubMed

Tang, Weng Jun; Mat Saad, Arman Zaharil

2018-03-01

Arteriovenous fistula is a lifeline for end-stage kidney disease patients on dialysis. The quality of the vein and artery to be used plays a crucial role in attaining a functioning, reliable and long-lasting arteriovenous fistula. The aim of the study is to present an alternative for haemodialysis access to preserve the upper arm vasculature for future use - the forearm loop arteriovenous fistula. From October 2015 to September 2016, 202 patients with chronic kidney disease (CKD), stages 4 and 5, underwent arteriovenous fistula creation at the Universiti Sains Malaysia Hospital, Malaysia. Nine patients, with severe atherosclerosis of the distal artery, but with satisfactory veins, underwent forearm loop arteriovenous fistula creation. Maturation of the fistula was based on the classification by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI). All nine patients who underwent forearm loop arteriovenous fistula have had diabetes mellitus for more than 10 years. Only one fistula failed to mature within 6 weeks. Two arteriovenous fistulas thrombosed at 3 and 5 months, respectively, after the commencement of haemodialysis. However, the other six matured fistulas are still functioning well after a year of regular usage. Distal forearm arteries in diabetics may be severely atherosclerotic. Forearm loop arteriovenous fistula can be considered as the primary access for cases decided as inconvenient for fistula creation due to severe occlusive atherosclerotic disease of the forearm arteries; in order to preserve upper arm veins for future access procedures.

Intimal Hyperplasia, Stenosis, and Arteriovenous Fistula Maturation Failure in the Hemodialysis Fistula Maturation Study.

PubMed

Cheung, Alfred K; Imrey, Peter B; Alpers, Charles E; Robbin, Michelle L; Radeva, Milena; Larive, Brett; Shiu, Yan-Ting; Allon, Michael; Dember, Laura M; Greene, Tom; Himmelfarb, Jonathan; Roy-Chaudhury, Prabir; Terry, Christi M; Vazquez, Miguel A; Kusek, John W; Feldman, Harold I

2017-10-01

Intimal hyperplasia and stenosis are often cited as causes of arteriovenous fistula maturation failure, but definitive evidence is lacking. We examined the associations among preexisting venous intimal hyperplasia, fistula venous stenosis after creation, and clinical maturation failure. The Hemodialysis Fistula Maturation Study prospectively observed 602 men and women through arteriovenous fistula creation surgery and their postoperative course. A segment of the vein used to create the fistula was collected intraoperatively for histomorphometric examination. On ultrasounds performed 1 day and 2 and 6 weeks after fistula creation, we assessed fistula venous stenosis using pre-specified criteria on the basis of ratios of luminal diameters and peak blood flow velocities at certain locations along the vessel. We determined fistula clinical maturation using criteria for usability during dialysis. Preexisting venous intimal hyperplasia, expressed per 10% increase in a hyperplasia index (range of 0%-100%), modestly associated with lower fistula blood flow rate (relative change, -2.5%; 95% confidence interval [95% CI], -4.6% to -0.4%; P =0.02) at 6 weeks but did not significantly associate with stenosis (odds ratio [OR], 1.07; 95% CI, 1.00 to 1.16; P =0.07) at 6 weeks or failure to mature clinically without procedural assistance (OR, 1.07; 95% CI, 0.99 to 1.15; P =0.07). Fistula venous stenosis at 6 weeks associated with maturation failure (OR, 1.98; 95% CI, 1.25 to 3.12; P =0.004) after controlling for case mix factors, dialysis status, and fistula location. These findings suggest that postoperative fistula venous stenosis associates with fistula maturation failure. Preoperative venous hyperplasia may associate with maturation failure but if so, only modestly. Copyright © 2017 by the American Society of Nephrology.

Transforming Growth Factor-β1 T869C Gene Polymorphism Is Associated with Acquired Sick Sinus Syndrome via Linking a Higher Serum Protein Level

PubMed Central

Chen, Jan-Yow; Liu, Jiung-Hsiun; Wu, Hong-Dar Isaac; Lin, Kuo-Hung; Chang, Kuan-Cheng; Liou, Ying-Ming

2016-01-01

Background Familial sick sinus syndrome is associated with gene mutations and dysfunction of ion channels. In contrast, degenerative fibrosis of the sinus node tissue plays an important role in the pathogenesis of acquired sick sinus syndrome. There is a close relationship between transforming growth factor-β1 mediated cardiac fibrosis and acquired arrhythmia. It is of interest to examine whether transforming growth factor-β1 is involved in the pathogenesis of acquired sick sinus syndrome. Methods Overall, 110 patients with acquired SSS and 137 age/gender-matched controls were screened for transforming growth factor-β1 and cardiac sodium channel gene polymorphisms using gene sequencing or restriction fragment length polymorphism methods. An enzyme-linked immunosorbent assay was used to determine the serum level of transforming growth factor-β1. Results Two transforming growth factor-β1 gene polymorphisms (C-509T and T+869C) and one cardiac sodium channel gene polymorphism (H588R) have been identified. The C-dominant CC/CT genotype frequency of T869C was significantly higher in acquired sick sinus syndrome patients than in controls (OR 2.09, 95% CI 1.16–3.75, P = 0.01). Consistently, the level of serum transforming growth factor-β1 was also significantly greater in acquired sick sinus syndrome group than in controls (5.3±3.4 ng/ml vs. 3.7±2.4 ng/ml, P = 0.01). In addition, the CC/CT genotypes showed a higher transforming growth factor-β1 serum level than the TT genotype (4.25 ± 2.50 ng/ml vs. 2.71± 1.76 ng/ml, P = 0.028) in controls. Conclusion Transforming growth factor-β1 T869C polymorphism, correlated with high serum transforming growth factor-β1 levels, is associated with susceptibility to acquired sick sinus syndrome. PMID:27380173

Flow field and oscillatory shear stress in a tuning-fork-shaped model of the average human carotid bifurcation.

PubMed

Ding, Z; Wang, K; Li, J; Cong, X

2001-12-01

The oscillatory shear index (OSI) was developed based on the hypothesis that intimal hyperplasia was correlated with oscillatory shear stresses. However, the validity of the OSI was in question since the correlation between intimal thickness and the OSI at the side walls of the sinus in the Y-shaped model of the average human carotid bifurcation (Y-AHCB) was weak. The objectives of this paper are to examine whether the reason for the weak correlation lies in the deviation in geometry of Y-AHCB from real human carotid bifurcation, and whether this correlation is clearly improved in the tuning-fork-shaped model of the average human carotid bifurcation (TF-AHCB). The geometry of the TF-AHCB model was based on observation and statistical analysis of specimens from 74 cadavers. The flow fields in both models were studied and compared by using flow visualization methods under steady flow conditions and by using laser Doppler anemometer (LDA) under pulsatile flow conditions. The TF-shaped geometry leads to a more complex flow field than the Y-shaped geometry. This added complexity includes strengthened helical movements in the sinus, new flow separation zone, and directional changes in the secondary flow patterns. The results show that the OSI-values at the side walls of the sinus in the TF-shaped model were more than two times as large as those in the Y-shaped model. This study confirmed the stronger correlation between the OSI and intimal thickness in the tuning-fork geometry of human carotid bifurcation, and the TF-AHCB model is a significant improvement over the traditional Y-shaped model.

Fistula repair after hypospadias surgery using buccal mucosal graft.

PubMed

Hosseini, Jalil; Kaviani, Ali; Mohammadhosseini, Mojtaba; Rezaei, Alireza; Rezaei, Iraj; Javanmard, Babak

2009-01-01

The aim of this study was to evaluate the success rate of urethrocutaneous fistula repair using buccal mucosal graft in patients with a previous hypospadias repair. We reviewed records of our patients with urethrocutaneous fistula developed after hypospadias repair in whom buccal mucosal graft fistula repair had been performed. All of the patients had been followed up for 24 postoperative months. A successful surgical operation was defined as no fistula recurrence or urethral stricture. Retrograde urethrography and urethrocystoscopy would be performed in patients who had any history of decreased force and caliber of urine or any difficulty in urination. Fistula repair using buccal mucosa patch graft had been done in 14 children with urethrocutaneous fistula developing after hypospadias reconstruction. The mean age of the children was 8.70 +/- 1.99 years old (range, 4 to 11 years). Seven fistulas were in the midshaft, 4 were in the penoscrotal region, and 3 were in the coronal region. Repair of the fistulas was successful in 11 of 14 patients (78.6%). In the remaining children, the diameter of the fistula was smaller than that before the operation, offering a good opportunity for subsequent closure. Our findings showed that fistula repair using buccal mucosal graft can be one of the acceptable techniques for repairing fistulas developed after hypospadias repair.

Topographic analysis of maxillary premolars and molars and maxillary sinus using cone beam computed tomography.

PubMed

Yoshimine, Shin-Ichiro; Nishihara, Kazuhide; Nozoe, Etsuro; Yoshimine, Masako; Nakamura, Norifumi

2012-12-01

This study evaluated the anatomical characteristics of the maxillary premolars and molars and the maxillary sinus using cone beam computed tomography (CBCT) for dental implant treatment. Ten linear items and 1 angular item on 30 sites in 30 patients were measured on 3-dimensional computed tomography images using CBCT. The vertical relationship between the maxillary sinus and the maxillary molars was classified into 5 categories. The horizontal thickness of the buccal alveolar bone was thinnest on the maxillary first premolars, and the horizontal thickness of the palatal alveolar bone was thickest on the maxillary second molars. Type II was most common on the maxillary first molars. The internal angle at the maxillary premolars was significantly greater than that at the maxillary molars. The internal angle and vertical distance between the apex of the roots and the maxillary sinus floor showed a positive correlation on the maxillary first premolars (P = 0.003). For the selection of an appropriate approach on dental implant treatment, the evaluation of maxillary premolars and molars using of CBCT can be recommended.

De novo development of dural arteriovenous fistula after endovascular embolization of pial arteriovenous fistula.

PubMed

Paramasivam, Srinivasan; Toma, Naoki; Niimi, Yasunari; Berenstein, Alejandro

2013-07-01

The development of de novo dural arteriovenous fistula(s) following endovascular embolization of a prior high-flow pial arteriovenous fistula (PAVF) has not previously been reported and the natural history is unknown. The anatomic basis, pathophysiologic mechanism, management and outcome are discussed. Treatment-completed congenital PAVFs treated at our center between January 2005 and August 2011 were analyzed retrospectively. Among 16 cases of PAVFs treated by endovascular embolization, four developed de novo dural arteriovenous fistulas during treatment or on follow-up that were not present before treatment. Information was collected from the clinical case records, imaging by MRI on presentation and during follow-up, all angiographic images and records during each of the procedures and during follow-up. The time interval between the last embolization and identification of a dural fistula ranged from 3 to 14 months. Ten fistulas were identified in four patients, seven of which were embolized, four with glue, two with Onyx18 and one with absolute alcohol. None recanalized, while one patient developed fistula in an adjacent location that was subsequently treated with radiosurgery. Not all fistulas need treatment; small fistulas with a minimal flow can safely be observed. De novo dural fistulas following endovascular embolization of high-flow PAVFs is not an uncommon development. They are mostly asymptomatic and develop anywhere along the drainage of the fistula, maturing over time and diagnosed during follow-up studies, emphasizing the need for follow-up angiography. They can be effectively treated by endovascular embolization. Localized refractory dural fistulas can be dealt with by radiosurgery.

Respiratory sinus arrhythmia in Chagas disease.

PubMed

Neves, Victor Ribeiro; Peltola, Mirja; Huikuri, Heikki; Rocha, Manoel Otávio da Costa; Ribeiro, Antonio Luiz

2014-10-01

We applied the respiratory sinus arrhythmia (RSA) quantification algorithm to 24-hour ECG recordings of Chagas disease (ChD) patients with (G1, n=148) and without left ventricular dysfunction (LVD) (G2, n=33), and in control subjects (G0, n=28). Both ChD groups displayed a reduced RSA index; G1=299 (144-812); G2=335 (162-667), p=0.011, which was correlated with vagal indexes of heart rate variability analysis. RSA index is a marker of vagal modulation in ChD patients. Copyright © 2014 Elsevier B.V. All rights reserved.

The Use of Interventional Radiology Techniques in the Treatment of Pancreatic Fistula.

PubMed

Miłek, Tomasz; Baranowski, Krzysztof; Petryka, Robert; Ciostek, Piotr

2016-12-01

One of the complications of pancreatic disease is the formation of pancreatic fistulae. The presence of fistula leads to body wasting and cachexia. The standard treatment is intubation of the Wirsung duct and in cases where there are no improvements the next proposed form of treatment is surgery. The aim of the study was to evaluate the efficacy of pancreatic fistula closure using interventional radiology techniques. In 2009 to 2014, 46 patients diagnosed with pancreatic fistula were treated with interventional radiology techniques. Treatment consisted of vascular coil implanted at the entry of the fistula and then sealed with tissue glue adhesive during endoscopic procedure. Technical success of vascular coil implantation and the use of tissue glue adhesive were reported in all patients. Pancreatic fistula recurred in 7 patients (15.2%). The latter group of patients underwent statistical analysis to determine what the risk factors in recurring pancreatic fistulas were. The results indicate a significant relationship between etiology of the fistula and treatment effect. (1) the use of interventional radiology methods in the closure of pancreatic fistula is an effective and safe procedure; and (2) the recurrence of fistula is dependent on the etiology and often occurs after surgery or trauma.

The Relationship Between Female Genital Cutting and Obstetric Fistulas

PubMed Central

Browning, Andrew; Allsworth, Jenifer E.; Wall, L. Lewis

2013-01-01

Objective To evaluate any association between female genital cutting and vesicovaginal fistula formation during obstructed labor. Methods A comparison was made between 255 fistula patients who had undergone Type I or Type II female genital cutting and 237 patients who had not undergone such cutting. Women were operated on at the Barhirdar Hamlin Fistula Centre in Ethiopia. Data points used in the analysis included age, parity, length of labor, labor outcome (stillbirth or not), type of fistula, site, size and scarring of fistula, outcomes of surgery (fistula closed, persistent incontinence with closed fistula, urinary retention with overflow, site, size, and scarring of any rectovaginal fistula and operation outcomes, as well as specific methods employed during the operation (utilization of a graft or not, application of a pubococcygeal or similar autologous sling, vaginoplasty, catheterization of ureters, and flap reconstruction of vagina). Primary outcomes were site of genitourinary fistula and persistent incontinence despite successful fistula closure. Results The only statistically significant differences between the two groups (p = 0.05) was a slightly greater need to place ureteral catheters at the time of surgery in women who had not undergone a genital cutting operation, and slightly higher use of a pubococcygeal sling at the time of fistula repair and a slightly longer length of labor (by 0.3 of a day) in women who had undergone genital cutting. Conclusion Type I and Type II female genital cutting are not independent causative factors in the development of obstetric fistulas from obstructed labor. PMID:20177289

Digestive system fistula: a problem still relevant today.

PubMed

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

2011-01-01

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

CSF Venous Fistulas in Spontaneous Intracranial Hypotension: Imaging Characteristics on Dynamic and CT Myelography.

PubMed

Kranz, Peter G; Amrhein, Timothy J; Gray, Linda

2017-12-01

The objective of this study is to describe the anatomic and imaging features of CSF venous fistulas, which are a recently reported cause of spontaneous intracranial hypotension (SIH). We retrospectively reviewed the records of patients with SIH caused by CSF venous fistulas who received treatment at our institution. The anatomic details of each fistula were recorded. Attenuation of the veins involved by the fistula was compared with that of adjacent control veins on CT myelography (CTM). Visibility of the CSF venous fistula on CTM and a modified conventional myelography technique we refer to as dynamic myelography was also compared. Twenty-two cases of CSF venous fistula were identified. The fistulas were located between T4 and L1. Ninety percent occurred without a concurrent epidural CSF leak. In most cases (82%), the CSF venous fistula originated from a nerve root sleeve diverticulum. On CTM, the abnormal veins associated with the CSF venous fistula were seen in a paravertebral location in 45% of cases, centrally within the epidural venous plexus in 32%, and lateral to the spine in 23%. Differences in attenuation between the fistula veins and the control veins was highly statistically significant (p < 0.0001), with a threshold of 70 HU perfectly discriminating fistulas from normal veins in our series. When both CTM and dynamic myelography were performed, the fistula was identified on both modalities in 88% of cases. CSF venous fistulas are an important cause of SIH that can be detected on both CTM and dynamic myelograph y and may occur without an epidural CSF leak. Familiarity with the imaging characteristics of these lesions is critical to providing appropriate treatment to patients with SIH.

Complicating causality: patient and professional perspectives on obstetric fistula in Nigeria.

PubMed

Phillips, Beth S; Ononokpono, Dorothy N; Udofia, Nsikanabasi W

2016-09-01

Obstetric fistula, a preventable maternal morbidity characterised by chronic bladder and/or bowel incontinence, is widespread in Nigeria. This qualitative, multi-site study examined the competing narratives on obstetric fistula causality in Nigeria. Research methods were participant observation and in-depth interviews with 86 fistula patients and 43 healthcare professionals. The study found that both patient and professional narratives identified limited access to medical facilities as a major factor leading to obstetric fistula. Patients and professionals beliefs regarding the access problem, however, differed significantly. The majority of fistula patients reported either delivering or attempting to deliver in medical facilities and most patients attributed fistula to a lack of trained medical staff and mismanagement at medical facilities. Conversely, a majority of health professionals believed that women developed obstetric fistula because they chose to deliver at home due to women's traditional beliefs about womanhood and childbirth. Both groups described financial constraints and inadequate transport to medical facilities during complicated labour as related to obstetric fistula onset. Programmatic insights derived from these findings should inform fistula prevention interventions both with healthcare professionals and with Nigerian women.

Improved Cerebral Time-of-Flight Magnetic Resonance Angiography at 7 Tesla – Feasibility Study and Preliminary Results Using Optimized Venous Saturation Pulses

PubMed Central

Wrede, Karsten H.; Johst, Sören; Dammann, Philipp; Özkan, Neriman; Mönninghoff, Christoph; Kraemer, Markus; Maderwald, Stefan; Ladd, Mark E.; Sure, Ulrich; Umutlu, Lale; Schlamann, Marc

2014-01-01

Purpose Conventional saturation pulses cannot be used for 7 Tesla ultra-high-resolution time-of-flight magnetic resonance angiography (TOF MRA) due to specific absorption rate (SAR) limitations. We overcome these limitations by utilizing low flip angle, variable rate selective excitation (VERSE) algorithm saturation pulses. Material and Methods Twenty-five neurosurgical patients (male n = 8, female n = 17; average age 49.64 years; range 26–70 years) with different intracranial vascular pathologies were enrolled in this trial. All patients were examined with a 7 Tesla (Magnetom 7 T, Siemens) whole body scanner system utilizing a dedicated 32-channel head coil. For venous saturation pulses a 35° flip angle was applied. Two neuroradiologists evaluated the delineation of arterial vessels in the Circle of Willis, delineation of vascular pathologies, presence of artifacts, vessel-tissue contrast and overall image quality of TOF MRA scans in consensus on a five-point scale. Normalized signal intensities in the confluence of venous sinuses, M1 segment of left middle cerebral artery and adjacent gray matter were measured and vessel-tissue contrasts were calculated. Results Ratings for the majority of patients ranged between good and excellent for most of the evaluated features. Venous saturation was sufficient for all cases with minor artifacts in arteriovenous malformations and arteriovenous fistulas. Quantitative signal intensity measurements showed high vessel-tissue contrast for confluence of venous sinuses, M1 segment of left middle cerebral artery and adjacent gray matter. Conclusion The use of novel low flip angle VERSE algorithm pulses for saturation of venous vessels can overcome SAR limitations in 7 Tesla ultra-high-resolution TOF MRA. Our protocol is suitable for clinical application with excellent image quality for delineation of various intracranial vascular pathologies. PMID:25232868

Cancer complicating chronic ulcerative and scarifying mucocutaneous disorders

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kaplan, R.P.

1987-01-01

Skin affected by a burn cancer is scarred, ulcerated, and often appears as erythema ab igne clinically in adjacent skin. The latent period in burn scar malignancy is much longer for SCC than BCC. Malignant melanoma and various sarcomas are reported to arise in burn scars, too. The other extreme on the temperature scale can less often result in enough permanent acral damage that poor wound healing may eventually result in cancer, usually SCC. About 1% of patients with chronic osteomyelitis develop cancer, usually SCC in sinus tracts. As with tumors arising in burn scars and chronic leg ulcers ofmore » varied etiology, black patients are disproportionately overrepresented in osteomyelitic malignancy. In nearly all of the patients with radiation-induced skin cancer, concomitant radiodermatitis is present. As with burn scar and osteomyelitic cancer, x-ray related cancer has a long latent period. Similar to burn scar cancer, SCC predominates in osteomyelitis and occurs on the extremities. BCC, when it arises, is more common on the face and neck in burn- and radiation-induced tumors. Multiple tumors are frequent as is recurrence in x-ray malignancy. Mortality is high: one out of three to four patients with burn scar, osteomyelitic, and radiation cancer die of dermatosis-related malignancy. Recently, radioactivity-contaminated gold rings have been implicated in causing SCC. Carcinoma tends to occur in irradiated benign dermatoses whereas sarcomas tend to complicate irradiated malignancies. Stasis ulceration and anogenital fistulae may rarely lead to cancer, SCC in the former and adenocarcinoma in the latter. SCC can rarely develop in four related conditions (acne conglobata, dissecting perifolliculitis of the scalp, hidradenitis suppurativa, and pilonidal sinus) after a lengthy latent period; prognosis is poor with a high metastatic rate. 147 references.« less

Oral cutaneous sinus tract, vertical root fracture, and bisphosphonate-related osteonecrosis: a case report.

PubMed

Wigler, Ronald; Steinbock, Nelly; Berg, Tal

2013-08-01

Oral cutaneous sinus tracts (OCSTs) of dental origin are often initially misdiagnosed and inappropriately treated. Accurate diagnosis is especially important in cases of bisphosphonate (BP) therapy because extraction may lead to a risk of osteonecrosis. A case report of misdiagnosis related to a tooth with a vertical root fracture in an oncologic patient treated with BPs is reported here. In 2011, a 75-year-old woman was examined at the oral medicine clinic because of pain and swelling of the left submandibular area. The patient's medical history included oral and intravenous BP therapy because she was diagnosed with metastatic breast cancer and left maxillary stage 1 antiresorptive agent-induced osteonecrosis of the jaw. The lower left odontogenic region showed no signs or symptoms, and no apical pathosis was observed on imaging. Although antibiotics were applied, clinical symptoms worsened and an OCST appeared. Intravenous antibiotic treatment was pursued. Biopsy and direct smear from fistula were not conclusive. A diagnosis of a nonexposed variant of stage 3 antiresorptive agent-induced osteonecrosis of the jaw was established. Symptoms resolved after 2 weeks of antibiotic treatment and reappeared a month later. Endodontic examination revealed that the origin of the OCST was tooth no. 18 caused by a vertical root fracture, and the tooth was extracted. The patient was scheduled for routine checkups because of the fact that osteonecrosis may occur in intravenous BP-treated patients. Early correct diagnosis can prevent unnecessary and ineffective antibiotic therapy and surgical intervention, which is not recommended in intravenous BP cases. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Exploring the needs and challenges of women reintegrating after obstetric fistula repair in northern Ghana.

PubMed

Jarvis, Kimberly; Richter, Solina; Vallianatos, Helen

2017-07-01

to explore the cultural, social and economic needs and challenges of women in northern Ghana as they resume their day-to-day lives post obstetric fistula repair. a critical ethnographic approach. a state run fistula treatment center in Tamale, northern Ghana, and 24 rural communities in northern Ghana. ninety-nine (N=99) participants were recruited using purposive, convenience and snowball sampling. The sample consisted of women (N=41) who had experienced an obstetric fistula repair and their family members (N=24). Health care providers (N=17) and stakeholders (N=17) who had specialised knowledge about reintegration programs at a community or national level were also included. the needs and challenges of northern Ghanaian women post obstetric fistula repair were historically and culturally rooted. A woman's psychosocial acceptance back into her community post obstetric fistula was significant to her well-being but many women felt they had to 'prove' themselves worthy of acceptance and hid any signs of urinary incontinence post obstetric fistula repair. The cost of treatment compounded by a woman's inability to work while having the obstetric fistula exaggerated her economic needs. Skills training programs offered assistance but were often not suited to a woman's physical capability or geographic location. Many women who have experienced obstetric fistula along with women leaders have initiated obstetric fistula awareness campaigns in their communities with the aim of overcoming the challenges and improving the reintegration experiences of others who have had an obstetric fistula repair. developing understanding about the needs and challenges of women post obstetric fistula is an important step forward in creating social and political change in obstetric fistula care and reintegration. Strategies to support women reintegrating to their communities post obstetric fistula repair include exploring alternative forms of skills training and income generation activities, creating innovative pre and post obstetric fistula health education and community awareness to reduce the perception of the condition as 'incurable', and promoting peer advocacy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Do altitude and climate affect paranasal sinus volume?

PubMed

Selcuk, Omer Tarık; Erol, Bekir; Renda, Levent; Osma, Ustun; Eyigor, Hulya; Gunsoy, Behcet; Yagci, Buket; Yılmaz, Deniz

2015-09-01

The aim of this study was to evaluate the effect of climate and altitude differences on the volume of paranasal sinuses and on the frequency of anatomic variations by comparing the paranasal sinus tomograms (PNSCT) of patients who were born and living in a cold, dry climate at high altitude with those of patients who were born and living on the coast at sea level in a temperate climate. We also aimed to determine differences relating to gender. A total of 55 PNSCTs of 55 patients from the city center of Antalya and 60 PNSCTs of 60 patients from the city center of Agrı were evaluated and compared prospectively. The study included a total of 115 patients with a mean age of 44.75 ± 9.64 years (range, 27-63 years). Group 1 (Antalya) comprised 26 females (47.3%) and 29 males (52.7%) with a mean age of 36.7 ± 12.4 years. Group 2 (Agrı) comprised 25 females (41.7%) and 35 males (58.3%) with a mean age of 35.1 ± 13.4 years. Maxillary sinus volumes were 18.27 cm(3) (range, 5.04-37.62) and 15.06 cm(3) (4.11-41.40); sphenoid sinus volumes were 7.81 cm(3) (1.80-20.63) and 6.35 cm(3) (0.54-16.50); frontal sinus volumes were 5.51 cm(3) (0.50-29.25) and 3.76 cm(3) (0.68-22.81) respectively. There was no statistically significant difference between the groups in term of volumes (p > 0.025). Both maxillary and frontal sinus volumes were greater in males compared to females (p < 0.025). The mean value of the maxillary sinus volume was 15.7 ± 5.3 cm(3) and was significantly larger in males than in females (p = 0.004). There was no statistically significant correlation between the volume of maxillary sinuses with age or side. There was no statistically significant difference between the groups in terms of septum deviation and concha bullosa rates (p = 0.469 and p = 0.388). There have been many studies of nasal cavity changes due to climatic conditions but this is the first study to measure the difference of paranasal sinus volumes. No difference was determined in the anatomic variations and volumes of the maxillary, frontal, sphenoid sinuses on PNSCT of patients from different climates and altitudes. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Logistic regression analysis of the risk factors of anastomotic fistula after radical resection of esophageal‐cardiac cancer

PubMed Central

Huang, Jinxi; Wang, Chenghu; Yuan, Weiwei; Zhang, Zhandong; Chen, Beibei; Zhang, Xiefu

2017-01-01

Background This study was conducted to investigate the risk factors of anastomotic fistula after the radical resection of esophageal‐cardiac cancer. Methods Five hundred and forty‐four esophageal‐cardiac cancer patients who underwent surgery and had complete clinical data were included in the study. Fifty patients diagnosed with postoperative anastomotic fistula were considered the case group and the remaining 494 subjects who did not develop postoperative anastomotic fistula were considered the control. The potential risk factors for anastomotic fistula, such as age, gender, diabetes history, smoking history, were collected and compared between the groups. Statistically significant variables were substituted into logistic regression to further evaluate the independent risk factors for postoperative anastomotic fistulas in esophageal‐cardiac cancer. Results The incidence of anastomotic fistulas was 9.2% (50/544). Logistic regression analysis revealed that female gender (P < 0.05), laparoscopic surgery (P < 0.05), decreased postoperative albumin (P < 0.05), and postoperative renal dysfunction (P < 0.05) were independent risk factors for anastomotic fistulas in patients who received surgery for esophageal‐cardiac cancer. Of the 50 anastomotic fistulas, 16 cases were small fistulas, which were only discovered by conventional imaging examination and not presenting clinical symptoms. All of the anastomotic fistulas occurred within seven days after surgery. Five of the patients with anastomotic fistulas underwent a second surgery and three died. Conclusion Female patients with esophageal‐cardiac cancer treated with endoscopic surgery and suffering from postoperative hypoproteinemia and renal dysfunction were susceptible to postoperative anastomotic fistula. PMID:28940985

Myospherulosis following sinus surgery: pathological curiosity or important clinical entity?

PubMed

Sindwani, Raj; Cohen, Jacob T; Pilch, Ben Z; Metson, Ralph B

2003-07-01

Myospherulosis is a foreign body reaction to lipid material used on nasal packing at the conclusion of sinus surgery. This reaction has been associated with postoperative adhesion formation. The purpose of the study was to determine whether the occurrence of myospherulosis has an adverse effect on clinical outcome following sinus surgery. Case-control study at an academic medical center. Thirty-two cases of myospherulosis were identified in 28 patients (4 with bilateral disease) who underwent sinus surgery between 1989 and 1999. Cases were staged according to histological and radiological grading systems. Clinical outcome was compared with a control group of 28 patients who had similar surgery during the same time period. Patients with myospherulosis were found to have a significantly higher likelihood of developing postoperative adhesions compared with control subjects (50% vs. 18%, respectively [P =.023]). Histological stage, based on the extent of lipid vacuoles and spherules (erythrocyte remnants) present in the surgical specimen, was found to correlate with disease severity based on preoperative sinus computed tomography staging (P =.009). Patients with myospherulosis tended to have a shorter interval between their last two surgeries than did control subjects (2.2 +/- 2.1 vs. 4.5 +/- 7.1 y, respectively [P =.086]). Patient age, sex, comorbid conditions, CT stage, and number of previous operations were not predictive for the occurrence of myospherulosis. Patients who develop myospherulosis from lipid-based packing material used during sinus surgery are more likely to form postoperative adhesions. These adhesions appear to be clinically relevant and may hasten the need for revision surgery.

Out of the shadows and 6000 reasons to celebrate: An update from FIGO's fistula surgery training initiative.

PubMed

Slinger, Gillian; Trautvetter, Lilli; Browning, Andrew; Rane, Ajay

2018-06-01

Obstetric fistula is a devastating childbirth injury caused by unrelieved obstructed labor. Obstetric fistula leads to chronic incontinence and, in most cases, significant physical and emotional suffering. The condition continues to blight the lives of 1-2 million women in low-resource settings, with 50 000-100 000 new cases each year adding to the backlog. A trained, skilled fistula surgeon is essential to repair an obstetric fistula; however, owing to a global shortage of these surgeons, few women are able to receive life-restoring treatment. In 2011, to address the treatment gap, FIGO and partners released the Global Competency-Based Fistula Surgery Training Manual, the first standardized curriculum to train fistula surgeons. To increase the number of fistula surgeons, the FIGO Fistula Surgery Training Initiative was launched in 2012, and FIGO Fellows started to enter the program to train as fistula surgeons. Following a funding boost in 2014, the initiative has grown considerably. With 52 fellows involved and a new Expert Advisory Group in place, the program is achieving major milestones, with a record-breaking number of fistula repairs performed by FIGO Fellows in 2017, bringing the total number of repairs since the start of the project to more than 6000. © 2018 International Federation of Gynecology and Obstetrics.

Outcomes in endoscopic sinus surgery: olfaction, nose scale and quality of life in a prospective cohort study.

PubMed

Andrews, P J; Poirrier, A-L; Lund, V J; Choi, D

2016-12-01

To determine the efficacy of endoscopic sinus surgery (ESS) on olfactory function in chronic rhinosinusitis patients with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) and to compare the nasal obstruction and symptom evaluation (NOSE) scale before and after surgery. A prospective cohort study SETTING: Royal National Throat and Nose and Ear Hospital, London UK. One hundred and thirteen patients with CRS; 60 CRSwNP and 53 CRSsNP. Olfaction was measured using both the University of Pennsylvania Smell Investigation Test (UPSIT) and the 'sense of smell' visual analogue scale (VAS). The NOSE scale, the sinonasal outcome test (SNOT 22) and the Lund-Kennedy (LK) surgeon reported scores were also measured pre- and postoperatively at 6 months. The UPSIT psychophysical measurement significantly improved following ESS in the CRSwNP subgroup as did the patients perceived VAS sense of smell. However, in the CRSsNP subgroup, the improved VAS and UPSIT measurements were not significant. The NOSE, SNOT 22 and LK scores all improved significantly. The olfactory improvement as measured by the UPSIT correlated to the SNOT-22, but a correlation between the NOSE score and UPSIT was not found. Endoscopic sinus surgery significantly improved the patient's perceived and measured sense of smell in the CRSwNP subgroup which is the most surgically responsive CRS subgroup. Additionally, improved olfaction in the CRSwNP subgroup is most likely to improve the patient's quality of life. Endoscopic sinus surgery significantly improved the NOSE scale in both CRS subgroups at 6 months following surgery. © 2016 John Wiley & Sons Ltd.

3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound.

PubMed

Felt-Bersma, Richelle J F; Vlietstra, Maarten S; Vollebregt, Paul F; Han-Geurts, Ingrid J M; Rempe-Sorm, Vera; Vander Mijnsbrugge, Grietje J H; Molenaar, Charlotte B H

2018-04-04

Perianal fistula surgery can damage the anal sphincters which may cause faecal incontinence. By measuring regional pressures, 3D-HRAM potentially provides better guidance for surgical strategy in patients with perianal fistulas. The aim was to measure regional anal pressures with 3D-HRAM and to compare these with 3D-EUS findings in patients with perianal fistulas. Consecutive patients with active perianal fistulas who underwent both 3D-EUS and 3D-HRAM at a clinic specialised in proctology were included. A group of 30 patients without fistulas served as controls. Data regarding demographics, complaints, previous perianal surgical procedures and obstetric history were collected. The mean and regional anal pressures were measured with 3D-HRAM. Fistula tract areas detected with 3D-EUS were analysed with 3D-HRAM by visual coding and the regional pressures of the corresponding and surrounding area of the fistula tract areas were measured. The study was granted by the VUmc Medical Ethical Committee. Forty patients (21 males, mean age 47) were included. Four patients had a primary fistula, 19 were previously treated with a seton/abscess drainage and 17 had a recurrence after previously performed fistula surgery. On 3D-HRAM, 24 (60%) fistula tract areas were good and 8 (20%) moderately visible. All but 7 (18%) patients had normal mean resting pressures. The mean resting pressure of the fistula tract area was significantly lower compared to the surrounding area (47 vs. 76 mmHg; p < 0.0001). Only 2 (5%) patients had a regional mean resting pressure < 10 mmHg of the fistula tract area. Using a Δ mean resting pressure ≥ 30 mmHg difference between fistula tract area and non-fistula tract area as alternative cut-off, 21 (53%) patients were identified. In 6 patients 3D-HRAM was repeated after surgery: a local pressure drop was detected in one patient after fistulotomy with increased complaints of faecal incontinence. Profound local anal pressure drops are found in the fistula tract areas in patients normal mean resting pressures. Fistulotomy may affect local sphincter pressure. This might influence surgical decision making in future.

An outcome study of a 2-flap pushback palatoplasty used in the treatment of wide cleft palates.

PubMed

Lin, Kant Y; Black, Jonathan S; Wang, Jessica S; Kerpelman, Jocelyn; Ho, Thuy-Van Tina; Borowitz, Kathleen

2015-05-01

Cleft palate remains a common congenital deformity. The wide cleft palate in particular presents a unique challenge when attempting to restore a competent velopharyngeal mechanism. We present an outcome study of a single surgeon's experience using a modified surgical technique designed to specifically address the wide cleft palate. The surgical technique consisted of a 2-flap pushback palatoplasty without nasal mucosa closure combined with an end-to-end intravelar veloplasty and was used in cleft palates greater than or equal to 10 mm in width. A retrospective, longitudinal outcome study from chart review was then performed where age at surgery, sex, Veau classification of the cleft type, and follow-up length were recorded for each patient. Postsurgery speech outcomes were assessed by standardized speech evaluation performed by a speech language pathologist, and the presence and location of unplanned oronasal fistulas were recorded. Our study revealed an overall incidence of velopharyngeal insufficiency (VPI) of 10.8% and an unplanned symptomatic fistula rate of 16.8%. There was a significant correlation between the Veau classification of the cleft type with the incidence of both VPI and the occurrence of an unplanned oronasal fistula. Application of this surgical technique, specifically to wider cleft palates, resulted in VPI and fistula rates comparable to rates reported with other techniques used in clefts of all widths. Additional information regarding subsequent growth disturbances of the craniofacial skeleton in these patients is currently being collected.

Fistula Isolation and the Use of Negative Pressure to Promote Wound Healing: A Case Study.

PubMed

Reider, Kersten E

A 54-year-old morbidly obese woman with a small bowel obstruction and large ventral hernia was admitted to hospital. She underwent an exploratory laparotomy, lysis of adhesions, and ventral hernia repair with mesh placement. She subsequently developed an enteroatmospheric fistula; several months of hospital care was required to effectively manage the wound and contain effluent from the fistula. Several approaches were used to manage output from the fistula during her hospital course. She was initially discharged to a skilled nursing facility where a fistula management pouch was used for several months to encompass the wound and contain effluent, but this method ultimately proved ineffective. The fistula was then isolated using a collapsible enteroatmospheric fistula isolation device and an ostomy appliance to contain effluent. The application of the collapsible enteroatmospheric fistula isolation and effluent containment devices in conjunction with negative-pressure wound therapy produced positive patient outcomes; it improved patient satisfaction with fistula management, promoted wound healing, and diminished cost.

Embolization of Brain Aneurysms and Fistulas

MedlinePlus

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

Management of Gastropleural Fistula after Revisional Bariatric Surgery: A Hybrid Laparoendoscopic Approach.

PubMed

Ghanem, Omar M; Abu Dayyeh, Barham K; Kellogg, Todd A

2017-10-01

Gastropleural fistula (GPF) is a serious complication after bariatric surgery. Multiple treatment modalities including pharmacologic, endoscopic, and revisional surgery have been proposed. We present a case of a GPF managed successfully with a laparoendoscopic approach utilizing a fistula plug. A 43-year-old male patient presented with a GPF after a revisional bariatric surgery. A laparoendoscopic approach including lysis of adhesions, identification of the fistula, plugging the fistula with a BioGore A® fistula plug, placement an enteric stent, placement of a feeding tube, and surgical drainage was performed. The multimedia video illustrates the technique used. Postoperatively, upper gastrointestinal (UGI) imaging showed no evidence of leak. The enteric stent was removed after 2 months after verifying complete healing of the fistula. A laparoendoscopic approach to GPF repair with the use of fistula plug is effective, safe, and feasible.

A fibrin adhesive sealing method for the prevention of pancreatic fistula following distal pancreatectomy.

PubMed

Mita, Kazuhito; Ito, Hideto; Fukumoto, Masato; Murabayashi, Ryo; Koizumi, Kazuya; Hayashi, Takashi; Kikuchi, Hiroyuki; Kagaya, Tadashi

2011-01-01

Pancreatic fistula is the most common complication following distal pancreatectomy. We have developed a fibrin adhesive sealing method which covers the cut surface and parenchyma of the pancreas, to prevent pancreatic fistula. We performed 25 distal pancreatectomies. Fibrin adhesive (TachoComb) was applied to the staple line of the pancreas before stapling. Pancreatic fistula was defined and graded according to the International Study Group of Postoperative Pancreatic Fistula (ISGPF) definition. The overall incidence of pancreatic fistula was five cases (20%). Four cases (16%) were classified as Grade A. Only one case (4%) was classified as Grade B. In patients with or without pancreatic fistula, the mean length of postoperative hospital stay was not significant. The fibrin adhesive sealing method is a simple and effective method of preventing postoperative pancreatic fistula formation after distal pancreatectomy.

Enterovesical fistulas complicating Crohn's disease: clinicopathological features and management.

PubMed

Yamamoto, T; Keighley, M R

2000-08-01

Enterovesical fistula is a relatively rare condition in Crohn's disease. This study was undertaken to examine clinicopathological features and management of enterovesical fistula complicating Crohn's disease. Thirty patients with enterovesical fistula complicating Crohn's disease, treated between 1970 and 1997, were reviewed. Urological symptoms were present in 22 patients; pneumaturia in 18, urinary tract infection in 7, and haematuria in 2. In 5 patients clinical symptoms were successfully managed by conservative treatment, and they required no surgical treatment for enterovesical fistula. Twenty-five patients required surgery. All the patients were treated by resection of diseased bowel and pinching off the dome of the bladder. No patients required resection of the bladder. The Foley catheter was left in situ for an average of 2 weeks after operation. Three patients developed early postoperative complications; two bowel anastomotic leaks, and one intra-abdominal abscess. All these complications were associated with sepsis and multiple fistulas at the time of laparotomy. After a median follow-up of 13 years, 3 patients having postoperative sepsis (anastomotic leak or abscess) developed a recurrent fistula from the ileocolonic anastomosis to the bladder, which required further surgery. In the other 22 patients without postoperative complications there has been no fistula recurrence. In conclusion, the majority of patients with enterovesical fistula required surgical treatment: resection of the diseased bowel and oversewing the defect in the bladder. The fistula recurrence was uncommon, but the presence of sepsis and multiple fistulas at the time of laparotomy increased the incidence of postoperative complications and fistula recurrence.

Infratemporal fossa fat enlargement in chronic maxillary atelectasis.

PubMed

Kohn, Jocelyne C; Rootman, Daniel B; Xu, Dongdong; Goldberg, Robert A

2013-08-01

To describe the radiographic findings in chronic maxillary atelectasis and analyse the volume changes of the affected maxillary sinus, orbit, nasal vault and infratemporal fossa. Case series of all patients with diagnosis of chronic maxillary atelectasis presenting between January 2000 and August 2012 who underwent full oculoplastic and orbital evaluation including standardised photography and CT or MRI. Two-dimensional imaging features and volumetric changes were assessed. Affected and unaffected sides were compared. Demographic data, clinical presentation, Hertel measurements, photographic and radiological findings were analysed. 22 patients (64% men) met the inclusion criteria. Mean relative enophthalmos was 2.1 mm and mean hypoglobus was 1.8 mm. The most common radiographic findings were sinus opacification (91%), uncinate process retraction/middle meatus increase (91%), orbit enlargement (100%), ipsilateral septum deviation (64%) and infratemporal fossa fat enlargement (100%). Infratemporal fossa fat area and volume were significantly larger in the affected side (p<0.01). Additionally, ipsilateral orbit (p<0.01) and nasal vault volume (p<0.01) were similarly increased. Maxillary sinus volume correlated significantly only with infratemporal fossa fat enlargement (p<0.05). There is a significant increase in the infratemporal fossa fat, nasal and orbital volume corresponding to a decrease in maxillary sinus size in chronic maxillary atelectasis. Chronic maxillary atelectasis is associated with redistribution of volume between the maxillary sinus and the surrounding infratemporal fossa, orbit and nasal cavity.

Branchial cleft anomalies: accuracy of pre-operative diagnosis, clinical presentation and management.

PubMed

Guldfred, L-A; Philipsen, B B; Siim, C

2012-06-01

To examine the accuracy of the pre-operative diagnosis of branchial cleft anomalies, and also to describe their occurrence, clinical presentation and management. Retrospective review of the records of patients diagnosed with a branchial cleft anomaly between 1997 and 2006. One hundred and twenty-six patients were included. Pre-operative diagnosis had a positive predictive value of 0.856 (95 per cent confidence interval, 0.771-0.918) and a sensitivity of 0.944 (95 per cent confidence interval, 0.869-0.979). These patients' demographic data, investigations, findings and management are presented, along with a possible strategy for dealing with solitary cystic masses in the neck. As pre-operative diagnosis has a positive predictive value of 86 per cent, cystic lesions in the neck should be presumed to be carcinomatous until proven otherwise. Branchial fistulae and sinuses seem to be a disease of childhood, while branchial cysts occur mainly in adults. Branchial cleft anomalies are equally frequent in men and women, and equally distributed on the left and right side of the neck.

Guided surgical debridement: staining tissues with methylene blue.

PubMed

Dorafshar, Amir H; Gitman, Marina; Henry, Ginard; Agarwal, Shailesh; Gottlieb, Lawrence J

2010-01-01

Precise surgical debridement of wounds is required to achieve wound closure. The authors describe their experience with a technique using topical methylene blue to facilitate precise surgical debridement. In this technique, methylene blue dye is applied topically to the wound surface at the onset of surgery. The stained wound site is then wiped to remove dye from the surface of normal epithelium; eschar, nonviable tissue, and granulation tissue remain stained. The methylene blue-stained tissue is surgically removed, and the newly debrided surface of the wound is assessed for adequate vascularity and biopsied to verify presence of bacteriologic balance before closure. The authors have used this technique in more than 200 wound debridements during the past year, including acute surgical or traumatic wounds, acute and subacute burn wounds, chronic granulating wounds, partially epithelialized wounds, sinus tracts, and fistulae. No adverse reactions have been noted, even on patients undergoing multiple applications through serial operations. Topical application of methylene blue to wounds with mixed tissue content helps to distinguish between viable and nonviable tissue and between epithelialized and nonepithelialized areas, facilitating more precise and complete wound debridement.

Differential diagnosis and treatment of periodontitis-mimicking actinomycosis.

PubMed

Kim, Nam Ryang; Park, Jun-Beom; Ko, Youngkyung

2012-12-01

Actinomycosis is an uncommon chronic granulomatous disease that presents as a slowly progressive, indolent, indurated infiltration with multiple abscesses, fistulas, and sinuses. The purpose of this article is to report on a case of actinomycosis with clinical findings similar to periodontitis. A 46-year-old female presented with recurrent throbbing pain on the right first and second molar of the mandible three weeks after root planing. Exploratory flap surgery was performed, and the bluish-gray tissue fragment found in the interproximal area between the two molars was sent for histopathology. The diagnosis from the biopsy was actinomycosis. The clinical and radiographic manifestations of this case were clinically indistinguishable from periodontitis. The patient did not report any symptoms, and she is scheduled for a follow-up visit. The present study has identified periodontitis-mimicking actinomycosis. Actinomycosis should be included in the differential diagnosis in cases with periodontal pain and inflammation that do not respond to nonsurgical treatment for periodontitis. More routine submissions of tissue removed from the oral cavity for biopsies may be beneficial for differential diagnosis.

Dental anatomy and pathology encountered on routine CT of the head and neck.

PubMed

Steinklein, Jared; Nguyen, Vinh

2013-12-01

Although dental CT is not routinely performed at hospital imaging centers, dental and periodontal disease can be recognized on standard high-resolution CT of the neck and face. These findings can have significant implications with regard to not only dental disease, but also diseases of the sinuses, jaw, and surrounding soft tissues. This article serves to review dental and periodontal anatomy and pathology as well as other regional entities with dental involvement and to discuss the imaging findings. Recognition of dental and periodontal disease has the potential to affect management and preclude further complications, thereby preserving the smile, one of the most recognizable and attractive features of the human face and, unfortunately, often disease ridden. Although practicing good oral hygiene and visiting the dentist for regular examinations and cleanings are the most effective ways to prevent disease, some patients do not take these preventative measures. Thus, radiologists play a role in diagnosing dental disease and complications such as chronic periodontitis and abscesses, nonhealing fractures and osteomyelitis, oroantral fistulas, tumoral diseases, osteonecrosis of the jaw, and other conditions.

[Excision and immediate suture technic in the treatment of pilonidal fistula. Our experience].

PubMed

Calcina, G; Setti, P; Benati, L; Savioli, A; Galli, G

1995-09-01

The authors report their personal experience of the "excision and primary suture" operating technique in the surgical treatment of pilonidal sinus. A rapid recovery by postoperative day 10 was achieved in 58 out of 60 cases treated (96.7%). Dehiscence of the surgical wound was observed in 2 cases (3.3%) following ischemic lesion caused by decubitus of the cutaneous margins and healing occurred by second intenti. No cases of short- or long-term recidivation were observed. The advantages of this method are the early return to working activities, minor patient discomfort and the reduced risk that the surgical would might become infected. Three basic stages for the successful outcome of this type of surgery have been identified as follows: 1) Although and accurate tricotomy of the sacro-coccigeal region. Antibiotic therapy is started about 2 hours before surgery. 2) The precise execution of the surgical technique. 3) The continuation of antibiotic therapy until postoperative day 7. Compressive medication is removed on postoperative day 4. If these three basic stages are respected, no cases of recidivation will occur.

The incidence of coronary anomalies on routine coronary computed tomography scans

PubMed Central

Karabay, Kanber Ocal; Yildiz, Abdulmelik; Bagirtan, Bayram; Geceer, Gurkan; Uysal, Ender

2013-01-01

Summary Objective This study aimed to assess the incidence of coronary anomalies using 64-multi-slice coronary computed tomography (MSCT). Methods The diagnostic MSCT scans of 745 consecutive patients were reviewed. Results The incidence of coronary anomalies was 4.96%. The detected coronary anomalies included the conus artery originating separately from the right coronary sinus (RCS) (n = 8, 1.07%), absence of the left main artery (n = 7, 0.93%), a superior right coronary artery (RCA) (n = 7, 0.93%), the circumflex artery (CFX) arising from the RCS (n = 4, 0.53%), the CFX originating from the RCA (n = 2, 0.26%), a posterior RCA (n = 1, 0.13%), a coronary fistula from the left anterior descending artery and RCA to the pulmonary artery (n = 1, 0.13%), and a coronary aneurysm (n = 1, 0.13%). Conclusions This study indicated that MSCT can be used to detect common coronary anomalies, and shows it has the potential to aid cardiologists and cardiac surgeons by revealing the origin and course of the coronary vessels. PMID:24042853

Surgical management of enterocutaneous fistula.

PubMed

Lee, Suk-Hwan

2012-01-01

Enterocutaneous (EC) fistula is an abnormal connection between the gastrointestinal (GI) tract and skin. The majority of EC fistulas result from surgery. About one third of fistulas close spontaneously with medical treatment and radiologic interventions. Surgical treatment should be reserved for use after sufficient time has passed from the previous laparotomy to allow lysis of the fibrous adhesion using full nutritional and medical treatment and until a complete understanding of the anatomy of the fistula has been achieved. The successful management of GI fistula requires a multi-disciplinary team approach including a gastroenterologist, interventional radiologist, enterostomal therapist, dietician, social worker and surgeons. With this coordinated approach, EC fistula can be controlled with acceptable morbidity and mortality.

Surgical Management of Enterocutaneous Fistula

PubMed Central

2012-01-01

Enterocutaneous (EC) fistula is an abnormal connection between the gastrointestinal (GI) tract and skin. The majority of EC fistulas result from surgery. About one third of fistulas close spontaneously with medical treatment and radiologic interventions. Surgical treatment should be reserved for use after sufficient time has passed from the previous laparotomy to allow lysis of the fibrous adhesion using full nutritional and medical treatment and until a complete understanding of the anatomy of the fistula has been achieved. The successful management of GI fistula requires a multi-disciplinary team approach including a gastroenterologist, interventional radiologist, enterostomal therapist, dietician, social worker and surgeons. With this coordinated approach, EC fistula can be controlled with acceptable morbidity and mortality. PMID:22563283

[Role of nutritional support in the treatment of enteric fistulas].

PubMed

Amodeo, Corrado; Caglià, Pietro; Gandolfo, Luigi; Veroux, Massimiliano; Brancato, Giovanna; Donati, Marcello

2002-01-01

Enteric fistulas are nowadays considered an important therapeutic challenge. Artificial, total parenteral and enteral nutrition have allowed an improvement in the healing of these fistulas and a lower incidence of mortality. Fourteen patients with enteric fistulas (10 men, 4 women; mean age: 64.4 years; range: 20-80 years) were observed. The fistula was located in the large bowel in 11 patients, in the ileum in 2, and in the jejunum in 1. Thirteen patients received enteral nutrition. The patient with the jejunal fistula received total parenteral nutrition for 30 days and then enteral nutrition. The fistulas were successfully treated in 11 patients. One patients underwent surgery after 6 weeks of treatment with enteral nutrition because of lack of improvement of the symptomatology. In two patients, with advanced cancer of the colon and stomach, respectively, only a reduction of the fistula output was achieved. Nutritional support in the treatment of enteric fistulas is an effective procedure widely utilised to restore adequate nutritional status and bowel rest, which are two important targets for achieving fistula closure. Nutritional support is also useful in the management of patients undergoing surgery in order to reduce the postoperative complication rate.

Psychological Symptoms Among Obstetric Fistula Patients Compared to Gynecology Outpatients in Tanzania

PubMed Central

Wilson, Sarah M.; Sikkema, Kathleen J.; Watt, Melissa H.; Masenga, Gileard G.

2016-01-01

Background Obstetric fistula is a childbirth injury prevalent in sub-Saharan Africa that causes uncontrollable leaking of urine and/or feces. Research has documented the social and psychological sequelae of obstetric fistula, including mental health dysfunction and social isolation. Purpose This cross-sectional study sought to quantify the psychological symptoms and social support in obstetric fistula patients, compared with a patient population of women without obstetric fistula. Methods Participants were gynecology patients (N = 144) at the Kilimanjaro Christian Medical Center in Moshi, Tanzania, recruited from the Fistula Ward (n = 54) as well as gynecology outpatient clinics (n = 90). Measures included previously validated psychometric questionnaires, administered orally by Tanzanian nurses. Outcome variables were compared between obstetric fistula patients and gynecology outpatients, controlling for background demographic variables and multiple comparisons. Results Compared to gynecology outpatients, obstetric fistula patients reported significantly higher symptoms of depression, posttraumatic stress disorder, somatic complaints, and maladaptive coping. They also reported significantly lower social support. Conclusions Obstetric fistula patients present for repair surgery with more severe psychological distress than gynecology outpatients. In order to address these mental health concerns, clinicians should engage obstetric fistula patients with targeted mental health interventions. PMID:25670025

Imaging features of colovesical fistulae on MRI.

PubMed

Tang, Y Z; Booth, T C; Swallow, D; Shahabuddin, K; Thomas, M; Hanbury, D; Chang, S; King, C

2012-10-01

MRI is routinely used in the investigation of colovesical fistulae at our institute. Several papers have alluded to its usefulness in achieving the diagnosis; however, there is a paucity of literature on its imaging findings. Our objective was to quantify the MRI characteristics of these fistulae. We selected all cases over a 4-year period with a final clinical diagnosis of colovesical fistula which had been investigated with MRI. The MRI scans were reviewed in a consensus fashion by two consultant uroradiologists. Their MRI features were quantified. There were 40 cases of colovesical fistulae. On MRI, the fistula morphology consistently fell into three patterns. The most common pattern (71%) demonstrated an intervening abscess between the bowel wall and bladder wall. The second pattern (15%) had a visible track between the affected bowel and bladder. The third pattern (13%) was a complete loss of fat plane between the affected bladder and bowel wall. MRI correctly determined the underlying aetiology in 63% of cases. MRI is a useful imaging modality in the diagnosis of colovesical fistulae. The fistulae appear to have three characteristic morphological patterns that may aid future diagnoses of colovesical fistulae. To the authors' knowledge, this is the first publication of the MRI findings in colovesical fistulae.

Permacol™ collagen paste injection for the treatment of complex anal fistula: 1-year follow-up.

PubMed

Fabiani, B; Menconi, C; Martellucci, J; Giani, I; Toniolo, G; Naldini, G

2017-03-01

Optimal surgical treatment for anal fistula should result in healing of the fistula track and preserve anal continence. The aim of this study was to evaluate Permacol™ collagen paste (Covidien plc, Gosport, Hampshire, UK) injection for the treatment of complex anal fistulas, reporting feasibility, safety, outcome and functional results. Between May 2013 and December 2014, 21 consecutive patients underwent Permacol paste injection for complex anal fistula at our institutions. All patients underwent fistulectomy and seton placement 6-8 weeks before Permacol™ paste injection. Follow-up duration was 12 months. Eighteen patients (85.7%) had a high transsphincteric anal fistula, and three female patients (14.3%) had an anterior transsphincteric fistula. Fistulas were recurrent in three patients (14.3%). Seven patients (33%) had a fistula with multiple tracts. After a follow-up of 12 months, ten patients were considered healed (overall success rate 47.6%). The mean preoperative FISI score was 0.33 ± 0.57 and 0.61 ± 1.02 after 12 months. Permacol™ paste injection was safe and effective in some patients with complex anal fistula without compromising continence.

New Methods for the Analysis of Heartbeat Behavior in Risk Stratification

PubMed Central

Glass, Leon; Lerma, Claudia; Shrier, Alvin

2011-01-01

Developing better methods for risk stratification for tachyarrhythmic sudden cardiac remains a major challenge for physicians and scientists. Since the transition from sinus rhythm to ventricular tachycardia/fibrillation happens by different mechanisms in different people, it is unrealistic to think that a single measure will be adequate to provide a good index for risk stratification. We analyze the dynamical properties of ventricular premature complexes over 24 h in an effort to understand the underlying mechanisms of ventricular arrhythmias and to better understand the arrhythmias that occur in individual patients. Two dimensional density plots, called heartprints, correlate characteristic features of the dynamics of premature ventricular complexes and the sinus rate. Heartprints show distinctive characteristics in individual patients. Based on a better understanding of the natures of transitions from sinus rhythm to sudden cardiac and the mechanisms of arrhythmia prior to cardiac arrest, it should be possible to develop better methods for risk stratification. PMID:22144963

Good clinical outcomes from a 7-year holistic programme of fistula repair in Guinea.

PubMed

Delamou, Alexandre; Diallo, Moustapha; Beavogui, Abdoul Habib; Delvaux, Thérèse; Millimono, Sita; Kourouma, Mamady; Beattie, Karen; Barone, Mark; Barry, Thierno Hamidou; Khogali, Mohamed; Edginton, Mary; Hinderaker, Sven Gudmund; Ruminjo, Joseph; Zhang, Wei-Hong; De Brouwere, Vincent

2015-06-01

Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country. This was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014. The majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3 months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up. Routine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Three-dimensional contrast-enhanced magnetic resonance angiography (3-D CE-MRA) in the evaluation of hemodialysis access complications, and the condition of central veins in patients who are candidates for hemodialysis access.

PubMed

Paksoy, Yahya; Gormus, Niyazi; Tercan, Mehmet Akif

2004-01-01

Arteriovenous (AV) fistulas are crucial in patients requiring long-term hemodialysis (HD). Dysfunctions of these fistulas are the most common causes of recurrent hospitalizations. This study aimed to evaluate the feasibility, safety and usefulness of contrast-enhanced magnetic resonance angiography (CE-MRA) in the evaluation of HD fistulas complications, and the condition of the central veins before HD access. This study comprised 30 consecutive patients (15 females, 15 males; age range 25-66 yrs, mean +/- SD 51.2 +/- 9.9 yrs). Of 30 patients, 26 had native AV fistulas and the remaining four patients, who had a history of previous subclavian vein catheterization, were candidates for HD fistulas. Nine patients had a radiocephalic fistula, 15 had a brachiobasilic fistula, one had a saphenous vein graft, and one had brachiobasilic vein transposition. To observe the fistula complications in these cases, three-dimensional (3-D) CE-MRA using gadolinium was performed. The results were considered normal in three patients (10%), who were candidates for AV fistula construction; one patient had central vein occlusion due to previous catheterization. Thirteen patients (43.3%) had venous stenosis or occlusion; three of them (10%) had low CE arteries distal to fistula region, leading to ischemic complications, and six (20%) had stenosis at the fistula region. Seven patients (23.3%) had venous pseudoaneurysms, whereas two of them had both pseudoaneurysms and fistula region stenosis, and one had both venous stenosis and pseudoaneurysm. There were no adverse or allergic-like reactions or heat and taste sensations observed in our series. 3-D CE-MRA is a useful, safe and a practical imaging modality in complicated fistula diagnosis with fewer complications and side-effects in comparison to fistulography.

Clinical Features of Tuberculous Versus Crohn's Anal Fistulas, in Korea.

PubMed

Choi, Yong-Sung; Kim, Do-Sun; Lee, Jae-Bum; Kim, Jong-Kyu; Jung, Hyung-Joong; Lee, Seong-Dae; Song, Kee-Ho; Lee, Doo-Han; Kim, Mi-Jung

2015-12-01

In Western countries, tuberculous anal fistula may not be an issue because tuberculosis [TB] is not common, and this is a very rare form of extrapulmonary manifestation of TB. However in TB-endemic countries, careful diagnostic differentiation is required because the clinical features of TB anal fistula and Crohn's disease [CD] anal fistula are similar, with distinguishing features remaining unclear. We aimed to analyse the clinical features of TB versus CD anal fistulas. Among 13872 patients who underwent anal fistula surgery from 2003 to 2014, 87 patients with TB fistulas and 116 patients with CD fistulas were included. Data on the annual incidence of TB and CD, as well as the clinical, pathological, ultrasonographic, colonoscopic and surgical data were analysed. Compared with CD, the TB group was older [median: 37 vs 22 years] and underlying chronic illness was more common [20.3% vs 2.6%]. In the TB group, 46 patients [59.7%] showed active or inactive pulmonary TB, and acid-fast bacilli and caseating granuloma were found in 56.3% and 62.1%, respectively. During colonoscopy, mucosal lesions were observed more frequently in CD [96.9% vs 16.9%]. TB anal fistula is clinically very similar to CD anal fistula. In Korea, the incidence of CD anal fistula has recently increased in prevalence, whereas the prevalence of TB anal fistula is decreasing but is still persistent. We recommend that clinicians should prepare for a possibility of TB as well as CD anal fistula in TB-endemic countries including Korea. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Three-dimensional endoanal ultrasound is accurate and reproducible in determining type and height of anal fistulas.

PubMed

Kołodziejczak, M; Santoro, G A; Obcowska, A; Lorenc, Z; Mańczak, M; Sudoł-Szopińska, I

2017-04-01

Surgical treatment of high anal fistulas is associated with the potential risk of faecal incontinence and recurrence. The primary aim of this study was to determine the accuracy of three-dimensional endoanal ultrasound (3D-EAUS) in the assessment of height and type of anal fistulas, compared to the intra-operative findings (gold standard). The secondary aim was to evaluate the inter-observer reproducibility of 3D-EAUS. The study design was a prospective analysis of retrospective data. 299 patients (202 men), mean age 45.3 years, who underwent surgery for anal fistulas, were included. All patients were preoperatively assessed by 3D-EAUS. Two readers independently reviewed the volumes to determine the type and height of fistulas. Sensitivity, specificity, positive and negative predictive values, proportion of agreements and Cohen's kappa coefficient (κ) were calculated for both examiners. Ultrasound findings were compared with intra-operative data (reference standard), evaluated blindly by the surgeons. At surgery, 201 (67%) were transsphincteric, 49 (16%) suprasphincteric, 47 (16%) intersphincteric and two (1%) extrasphincteric fistulas. Intra-operatively, 177 (59%) were low and 122 (41%) high fistulas. The overall accuracy of 3D-EAUS was 91% for fistula type (271/299 fistulas: 97% transsphincteric, 100% intersphincteric, 57% suprasphincteric, 0% extrasphincteric) and 92% for fistula height (275/299 fistulas: 80% high and 100% low). Both readers reported very good agreement with surgery in the assessment of fistula type (proportion of agreement 0.88, κ = 0.89) and height (proportion of agreement 0.90, κ = 0.91). 3D-EAUS is an accurate and reproducible modality for the assessment of type and height of anal fistulas. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

Logistic regression analysis of the risk factors of anastomotic fistula after radical resection of esophageal-cardiac cancer.

PubMed

Huang, Jinxi; Zhou, Yi; Wang, Chenghu; Yuan, Weiwei; Zhang, Zhandong; Chen, Beibei; Zhang, Xiefu

2017-11-01

This study was conducted to investigate the risk factors of anastomotic fistula after the radical resection of esophageal-cardiac cancer. Five hundred and forty-four esophageal-cardiac cancer patients who underwent surgery and had complete clinical data were included in the study. Fifty patients diagnosed with postoperative anastomotic fistula were considered the case group and the remaining 494 subjects who did not develop postoperative anastomotic fistula were considered the control. The potential risk factors for anastomotic fistula, such as age, gender, diabetes history, smoking history, were collected and compared between the groups. Statistically significant variables were substituted into logistic regression to further evaluate the independent risk factors for postoperative anastomotic fistulas in esophageal-cardiac cancer. The incidence of anastomotic fistulas was 9.2% (50/544). Logistic regression analysis revealed that female gender (P < 0.05), laparoscopic surgery (P < 0.05), decreased postoperative albumin (P < 0.05), and postoperative renal dysfunction (P < 0.05) were independent risk factors for anastomotic fistulas in patients who received surgery for esophageal-cardiac cancer. Of the 50 anastomotic fistulas, 16 cases were small fistulas, which were only discovered by conventional imaging examination and not presenting clinical symptoms. All of the anastomotic fistulas occurred within seven days after surgery. Five of the patients with anastomotic fistulas underwent a second surgery and three died. Female patients with esophageal-cardiac cancer treated with endoscopic surgery and suffering from postoperative hypoproteinemia and renal dysfunction were susceptible to postoperative anastomotic fistula. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

[Endovascular treatment of carotid-cavernous fistula type A with platinium coils].

PubMed

Culafić, Slobodan; Juszkat, Robert; Rusović, Sinisa; Stefanović, Dara; Minić, Ljubodrag; Spaić, Milan

2008-12-01

Carotid-cavernous fistulas are abnormal communications between carotid arteries or their branches and the cavernous system caused mostly by trauma. Posttraumatic fistulas represent 70% of all carotid-cavernous fistulas and they are mostly high-flow shunts (type A). This type gives characteristic eye symptoms. This paper presents a 44-year old male patient with carotid-cavernous fistula as a result of penetrating head injury. In clinical presentation the patient had exophthalmos, conjunctival chemosis and weakening of vision on the right eye, headache and diplopia. Digital subtracted angiography showed high-flow carotid-cavernous fistula, which was vascularised from the left carotid artery and from vertebrobasilar artery. Endovascular embolization with platinum coils was performed through the transarterial route (endoarterial approach). Check angiogram confirmed that the fistula was closed and that no new communications developed. Embolization of complex carotid-cavernous fistula type A was successfully performed with platinum coils by endovascular approach.

Percutaneous treatment of a duodenocutaneous high-flow fistula using a new biological plug

PubMed Central

Vallejo, Eduardo Crespo; Martinez-Galdamez, Mario; Del Olmo Martínez, Lourdes; Brunet, Eduardo Crespo; Martin, Ernesto Santos

2015-01-01

Enterocutaneous fistula is a challenging entity and a gold-standard treatment is not settled so far. Here, we describe the successful closure of a duodenocutaneous fistula with the use of the Biodesign enterocutaneous fistula plug (Cook Medical), which is derived from a biological plug that has been used in recent years in order to close anorectal fistula tracts. PMID:25835076

Acquired fistula of the lacrimal sac and laisser-faire approach. Description of the natural history of acquired fistulas between the lacrimal sac and the skin occurring before planned endonasal dacryocystorhinostomy (DCR) and without any treatment of the fistula.

PubMed

Pison, A; Fau, J-L; Racy, E; Fayet, B

2016-10-01

The formation of a fistula between the lacrimal sac and the skin is a classic outcome of resistant lacrimal sac abscesses. There is currently no consensus about treatment in such cases. The goal of this study was to describe the natural history of acquired fistulas between the lacrimal sac and the skin, occurring before planned endonasal dacryocystorhinostomy (DCR) and without any treatment of the fistula. This prospective study was only descriptive and included patients between 1999 and 2012. The patients included were adults with a nasolacrimal duct (NLD) obstruction that was planned to be treated with endonasal DCR. A resistant lacrimal sac abscess appeared a few days before the planned surgery, and fistulized spontaneously despite medical treatment. The surgery was not delayed. The DCR was endoscopic. Nothing was done for the fistula. Its healing was spontaneous. The exclusion criteria were the following: congenital fistulas, post-traumatic and/or iatrogenic fistulas, fistulas which had regressed by the day of the surgery, postoperative follow-up less than 5 months, post-traumatic and/or iatrogenic fistulas, any history of previous DCR or any other lacrimal surgery, children. Twenty adults (25 cases) were included in the analysis. Mean age was 79 years old (from 41 to 90). The mean follow-up was 41 months (from 5 to 108 months). The fistula spontaneously disappeared in all cases, less than one month after it had appeared and in a permanent fashion. No unsightly scar developed. Spontaneously acquired fistulas between the lacrimal sac and the skin may occur in the natural course of abscessed acute dacryocystitis. Our study showed spontaneous healing of the fistula post-endoscopic DCR. Fistula excision in fistulous acute dacryocystitis does not seem essential to its healing. The laisser-faire approach appears adequate for aesthetic outcomes as well as for functional outcomes of DCR. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Evaluation of the effectiveness of octreotide in the conservative treatment of postoperative enterocutaneous fistulas.

PubMed

Alivizatos, Vassilos; Felekis, Dimitrios; Zorbalas, Athanasios

2002-01-01

The aim of this study was to evaluate the effectiveness of Octreotide as an adjunct treatment to total parenteral nutrition in the spontaneous closure of postoperative enterocutaneous fistulas. Medical records of 39 patients with postoperative enterocutaneous fistulas treated in our Department between January 1988 and August 2000 were reviewed. Sixteen patients had duodenal fistulas and 23 had jejunal or ileal fistulas. According to the daily output, there were 20 low fistula output and 19 high fistula output. Conservative treatment consisted of nutritional support with total parenteral nutrition in all the patients. Administration of Octreotide (100 micrograms every 8 hours, subcutaneously) was done in 21 consecutive patients until spontaneous closure of the fistulas or their subsequent surgical closure. The occurrence of fistulas closure was compared using the Fisher's exact test. A mean reduction of 50% of fistula output was noted in all the patients who received Octreotide, within 24 hours of its administration. Spontaneous closure was achieved in 13 patients of the Octreotide group (mean closure time: 15.3 days, range: 6-35) and in 12 patients treated only with total parenteral nutrition (mean closure time: 13.9 days, range: 7-25); this difference was not significant (P = 0.5). Also, the fistula closure rate was not influenced by the anatomic site, the high or low output, and the age of the patient. The results of this study suggest that, as an adjunct treatment to total parenteral nutrition, Octreotide reduces rapidly the fistula output without significant influence in the spontaneous closure rate.

Superior Patency of Upper Arm Arteriovenous Fistulae in High Risk Patients

PubMed Central

Chiulli, Larissa C; Vasilas, Penny; Dardik, Alan

2011-01-01

Background Despite an increased propensity to primary failure in forearm arteriovenous fistulae compared to upper arm fistulae, forearm fistulae remain the preferred primary access type for chronic hemodialysis patients. In a high risk patient population with multiple medical comorbidities associated with requirement for intravenous access we compared the rates of access failure in forearm and upper arm fistulae. Materials and Methods The records of all patients having primary native arteriovenous fistulae placed between 2004 and 2009 at the VA Connecticut Healthcare system were reviewed (n=118). Primary and secondary patency of upper arm and forearm fistulae were evaluated using Kaplan-Meier survival analysis. The effects of medical comorbidities on access patency were analyzed with Cox regression. Results The median time to primary failure of the vascular access was 0.288 years in the forearm group compared to 0.940 years in the upper arm group (p=0.028). Secondary patency was 52% at 4.9 years in upper arm fistulae compared to 52% at 1.1 years in the forearm group (p=0.036). There was no significant effect of patient comorbidities on fistula failure; however, there was a trend toward upper arm surgical site as a protective factor for primary fistula patency (Hazard Ratio=0.573, p=0.076). Conclusions In veterans needing hemodialysis, a high risk population with extensive comorbid factors often requiring intravascular access, upper arm fistulae are not only a viable option for primary vascular access, but are likely to be a superior option to classic forearm fistulae. PMID:21571318

The association between female genital fistula symptoms and gender-based violence: A multicountry secondary analysis of household survey data.

PubMed

Mallick, Lindsay; Tripathi, Vandana

2018-01-01

The Demographic and Health Surveys (DHS), which include standardised questions on female genital fistula symptoms, provide a unique opportunity to evaluate the epidemiology of fistula. This study sought to examine associations between self-reported fistula symptoms and experience of gender-based violence (GBV) among women interviewed in DHS surveys. This study used data from thirteen DHS surveys with standardised fistula and domestic violence modules. Data from the most recent survey in each country were pooled, weighting each survey equally. Multivariable logistic regressions controlled for maternal and demographic factors. Prevalence of fistula symptoms in this sample of 95 625 women ranges from 0.3% to 1.8% by country. The majority of women reporting fistula symptoms (56%) have ever experienced physical violence, and more than one-quarter have ever experienced sexual violence (27%), compared with 38% and 13% among women with no symptoms, respectively. Similarly, 16% of women with fistula symptoms report recently experiencing sexual violence-twice the percentage among women not reporting symptoms (8%). Women whose first experience of sexual violence was from a non-partner have almost four times the odds of reporting fistula symptoms compared with women who never experienced sexual violence. These associations indicate a need to investigate temporal and causal relationships between violence and fistula. The increased risk of physical and sexual violence among women with fistula symptoms suggests that fistula programmes should incorporate GBV into provider training and services. © 2017 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Fistulizing Crohn's disease: Diagnosis and management.

PubMed

Gecse, Krisztina; Khanna, Reena; Stoker, Jaap; Jenkins, John T; Gabe, Simon; Hahnloser, Dieter; D'Haens, Geert

2013-06-01

Fistulizing Crohn's disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn's disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery.

[Effects of nutritional support on the hypermetabolism of patients with digestive tract fistula].

PubMed

Chi, Qiang

2012-05-01

Digestive tract fistulas are abnormal connections between gastrointestinal tract and other organs that most commonly occur after surgery. Morbidity and mortality associated with postoperative fistulas are substantial as they are highly associated with nutritional deficits, hypermetabolism, septic complications and concomitant diseases that may appear during prolonged hospital stay. Digestive tract fistula is a challenging condition that involves a multidisciplinary approach to management. The main treatment includes intestinal rest,correction of electrolytic disturbances, parenteral nutrition,protection of the skin surrounding the fistula, and treatment and prophylaxis of any related local or systemic septic complications. Nutritional support, which is an effective and promising treatment for patients with digestive tract fistulas, can promote the closure of the fistula and decrease the duration of hospital stay.

Minimally Invasive Repair of a Prostatorectal Fistula with an Over-the-Scope Rectal Clip

PubMed Central

Schmidt-Heikenfeld, Ekkehard; Degener, Stephan; Roosen, Alexander; Boy, Anselm

2017-01-01

Abstract Background: Fistulae between the prostatic urethra and the rectum are rare. They may result from prostatic or rectal surgery. Predisposing factors are previous radiation or immunosuppression. The repair of such fistulae usually involves major surgery. Recently, clips that can be deployed over an endoscope have been developed to close gastrointestinal fistulae or access points for natural orifice surgery. We report the first case of effective treatment of a prostatorectal fistula with a rectal “over-the-scope” clip. Case Presentation: A 64-year-old man under chronic immunosuppression presented with an iatrogenic fistula between the prostatic urethra and the rectum after transurethral resection of the prostate. A transverse colostomy was placed but the fistula failed to heal conservatively. The fistula was effectively closed with an endorectal clip. Six weeks after the procedure, spontaneous micturition was started. Two weeks further, the colostomy was reversed. At 32 months of follow-up, the remains closed, micturition is unimpaired. Conclusion: In select cases of prostatorectal fistula, an endorectal clip may be effectively used for closure. PMID:29098198

Brain oxygen saturation assessment in neonates using T2-prepared blood imaging of oxygen saturation and near-infrared spectroscopy.

PubMed

Alderliesten, Thomas; De Vis, Jill B; Lemmers, Petra Ma; Hendrikse, Jeroen; Groenendaal, Floris; van Bel, Frank; Benders, Manon Jnl; Petersen, Esben T

2017-03-01

Although near-infrared spectroscopy is increasingly being used to monitor cerebral oxygenation in neonates, it has a limited penetration depth. The T 2 -prepared Blood Imaging of Oxygen Saturation (T 2 -BIOS) magnetic resonance sequence provides an oxygen saturation estimate on a voxel-by-voxel basis, without needing a respiratory calibration experiment. In 15 neonates, oxygen saturation measured by T 2 -prepared blood imaging of oxygen saturation and near-infrared spectroscopy were compared. In addition, these measures were compared to cerebral blood flow and venous oxygen saturation in the sagittal sinus. A strong linear relation was found between the oxygen saturation measured by magnetic resonance imaging and the oxygen saturation measured by near-infrared spectroscopy ( R 2  = 0.64, p < 0.001). Strong linear correlations were found between near-infrared spectroscopy oxygen saturation, and magnetic resonance imaging measures of frontal cerebral blood flow, whole brain cerebral blood flow and venous oxygen saturation in the sagittal sinus ( R 2  = 0.71, 0.50, 0.65; p < 0.01). The oxygen saturation obtained by T 2 -prepared blood imaging of oxygen saturation correlated with venous oxygen saturation in the sagittal sinus ( R 2  = 0.49, p = 0.023), but no significant correlations could be demonstrated with frontal and whole brain cerebral blood flow. These results suggest that measuring oxygen saturation by T 2 -prepared blood imaging of oxygen saturation is feasible, even in neonates. Strong correlations between the various methods work as a cross validation for near-infrared spectroscopy and T 2 -prepared blood imaging of oxygen saturation, confirming the validity of using of these techniques for determining cerebral oxygenation.

PREVALENCE AND INTENSITY OF THE SINUS ROUNDWORM ( SKRJABINGYLUS CHITWOODORUM) IN RABIES-NEGATIVE SKUNKS OF TEXAS, USA.

PubMed

Hughes, Malorri R; Negovetich, Nicholas J; Mayes, Bonny C; Dowler, Robert C

2018-01-01

:  Estimates of the distribution and prevalence of the sinus roundworm ( Skrjabingylus chitwoodorum) have been based largely on the inspection of skunk (Mephitidae) skulls showing damage from infections. We examined 595 striped skunks ( Mephitis mephitis) and nine hog-nosed skunks ( Conepatus leuconotus) that had tested negative for rabies by the Texas Department of State Health Services (US) between November 2010 and April 2015 to determine species of Skrjabingylus, prevalence and intensity of infection, and distribution of infection in Texas by county. We expected ecoregions with more precipitation to have higher rates of infection than more-arid ecoregions. Prevalence of S. chitwoodorum in striped skunks was 48.7%, with a mean intensity of 19.4 (SD=24.44, range=1-181) nematodes. There was a bias for the left sinus. The prevalence of infection varied among ecoregions of Texas, but it was not correlated with precipitation. Infection intensity did not vary among ecoregions. The prevalence of sinus roundworms in rabies-negative skunks suggested that behavioral changes because of skrjabingylosis might have been responsible for the submission by the public of some skunks for rabies testing.

Sinonasal anatomical variations: their relationship with chronic rhinosinusitis and effect on the severity of disease-a computerized tomography assisted anatomical and clinical study.

PubMed

Kaygusuz, Ahmet; Haksever, Mehmet; Akduman, Davut; Aslan, Sündüs; Sayar, Zeynep

2014-09-01

The anatomy of the sinonasal area has a very wide rage of anatomical variations. The significance of these anatomical variations in pathogenesis of rhinosinusitis, which is the commonest disease in the region, is still unclear. The aims of the study were to compare the rate of sinonasal anatomical variations with development and severity of chronic rhinosinusitis patients. CT scan of paranasal sinuses images of 99 individuals were retrospectively reviewed. 65 cases of chronic rhinosinusitis (study group) who had undergone endoscopic sinus surgery were compared with 34 cases without chronic rhinosinusitis (control group). Also in study group Lund-Mackay score of the sinus disease were calculated and compared to the rate of related anatomical variations. There were 74 (74.7 %) males and 25 (25.2 %) females with ages ranging from 13 to 70 years (mean 32.2 years). The anatomical variations recorded were: Septal deviation 47 (72.3) in study and 25 (73.5 %) in control group, concha bullosa 27 (41.5 %) in study and 18 (52.9 %) in control group, overpneumatized ethmoid bulla 17 (26.1 %) in study and 14 (41.1 %) in control group, pneumatized uncinate 3 (4.6 %) in study and 3 (8.8 %) in control group, agger nasi 42 (64.6 %) in study and 19 (55.8 %) in control group, paradoxical middle turbinates 9 (13.8 %) in study and 4 (11.7 %) in control group, Onodi cell 6 (9.2 %) in study and 2 (5.8 %) in control group, Haller's cells (infraorbital ethmoid cell) 9 (13.8 %) in study and 7 (20.5 %) in control group. None of these results were statistically significant between study and control group (p > 0.05). Lund-Mackay score (which was assumed to show the severity of the disease) of the maxillary, ethmoid and frontal sinus were calculated and compared to rate of septal deviation, concha bullosa, agger nasi cells. No significant correlation was conducted (p > 0.05). The results of study showed no statistically significant correlation between sinonasal anatomical variations and pathologies of the paranasal sinus. Also these anatomical variations did not increase the severity of pre-existing sinusitis significantly. This is a retrospective cohort study (2b).

Arterio-biliary fistula as rare complication of chemoradiation therapy for intrahepatic cholangiocarcinoma

PubMed Central

Hayano, Koichi; Miura, Fumihiko; Amano, Hodaka; Toyota, Naoyuki; Wada, Keita; Kato, Kenichiro; Takada, Tadahiro; Asano, Takehide

2010-01-01

Significant hemobilia due to arterio-biliary fistula is a very rare complication of chemoradiation therapy (CRT) for unresectable intrahepatic cholangiocarcinoma (ICC). Here we report a case of arterio-biliary fistula after CRT for unresectable ICC demonstrated by angiographic examinations. This fistula was successfully treated by endovascular embolization. Hemobilia is a rare complication, but arterio-biliary fistula should be considered after CRT of ICC. PMID:21160700

Management of enterocutaneous fistulas.

PubMed

Schecter, William P

2011-06-01

Management of enterocutaneous fistulas (ECFs) involves (1) recognition and stabilization, (2) anatomic definition and decision, and (3) definitive operation. Phase 1 encompasses correction of fluid and electrolyte imbalance, skin protection, and nutritional support. Abdominal imaging defines the anatomy of the fistula in phase 2. ECFs that do not heal spontaneously require segmental resection of the bowel segment communicating with the fistula and restoration of intestinal continuity in phase 3. The enteroatmospheric fistula (EAF) is a malevolent condition requiring prolonged wound care and nutritional support. Complex abdominal wall reconstruction immediately following fistula resection is necessary for all EAFs. 2011 Elsevier Inc. All rights reserved.

Urethrocutaneous fistulae after hypospadias repair: When do they occur?

PubMed

Liao, Adelene Y; Smith, Grahame Hh

2016-05-01

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

Enterocutaneous fistula: a review of 82 cases.

PubMed

Njeze, G E; Achebe, U J

2013-01-01

Enterocutaneous fistula is an unpleasant and troublesome complication of abdominal operations. The objective was to review the outcome of treatment of patients treated for enterocutaneous fistula. This is a retrospective study of 82 teenage and adult patients, who suffered from enterocutaneous fistula, seen over an 11 year period, in the University of Nigeria Teaching Hospital, Enugu. Patients' charts were reviewed for biodata, etiology of the fistula, volume of the fistula output, and result of treatment. Majority of the fistulas occurred after abdominal operations; many by general practitioners. After treatment for correction of fluid and electrolyte deficits, they were all tried on conservative therapy with enteral nutritional support as the main stay of management. Those, whose fistulas did not close, underwent surgical treatment. Total parenteral nutrition, octreotide, fibrin glue, and wound vacuum assisted closure (VAC) were not used for treating these patients. Spontaneous healing of fistulas occurred in 26 patients (31.7%), whereas 42 patients out of 50 (84%) healed after definitive operation. Fourteen patients (17%) in this study, died. Proper management of fluid and electrolyte imbalances, enteral nutritional support, control of sepsis and correctly timed surgical therapy, resulted in this good healing rate and acceptable mortality, without the use of parenteral nutrition, biologic fibrin glue injection or VAC. Suggestions are offered about steps that may help in eradicating some of these enterocutaneous fistulas.

The role of counseling for obstetric fistula patients: Lessons learned from Eritrea

PubMed Central

Johnson, Khaliah A.; Turan, Janet M.; Hailemariam, Letu; Mengsteab, Elsa; Jena, Dirk; Polan, Mary Lake

2013-01-01

Objective The goal of this study was to evaluate the first formal counseling program for obstetric fistula patients in Eritrea. Methods To evaluate the impact of the counseling program, clients were interviewed both before pre-operative counseling and again after post-operative counseling. A questionnaire was used in the interviews to assess women's knowledge about fistula, self-esteem, and their behavioral intentions for health maintenance and social reintegration following surgical repair. In addition, two focus groups were conducted with a total of 19 clients assessing their experiences with the surgical care and counseling. Results Data from the questionnaires revealed significant improvements in women's knowledge about fistula, self-esteem, and behavioral intentions following counseling. Focus group data also supported increased knowledge and self-esteem. Conclusion Evaluation of the short-term impact of an initial formal counseling program for fistula patients in sub-Saharan Africa affirmed the positive effects that such a program has for fistula patients, with increased knowledge about the causes of fistula, fistula prevention and enhanced self-esteem. Practical implications Culturally appropriate counseling can be incorporated into services for surgical repair of obstetric fistula in low-resource settings and has the potential to improve the physical and mental well-being of women undergoing fistula repair. PMID:20034756

Ligation of Intersphincteric Fistula Tract Is Suitable for Recurrent Anal Fistulas from Follow-Up of 16 Months.

PubMed

Xu, Yansong; Tang, Weizhong

2017-01-01

Since 2007, ligation of the intersphincteric fistula tract (LIFT) for the management of anal fistula was all introduced with initial success and excitement. It remains controversial which surgical procedure is suitable for transsphincteric fistula, especially to complex anal fistula. This retrospective study was designed to evaluate the results in patients with recurrent anal fistula by LIFT. A retrospective study of 55 complex fistula patients who underwent LIFT procedure in a single medical center was analyzed. Patients and fistula characteristics, complications, and recurrences were reviewed. All 55 patients underwent the procedure with a median follow-up of 16 months. Median operative time was 44 (range 23-88) minutes. Of the 55 patients, 33 (60%) healed completely and did not require any further surgical treatment at end of follow-up. Twenty-two (40%) recurrences and six complications were observed. Compared with patients who had undergone more than two surgical procedures, LIFT was more suitable for patients who had undergone one to two surgical procedures, and significant difference was observed in number of operations before LIFT ( p = 0.002). Clinicians can consider the use of LIFT for the treatment of recurrent anal fistulas. A larger number of patients and prospective study are needed to be performed.

Salvage of inaccessible arteriovenous fistulas in obese patients: a review of 132 brachiocephalic fistulas.

PubMed

Stoikes, Nathaniel; Nezakatgoo, Nosratollah; Fischer, Peter; Bahr, Michael; Magnotti, Louis

2009-08-01

The two main factors leading to a functional fistula are maturity and accessibility. The aim of this review was to describe a technique of superficialization for inaccessible brachiocephalic fistulas, and to identify the patients that benefit from superficialization. One hundred and thirty-two brachiocephalic arteriovenous fistulas developed from November 2003 to December 2006 were reviewed for primary maturation. In the mature group, patients were evaluated for fistula accessibility. Inaccessible fistulas were selected for superficialization via our technique of vein mobilization using small skip incisions. Analysis of superficialized and nonsuperficialized groups included age, demographics, and comorbidities. Ninety-nine patients were in the mature group, and 33 in the immature group; primary nonmaturation was 25 per cent. Analysis within the mature group was between nonsuperficialized (n = 81) and superficialized (n = 18) patients. The superficialized group had less hypertension (83% vs 98%, P < 0.05), significantly higher BMI (31 vs 27, P < 0.05), and was mostly female (78% vs 49%, P < 0.05). All superficialized fistulas accommodated successful hemodialysis postoperatively. To conclude, patients with mature but inaccessible fistulas were salvaged by superficialization. This population had significantly higher BMI, less hypertension, and female prevalence. Identifying these patients is important because salvage of their fistula can prevent premature progression to alternate autogenous arteriovenous access procedures.

Evaluating the use of fibrin glue for sealing low-output enterocutaneous fistulas: study protocol for a randomized controlled trial.

PubMed

Wu, Xiuwen; Ren, Jianan; Wang, Gefei; Wang, Jianzhong; Wang, Feng; Fan, Yueping; Li, Yuanxin; Han, Gang; Zhou, Yanbing; Song, Xiaofei; Quan, Bin; Yao, Min; Li, Jieshou

2015-10-07

The management of an enterocutaneous fistula poses a significant challenge to surgeons and is often associated with a costly hospital stay and long-term discomfort. The use of fibrin glue in the fistula tract has been shown to promote closure of low output enterocutaneous fistulas. Our previous nonrandomized study demonstrated that autologous platelet-rich fibrin glue treatment significantly decreased time to fistula closure and promoted closure rates. However, there are several limitations in the study, which may lead to bias in our conclusion. Thus, a multicenter, randomized, controlled clinical trial is required. The study is designed as a randomized, open-label, three-arm, multicenter study in nine Chinese academic hospitals for evaluating the efficacy and safety of fibrin glue for sealing low-output fistulas. An established number of 171 fistula patients will undergo prospective random assignment to autologous fibrin glue, commercial porcine fibrin sealants or drainage cessation (1:1:1). The primary endpoint is fistula closure time (defined as the interval between the day of enrollment and day of fistula closure) during the 14-day treatment period. To our knowledge, this is the first study to evaluate the safety and efficacy of both autologous and commercial fibrin glue sealing for patients with low-output volume fistulas. NCT01828892 . Registration date: April 2013.

Unexpected Silent Infarctions after Embolization of Cerebral Arteriovenous Malformations and Fistulas

PubMed Central

Suazo, L.; Putman, J.O.; Vilchez, C.; Stoeter, P.

2013-01-01

Summary We investigated the number and possible causes of clinically silent lesions seen in diffusion-weighted magnetic resonance imaging after embolization of arteriovenous malformations (AVMs) and fistulas using acrylate only or in combination with coils. Included were 19 patients with 18 AVMs and one case of a vein of Galen aneurysm in which 25 interventions were carried out. Results of diffusion-weighted imaging, the appearance of perinidal and distant lesions, were correlated to Spetzler grade, nidus size, flow, number of feeders occluded, rate of nidus occlusion and duration of the intervention. We found seven distant lesions corresponding to non-symptomatic infarcts in the given clinical setting. The only significant correlation between lesion size and parameters analyzed was the degree of nidus occlusion achieved during the intervention. Because most of the lesions presented in cases with a high occlusion rate, they appear to be related to the intention to reach a complete occlusion of the nidus. These results emphasize that the risk involved in eliminating the nidus completely must be reconsidered with special care, particularly in a situation where most high-flow feeders have been occluded. PMID:23693045

The second branchial cleft fistula.

PubMed

Maddalozzo, John; Rastatter, Jeffrey C; Dreyfuss, Heath F; Jaffar, Reema; Bhushan, Bharat

2012-07-01

To review the surgical anatomy and histopathology of second branchial cleft fistulae. Retrospective study of patients treated for second branchial cleft fistulae at a tertiary care pediatric hospital. The senior author noted anatomic and histologic features of second branchial cleft fistulae, not previously described. Tertiary care children's hospital. Retrospective examination of 28 patients was conducted who were operated upon for second branchial cleft fistula. Data collected included age at surgery, initial presentation, imaging characteristics prior to surgery, laterality of the fistula tract, pathology results and follow-up data. Twenty-eight patients met the criteria for inclusion. Three patients (11%) had bilateral fistulae. 11 (39%) were male and 17 (61%) were female. 23 (74.2%) tracts were lined with ciliated columnar epithelium, 3 (9.7%) had cuboidal epithelium, and 5 (16.7%) had squamous epithelium. Nineteen (61.3%) tracts contained salivary tissue. Of the unilateral fistula tracts, 25 (100%) were on the right side. Of the 3 patients with bilateral lesions, 2 (66%) had associated branchio-oto-renal syndrome (BORS). Second branchial cleft fistulae are rare. They are usually right-sided. If bilateral fistulae are present, one should consider an underlying genetic disorder. The histology of the fistulae mostly demonstrates ciliated columnar epithelium with the majority of specimens showing salivary tissue. There is a clear association with the internal jugular vein (IJV). Dissection should continue until superior to the hyoid bone, ensuring near complete surgical dissection and less risk of recurrence. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda.

PubMed

Kasamba, Nassar; Kaye, Dan K; Mbalinda, Scovia N

2013-12-10

Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis. The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse.

Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda

PubMed Central

2013-01-01

Background Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. Methods A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis. Results The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. Conclusion Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse. PMID:24321441

Sphenoid Sinus and Sphenoid Bone Fractures in Patients with Craniomaxillofacial Trauma

PubMed Central

Cantini Ardila, Jorge Ernesto; Mendoza, Miguel Ángel Rivera; Ortega, Viviana Gómez

2013-01-01

Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirty-eight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures. PMID:24436756

[Observing effect of treatment of the second branchial fistula with endoscopic resection].

PubMed

Jiang, Jiping; Wang, Shuyun; Tong, Kang

2014-03-01

To explore synergic effect of treatment of the second branchial fistula with endoscopic resection. All patients of the second branchial fistula were scanned in neck with CT (computed tomography), we injected ioversol-320 from the entrance of the second branchial fistula in front of sternocleidomastiod into the second branchial fistula, then scanned the neck with CT (computed tomography), and rebuilding the picture of the second branchial fistula, to prepare for the operation. 9 patients of the second branchial fistula were operated under general anesthesia with endoscopic resection. All of 9 patients were cured. no one recurred after follow-up of 6 months. It is minimally invasive and complete to resect the second branchial with endoscopic resection, the operation is simply and easy to promote.

Fistulizing Crohn’s disease: Diagnosis and management

PubMed Central

Gecse, Krisztina; Khanna, Reena; Stoker, Jaap; Jenkins, John T; Gabe, Simon; Hahnloser, Dieter

2013-01-01

Fistulizing Crohn’s disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn’s disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery. PMID:24917961

Social and economic consequences of obstetric fistula: life changed forever?

PubMed

Ahmed, S; Holtz, S A

2007-11-01

To summarize the social, economic, emotional, and psychological consequences incurred by women with obstetric fistula; present the results of a meta-analysis for 2 major consequences, divorce/separation and perinatal loss; and report on improvements in health and self-esteem and on the possibility of social reintegration following successful fistula repair. We conducted a review of the literature published between 1985 and 2005 on fistula in developing countries. We then performed a meta-analysis for 2 of the major consequences of having a fistula, divorce/separation and perinatal child loss. Studies suggest that surgical treatment usually closes the fistula and improves the physical and mental health of affected women. With additional social support and counseling, women may be able to successfully reintegrate socially following fistula repair.

Sources of support for women experiencing obstetric fistula in northern Ghana: A focused ethnography.

PubMed

Sullivan, Ginger; O'Brien, Beverley; Mwini-Nyaledzigbor, Prudence

2016-09-01

we explored how women in northern Ghana who have or have had obstetric fistula and those close to them perceive support. focused ethnography, that includes in-depth interviews, participant observation, and scrutiny of relevant records. a fistula treatment centre in a regional urban centre and three remote villages located in northern Ghana. the sources of data included in-depth interview (n=14), non-participant observation and interaction, as well as scrutiny of relevant health records and documents. Participants for in-depth interviews and observation included women affected by obstetric fistula, their partners, parents, relatives, nurses and doctors. presentation of obstetric fistula information, particularly by Non-Governmental Organisations was not in a format that was readily understandable for many women and their families. Food and other basic requirements for daily living were not necessarily available in the fistula treatment centre. Travelling for care was costly and frequently not easily accessed from their communities. Fistula repair surgery was available at unpredictable times and only for a few days every one to two months. women perceived support from spouses/partner, family members, and other relatives but much of this is limited to tangible support. Perceptions of support were particularly focused on access to information and finances. the implementation of strategies to increase support for women living with obstetric fistula include improving access to fistula repair treatment, directing resources to create a dedicated specialist fistula centre located where most cases of OF occur and providing education to front-line workers. Strategies to prevent fistula as well as identify and support safe motherhood practices are needed for women affected by obstetric fistula. Copyright © 2016 Elsevier Ltd. All rights reserved.

Obstetric Fistula in Burundi: a comprehensive approach to managing women with this neglected disease

PubMed Central

2013-01-01

Background In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000–2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges. Methods Descriptive study using routine programme data. Results Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31–51 days). The main operational challenges included: i) early case finding and recruitment for conservative management, ii) national capacity building in obstetric fistula surgical repair, and iii) assessing the psychosocial impact of this model. Conclusion In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed. PMID:23965150

Continent vesicovaginal fistula

PubMed Central

de Toledo, Luís Gustavo Morato; Santos, Victor Espinheira; Maron, Paulo Eduardo Gourlat; Vedovato, Bruno César; Fucs, Moacyr; Perez, Marjo Deninson Cardenuto

2013-01-01

ABSTRACT Vesicovaginal fistula is an abnormal communication between the bladder and vagina and represents the most frequent type of fistula in the urinary tract. The most common cause in Brazil is iatrogenic fistula, secondary to histerectomia. Classically these women present continuous urinary leakage from the vagina and absence of micturition, with strong negative impact on their quality of life. We present a case of totally continent vesicovaginal fistula, with a follow-up of 11 years with no complications. PMID:23579756

Social Experiences of Women with Obstetric Fistula Seeking Treatment in Kampala, Uganda.

PubMed

Meurice, Marielle; Genadry, Rene; Heimer, Carol; Ruffer, Galya; Kafunjo, Barageine Justus

Obstetric fistula is a preventable and treatable condition predominately affecting women in low-income countries. Understanding the social context of obstetric fistula may lead to improved prevention and treatment. This study investigated social experiences of women with obstetric fistula seeking treatment at Mulago Hospital in Kampala, Uganda. A descriptive study was conducted among women seeking treatment for obstetric fistula during a surgical camp in July 2011 using a structured questionnaire. Descriptive statistics were computed regarding sociodemographics, obstetric history, and social experience. Fifty-three women participated; 39 (73.58%) leaked urine only. Median age was 29 years (range: 17-58), and most were married or separated. About half (28, 47.9%) experienced a change in their relationship since acquiring obstetric fistula. More than half (27, 50.94%) acquired obstetric fistula during their first delivery, despite almost everyone (50, 94.3%) receiving antenatal care. The median years suffering from obstetric fistula was 1.25. Nearly every participant's social participation changed in at least one setting (51, 96.23%). Most women thought that a baby being too big or having kicked their bladder was the cause of obstetric fistula. Other participants thought health care providers caused the fistula (15, 32.61%; n = 46), with 8 specifying that the bladder was cut during the operation (cesarean section). Knowing someone with obstetric fistula was influential in pursuing treatment. The majority of participants planned to return to family (40, 78.43%; n = 51) and get pregnant after repair (35, 66.04%; n = 53). Study participants experienced substantial changes in their social lives as a result of obstetric fistula, and there were a variety of beliefs regarding the cause. The complex social context is an important component to understanding how to prevent and treat obstetric fistula. Further elucidation of these factors may bolster current efforts in prevention and holistic treatment. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Laparoscopic approach is feasible in Crohn's complex enterovisceral fistulas: a case-match review.

PubMed

Beyer-Berjot, Laura; Mancini, Julien; Bege, Thierry; Moutardier, Vincent; Brunet, Christian; Grimaud, Jean-Charles; Berdah, Stéphane

2013-02-01

Complex enterovisceral fistulas are internal fistulas joining a "diseased" organ to any intra-abdominal "victim" organ, with the exception of ileoileal fistulas. Few publications have addressed laparoscopic surgery for complex fistulas in Crohn's disease. The aim of this study was to evaluate the feasibility of such an approach. This study is a retrospective, case-match review. This study was conducted at a tertiary academic hospital. : All patients who underwent a laparoscopic ileocecal resection for complex enterovisceral fistulas between January 2004 and August 2011 were included. They were matched to a control group undergoing operation for nonfistulizing Crohn's disease according to age, sex, nutritional state, preoperative use of steroids, and type of resection performed. Matching was performed blind to the peri- and postoperative results of each patient. The 2 groups were compared in terms of operative time, conversion to open surgery, morbidity and mortality rates, and length of stay. Eleven patients presenting with 13 complex fistulas were included and matched with 22 controls. Group 1 contained 5 ileosigmoid fistulas (38%), 3 ileotransverse fistulas (23%), 3 ileovesical fistulas (23%), 1 colocolic fistula (8%), and 1 ileosalpingeal fistula (8%). There were no significant differences between the groups in terms of operative time (120 (range, 75-270) vs 120 (range, 50-160) minutes, p = 0.65), conversion to open surgery (9% vs 0%, p = 0.33), stoma creation (9% vs 14%, p = 1), global postoperative morbidity (18% vs 32%, p = 0.68), and major complications (Dindo III: 0% vs 9%, p = 0.54; Dindo IV: 0% vs 0%, p = 1), as well as in terms of length of stay (8 (range, 7-32) vs 9 (range, 5-17) days, p = 0.72). No patients died. This is a retrospective review with a small sample size. A laparoscopic approach for complex fistulas is feasible in Crohn's disease, with outcomes similar to those reported for nonfistulizing forms.

Objectives and Design of the Hemodialysis Fistula Maturation Study

PubMed Central

Dember, Laura M.; Imrey, Peter B.; Beck, Gerald J.; Cheung, Alfred K.; Himmelfarb, Jonathan; Huber, Thomas S.; Kusek, John W.; Roy-Chaudhury, Prabir; Vazquez, Miguel A.; Alpers, Charles E.; Robbin, Michelle L.; Vita, Joseph A.; Greene, Tom; Gassman, Jennifer J.; Feldman, Harold I.

2014-01-01

Background A large proportion of newly created arteriovenous fistulas cannot be used for dialysis because they fail to mature adequately to support the hemodialysis blood circuit. The Hemodialysis Fistula Maturation (HFM) Study was designed to elucidate clinical and biological factors associated with fistula maturation outcomes. Study Design Multicenter prospective cohort study. Setting & Participants Approximately 600 patients undergoing creation of a new hemodialysis fistula will be enrolled at 7 centers in the United States and followed up for as long as 4 years. Predictors Clinical, anatomical, biological, and process-of-care attributes identified pre-operatively, intra-operatively, or post-operatively. Outcomes The primary outcome is unassisted clinical maturation defined as successful use of the fistula for dialysis for four weeks without any maturation-enhancing procedures. Secondary outcomes include assisted clinical maturation, ultrasound-based anatomical maturation, fistula procedures, fistula abandonment, and central venous catheter use. Measurements Pre-operative ultrasound arterial and venous mapping, flow-mediated and nitroglycerin-mediated brachial artery dilation, arterial pulse wave velocity, and venous distensibility; intra-operative vein tissue collection for histopathological and molecular analyses; post-operative ultrasounds at 1 day, 2 weeks, 6 weeks, and prior to fistula intervention and initial cannulation. Results Assuming complete data, no covariate adjustment, and unassisted clinical maturation of 50%, there will be 80% power to detect ORs of 1.83 and 1.61 for dichotomous predictor variables with exposure prevalences of 20% and 50%, respectively. Limitations Exclusion of two-stage transposition fistulas limits generalizability. The requirement for study visits may result in a cohort that is healthier than the overall population of patients undergoing fistula creation. Conclusions The HFM Study will be of sufficient size and scope to 1) evaluate a broad range of mechanistic hypotheses, 2) identify clinical practices associated with maturation outcomes, 3) assess the predictive utility of early indicators of fistula outcome, and 4) establish targets for novel therapeutic interventions to improve fistula maturation. PMID:23992885

A descriptive longitudinal study protocol: recurrence and pregnancy post-repair of obstetric fistula in Guinea.

PubMed

Delamou, Alexandre; Delvaux, Therese; Beavogui, Abdoul Habib; Levêque, Alain; Zhang, Wei-Hong; De Brouwere, Vincent

2016-10-10

Obstetric fistula is a serious medical condition which affects women in low income countries. Despite the progress of research on fistula, there is little data on long term follow-up after surgical repair. The objective of this study is to analyse the factors associated with the recurrence of fistula and the outcomes of pregnancy following fistula repair in Guinea. A descriptive longitudinal study design will be used. The study will include women who underwent fistula repair between 2012 and 2015 at 3 fistula repair sites supported by the Fistula Care Project in Guinea (Kissidougou Prefectoral Hospital, Labé Regional Hospital and Jean Paul II Hospital of Conakry). Participants giving an informed consent after a home visit by the Fistula Counsellors will be interviewed for enrolment at least 3 months after hospital discharge The study enrolment period is January 1, 2012 - June 30, 2015. Participants will be followed-up until June 30, 2016 for a maximum follow up period of 48 months. The sample size is estimated at 364 women. The cumulative incidence rates of fistula recurrence and pregnancy post-repair will be calculated using Kaplan-Meier methods and the risk factor analyses will be performed using adjusted Cox regression. The outcomes of pregnancy will be analysed using proportions, the Pearson's Chi Square (χ2) and a logistic regression with associations reported as risk ratios with 95 % confidence intervals. All analyses will be done using STATA version 13 (STATA Corporation, College Station, TX, USA) with a level of significance set at P < 0.05. This study will contribute to improving the prevention and management of obstetric fistula within the community and support advocacy efforts for the social reintegration of fistula patients into their communities. It will also guide policy makers and strategic planning for fistula programs. ClinicalTrials.gov Identifier: NCT02686957 . Registered 12 February 2016 (Retrospectively registered).

Relying on Visiting Foreign Doctors for Fistula Repair: The Profile of Women Attending Fistula Repair Surgery in Somalia.

PubMed

Gele, Abdi A; Salad, Abdulwahab M; Jimale, Liban H; Kour, Prabhjot; Austveg, Berit; Kumar, Bernadette

2017-01-01

Obstetric fistula is treatable by surgery, although access is usually limited, particularly in the context of conflict. This study examines the profile of women attending fistula repair surgery in three hospitals in Somalia. A cross-sectional study was conducted in Somalia from August to September 2016. Structured questionnaires were administered to 81 women who registered for fistula repair surgery in the Garowe, Daynile, and Kismayo General Hospitals in Somalia. Findings revealed that 70.4% of the study participants reported obstetric labor as the cause of their fistula, and 29.6% reported iatrogenic causes. Regarding the waiting time for the repair surgery, 45% waited for the surgery for over one year, while the rest received the surgery within a year. The study suggests that training for fistula surgery has to be provided for healthcare professionals in Somalia, fistula centers should be established, and access to these facilities has to be guaranteed for all patients who need these services.

[A Contrivance for Closure and Dressing of Orocutaneous Fistula Developed in Advanced Oral Cancer].

PubMed

Nariai, Yoshiki; Akutsu, Junichi; Okuma, Satoe; Odawara, Sho; Kanno, Takahiro; Sekine, Joji

2017-11-01

Orocutaneous fistula sometimes occurs in locallyadvanced unresectable or recurrent oral squamous cell carcinoma. The developed orocutaneous fistula results in constant leakage of saliva, ingested foods and liquids and decline in patients' quality of life(QOL). A 47-year-old Japanese man had received treatment for tongue carcinoma. At the routine follow-up, a cystic lesion in the right submandibular region was detected. Biopsyof the specimen of the cystic lesion revealed squamous cell carcinoma. After chemotherapy, an orocutaneous fistula between the right oropharyngeal and the right submandibular region developed and graduallyincreased. Although closure and dressing of the orocutaneous fistula with various materials was attempted, it was ultimatelyunsuccessful. Finally, application of a rubber film and silicone adhesive agent to the skin was successful for closure and dressing of the fistula. Orocutaneous fistula is one of major contributors to decline in patients' QOL. The sharing of information regarding effective methods or materials for closure and dressing of orocutaneous fistula is necessaryto maintain patients' QOL.

Relying on Visiting Foreign Doctors for Fistula Repair: The Profile of Women Attending Fistula Repair Surgery in Somalia

PubMed Central

Salad, Abdulwahab M.; Jimale, Liban H.; Kour, Prabhjot; Austveg, Berit; Kumar, Bernadette

2017-01-01

Obstetric fistula is treatable by surgery, although access is usually limited, particularly in the context of conflict. This study examines the profile of women attending fistula repair surgery in three hospitals in Somalia. A cross-sectional study was conducted in Somalia from August to September 2016. Structured questionnaires were administered to 81 women who registered for fistula repair surgery in the Garowe, Daynile, and Kismayo General Hospitals in Somalia. Findings revealed that 70.4% of the study participants reported obstetric labor as the cause of their fistula, and 29.6% reported iatrogenic causes. Regarding the waiting time for the repair surgery, 45% waited for the surgery for over one year, while the rest received the surgery within a year. The study suggests that training for fistula surgery has to be provided for healthcare professionals in Somalia, fistula centers should be established, and access to these facilities has to be guaranteed for all patients who need these services. PMID:28761443

Enterocutaneous Fistula: Different Surgical Intervention Techniques for Closure along with Comparative Evaluation of Aluminum Paint, Karaya Gum (Hollister) and Gum Acacia for Peristomal Skin Care

PubMed Central

Namrata; Ahmad, Shabi

2015-01-01

Introduction Gastrointestinal fistulas are serious complications and are associated with high morbidity and mortality rates. In majority of the patients, fistulas are treatable. However, the treatment is very complex and often multiple therapies are required. These highly beneficial treatment options which could shorten fistula closure time also result in considerable hospital cost savings. Aim This study was planned to study aetiology, clinical presentation, morbidity and mortality of enterocutaneous fistula and to evaluate the different surgical intervention techniques for closure of enterocutaneous fistula along with a comparative evaluation of different techniques for management of peristomal skin with special emphasis on aluminum paint, Karaya gum (Hollister) and Gum Acacia. Materials and Methods This prospective observational study was conducted in the Department of Surgery, M.L.N. Medical College, Allahabad and its associated hospital (S.R.N. Hospital, Allahabad) for a period of five years. Results Majority of enterocutaneous fistula were of small bowel and medium output fistulas (500-1000 ml/24hours). Most of the patients were treated with conservative treatment as compared to surgical intervention. Large bowel fistula has maximum spontaneous closure rate compare to small bowel and duodenum. Number of orifice whether single or multiple does not appear to play statistically significant role in spontaneous closure of fistula. Serum Albumin is a significantly important predictor of spontaneous fistula closure and mortality. Surgical management appeared to be the treatment of choice in distal bowel fistula. The application of karaya gum (Hollister kit), Gum Acacia and Aluminum Paint gave similar outcome. Conclusion Postoperative fistulas are the most common aetiology of enterocutaneous fistula and various factors do play role in management. Peristomal skin care done with Karaya Gum, Gum Acacia and Aluminum Paint has almost equal efficiency in management of skin excoriation. However, role of Gum Acacia was found to be good with inflamed, excoriated and ulcerative skin in comparison to Aluminum Paint and as efficacious as Karaya Gum but at much lower cost. PMID:26816943

Effect of Clopidogrel on Early Failure of Arteriovenous Fistulas for Hemodialysis

PubMed Central

Dember, Laura M.; Beck, Gerald J.; Allon, Michael; Delmez, James A.; Dixon, Bradley S.; Greenberg, Arthur; Himmelfarb, Jonathan; Vazquez, Miguel A.; Gassman, Jennifer J.; Greene, Tom; Radeva, Milena K.; Braden, Gregory L.; Ikizler, T. Alp; Rocco, Michael V.; Davidson, Ingemar J.; Kaufman, James S.; Meyers, Catherine M.; Kusek, John W.; Feldman, Harold I.

2016-01-01

Context The arteriovenous fistula is the preferred type of vascular access for hemodialysis because of lower thrombosis and infection rates and lower health care expenditures compared with synthetic grafts or central venous catheters. Early failure of fistulas due to thrombosis or inadequate maturation is a barrier to increasing the prevalence of fistulas among patients treated with hemodialysis. Small, inconclusive trials have suggested that antiplatelet agents may reduce thrombosis of new fistulas. Objective To determine whether clopidogrel reduces early failure of hemodialysis fistulas. Design, Setting, and Participants Randomized, double-blind, placebo-controlled trial conducted at 9 US centers composed of academic and community nephrology practices in 2003–2007. Eight hundred seventy-seven participants with end-stage renal disease or advanced chronic kidney disease were followed up until 150 to 180 days after fistula creation or 30 days after initiation of dialysis, whichever occurred later. Intervention Participants were randomly assigned to receive clopidogrel (300-mg loading dose followed by daily dose of 75 mg; n = 441) or placebo (n = 436) for 6 weeks starting within 1 day after fistula creation. Main Outcome Measures The primary outcome was fistula thrombosis, determined by physical examination at 6 weeks. The secondary outcome was failure of the fistula to become suitable for dialysis. Suitability was defined as use of the fistula at a dialysis machine blood pump rate of 300 mL/min or more during 8 of 12 dialysis sessions. Results Enrollment was stopped after 877 participants were randomized based on a stopping rule for intervention efficacy. Fistula thrombosis occurred in 53 (12.2%) participants assigned to clopidogrel compared with 84 (19.5%) participants assigned to placebo (relative risk, 0.63; 95% confidence interval, 0.46–0.97; P = .018). Failure to attain suitability for dialysis did not differ between the clopidogrel and placebo groups (61.8% vs 59.5%, respectively; relative risk, 1.05; 95% confidence interval, 0.94–1.17; P = .40). Conclusion Clopidogrel reduces the frequency of early thrombosis of new arteriovenous fistulas but does not increase the proportion of fistulas that become suitable for dialysis. Trial Registration clinicaltrials.gov Identifier: NCT00067119 PMID:18477783

Embolization of a High-Output Postnephrectomy Aortocaval Fistula with Gianturco Coils and Cyanoacrylate

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cekirge, Saruhan; Oguzkurt, Levent; Saatci, Isil

1996-11-15

The authors describe the endovascular treatment of a high-output, large-caliber, postnephrectomy aortocaval fistula using a mixture of cyanoacrylate and lipiodol combined with Gianturco coil embolization. Thirty-nine coils were used to decrease the flow through the fistula so that a fast-polymerizing glue mixture could be injected into the fistula. During rapid polymerization, the N-butyl-2-cyanoacrylate (NBCA) mixture was trapped within the coils, providing an easily controllable glue cast in the fistula, thereby preventing inadvertent embolization into the lungs. This approach can be of considerable benefit for the endovascular treatment of central high-output fistulas.

Open abdomen treatment for septic patients with gastrointestinal fistula: from fistula control to definitive closure.

PubMed

Ren, Jianan; Yuan, Yujie; Zhao, Yunzhao; Gu, Guosheng; Wang, Gefei; Chen, Jun; Fan, Chaogang; Wang, Xinbo; Li, Jieshou

2014-04-01

The use of open abdomen in the management of gastrointestinal fistula complicated with severe intra-abdominal infection is uncommon. This study was designed to evaluate outcomes of our staged approach for the infected open abdomen. Patients who had gastrointestinal fistula and underwent open abdomen treatment were retrospectively reviewed. Various materials such as polypropylene mesh and a modified sandwich package were used to achieve temporary abdominal closure followed by skin grafting when the granulation bed matured. A delayed definitive operation was performed for final abdominal closure without implant of prosthetic mesh. Between 1999 and 2009, 56 (68.3%) of 82 patients survived through this treatment. Among them, 42 patients achieved final abdominal closure. Spontaneous fistula closure occurred in 16 patients with secondary fistula recorded in six patients. Besides, wound complications occurred in 13 patients with two cases for pulmonary infection. Within a 12-month follow-up period after definitive closure, no additional fistula was recorded excluding planned ventral hernia repair. Open abdomen treatment was effective for gastrointestinal fistula complicated by severe intra-abdominal infection. A delayed and deliberate operative strategy aiming at fistula excision and fascial closure, with simultaneous abdominal wall reconstruction, was required for the infected open abdomen.

"Enteroatmospheric fistulae"--gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique.

PubMed

Marinis, A; Gkiokas, G; Argyra, E; Fragulidis, G; Polymeneas, G; Voros, D

2013-01-01

The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.

Management of lymph fistulas in thyroid surgery.

PubMed

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

2010-09-01

Postoperative lymphatic leakage following thyroid surgery represents a management problem with considerate potential morbidity, psychological, and economical impact. Conservative and surgical management strategies for high- and low-output lymph fistulas are inconsistent. Reliable criteria to predict outcome of conservative versus surgical treatment in clinically evident lymph fistula are lacking. A retrospective single-center chart review of consecutively quality-control-documented thyroid surgeries from January 1998 to December 2009 was performed to identify reported postoperative lymph fistulas. Documentation of surgical procedures, drainage, medical, and nutritional management was analyzed to identify risk factors for occurrence and criteria for management of evident lymph fistulas. There were 29 patients identified with postoperative clinical evidence of lymph fistulas following thyroid surgery; incidence was 0.5%. Indication to surgery comprised benign nodular goiter, recurrent nodular goiter, and thyroid carcinoma or local and lymphonodal carcinoma recurrences. There were 12 (41%) primary and 17 (59%) redo surgeries performed. Surgical procedures performed included thyroidectomy, completion thyroidectomy, and primary and redo central and lateral systematic microdissection of lymphatic compartments. All patients were initially submitted to fasting diet and medical treatment, successfully in 19 (66%), whereas ten (34%) patients underwent surgical intervention for fistula closure after failure of conservative treatment. Complications were one wound infection and fistula recurrence in five (26%) patients in the conservative group and two (20%) in the surgical group. Hospital stay was exceedingly prolonged in both groups with a median of 21 and 11 versus 6 days in patients with regular postoperative course following thyroid surgery. Data of this series support definition of the two categories of high- and low-output fistulas according to drainage collection with >300 versus <200 ml/day. Fasting in low-output fistula facilitates conservative treatment with closed drainage, whereas in high-output fistulas surgical intervention should be sought. Attendant criteria for treatment stratification are equally important, like patient's compliance, nutritional, and general health status as well as evidence for wound infection. Surgical closure of lymph fistula may be demanding when identification of the secreting fistula is limited and even muscle flap fortification may fail. Ultimately, in unsuccessfully reoperated fistula recurrences, open drainage may become necessary. Lymph fistulas cause significantly prolonged hospital stay, possible critical clinical decay, and unfavorable cosmetic and oncologic outcome while the superior management remains to be defined.

[Diagnostic and therapeutic concepts for vesicovaginal and ureterovaginal fistulas].

PubMed

Lang, Isabelle Joy; Fisch, Margit; Kluth, Luis Alex

2018-02-01

 Vesico- and ureterovaginal fistulas are defined as abnormal connections between the urinary tract, on the one side, and the female genital system, on the other. Despite being highly prevalent as an acquired pathology of the urogenital system, there has as yet been no standardized protocol in place for diagnosing and treating these fistulas. This review analyses the current literature concerning vesico- and ureterovaginal fistulas in order to profile common diagnostic and therapeutic concepts.  Literature research was carried out using the data bases of Medline and PubMed. A general internet research was added as well as the subsequent analysis of textbooks. Subsequently 40 scientific publications, four textbooks and one internet source were consulted.  In the diagnostic process of not only vesicovaginal, but also ureterovaginal fistulas a timely vaginal examination followed by a cystoscopy and further imaging by retrograde vaginal methylene blue instillation should be carried out. In order to further the differential diagnosis of ureterovaginal fistulas in particular, additional imaging techniques may be required. However, the therapies of both fistulas manifest essential differences. Ureterovaginal fistulas are closed in a two-stage procedure. At first, a percutaneous nephrostomy is placed to decompress the renal collecting system and further drain the urine, followed by a second intervention, which closes the fistula. The management of vesicovaginal fistulas includes both conservative and surgical concepts, the latter of which may in turn be divided into a transabdominal and/or a transvaginal approach. Essentially, transabdominal fistula surgery should, at first, include the identification of the orifices of both ureters to subsequently splint them as indicated. This should be followed by the excision of the fistula. In the case of large fistulas a flap reconstruction of the area may be considered after the mobilisation of the surrounding tissue. Despite almost all surgical techniques leading to successful outcomes, patients with radiogenic damage to the area might require an alternative form of urinary drainage.  Industrial and developing countries continue to display significant differences in the etiology of fistulas as well as the operative treatment. The therapeutic concepts in place exhibit high success rates irrespecitve of the surgical approach and should be individually developed in accordance with the etiology, location and size of the fistula as well as the condition of the surrounding tissue. © Georg Thieme Verlag KG Stuttgart · New York.

The Surgical Management of Complex Fistulas After Sleeve Gastrectomy.

PubMed

Nguyen, David; Dip, Fernando; Hendricks, LéShon; Lo Menzo, Emanuele; Szomstein, Samuel; Rosenthal, Raul

2016-02-01

Laparoscopic sleeve gastrectomy (LSG) is gaining acceptance as the preferred option for treating obesity. Risks of leak and subsequent fistula after sleeve gastrectomy still present significant concerns in clinical practice. This current series presents unusual fistulas post-LSG and their surgical management. The series presents chronic leaks that have progressed into fistulas. Three patients with fistulas are presented: gastrocolic, gastropleural, and gastrosplenic. Surgical intervention was warranted in all cases with en-bloc resection of the fistula with subtotal gastrectomy and Roux-en-Y esophagojejunostomy reconstruction. A subtotal colectomy with ileo-descending colon anastomosis was additionally necessary in the gastrocolic patient. The patients with the gastropleural and gastrosplenic fistulas were discharged home on postoperative Day 6 and Day 7, respectively. The patient with the gastrocolic fistula had an extended postoperative hospital course and was discharged home on postoperative Day 35. All cases were negative for staple line leaks. To date, the fistulas healed with no recurrence. En-bloc resection of the fistula with proximal gastrectomy and Roux-en-Y esophagojejunostomy (PGRYEJ) is a surgical option to treat chronic staple line leakage when non-operative therapy is rendered ineffective. Adequate preoperative planning with optimization of nutritional status and control of local and systemic sepsis is paramount for ultimate success. A symptomatic leak requires immediate operation regardless of the time interval between the primary sleeve operation and appearance of the leak.

Obstetric fistula in low and middle income countries.

PubMed

Capes, Tracy; Ascher-Walsh, Charles; Abdoulaye, Idrissa; Brodman, Michael

2011-01-01

Vesicovaginal fistula secondary to obstructed labor continues to be an all-too-common occurrence in underdeveloped nations throughout Africa and Asia. Vesicovaginal fistula remains largely an overlooked problem in developing nations as it affects the most marginalized members of society: young, poor, illiterate women who live in remote areas. The formation of obstetric fistula is a result of complex interactions of social, biologic, and economic influences. The key underlying causes of fistula are the combination of a lack of functional emergency obstetric care, poverty, illiteracy, and low status of women. In order to prevent fistula, some strategies include creation of governmental policy aimed toward reducing maternal mortality/morbidity and increasing availability of skilled obstetric care, as well as attempts to increase awareness about its prevention and treatment among policymakers, service providers, and communities. Whereas prevention will require the widespread development of infrastructure within these developing countries, treatment of fistula is an act which can be done "in the now." Treatment and subsequent reintegration of fistula patients requires a team of specialists including surgeons, nurses, midwives, and social workers, which is largely unavailable in developing countries. However, there is increasing support for training of fistula surgeons through standardized programs as well as establishment of rehabilitation centers in many nations. The eradication of fistula is dependent upon building programs that target both prevention and treatment. © 2011 Mount Sinai School of Medicine.

Surgical treatment of trans-sphincteric anal fistulas with the Fat GRAFT technique: a minimally invasive procedure.

PubMed

Stroumza, N; Fuzco, G; Laporte, J; Nail Barthelemy, R; Houry, S; Atlan, M

2017-08-01

Anal fistulas are common pathologies with a significant social impact; however, their treatment is often complex and the recurrence rate can be significant. Some surgical treatments for fistula are also associated with the risk of sphincter injury. In this technical note, we aim to evaluate the feasibility and efficacy of the Fat GRAFT technique (Fat Grafting in Anal Fistula Treatment) in the treatment of recurrent anal fistulas. All patients presenting with recurrent trans-sphincteric anal fistulas over an 18-month period were included. After abdominal fat harvesting and fat preparation, fat grafting was performed in the track and peripheral area of the fistula. The internal and external openings of the fistula were closed to maximally preserve the retention of the adipocyte graft in the fistula. Eleven patients underwent the Fat GRAFT procedure (seven men, four women). The average re-injected volume for each fistula was 21 ml (range 10-30 ml). The postoperative course was uneventful. At 6 months three patients developed recurrence (73% healed). There were no postoperative complications. The Fat GRAFT technique appears to be a promising technique with a low risk of anal incontinence, in contrast to other techniques. This method was effective in > 70% of patients in a single session. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

Obstetric fistulae in West Africa: patient perspectives.

PubMed

Nathan, Lisa M; Rochat, Charles H; Grigorescu, Bogdan; Banks, Erika

2009-05-01

The objective of this study is to gain insight into the nature of obstetric fistulae in Africa through patient perspectives. At l'Hôpital Saint Jean de Dieu in Tanguieta, Benin, 37 fistula patients underwent structured interviews about fistula cause, obstacles to medical care, prevention, and reintegration by 2 physicians via interpreters. The majority of participants (43%) thought their fistulae were a result of trauma from the operative delivery. Lack of financial resources (49%) was the most commonly reported obstacle to care, and prenatal care (38%) was most frequently reported as an intervention that may prevent obstetric fistulae. The majority (49%) of the participants requested no further reintegration assistance aside from surgery. Accessible emergency obstetric care is necessary to decrease the burden of obstetric fistulae in Africa. This may be accomplished through increased and improved health care facilities and education of providers and patients.

Male Zuska's disease

PubMed Central

Johnson, Shepard P; Kaoutzanis, Christodoulos; Schaub, George A

2014-01-01

Subareolar abscess of the male breast is a rare condition, which can be complicated by a fistula from the areolar skin into a lactiferous duct. In 1951, Zuska et al first characterised this entity in women. Literature on mammillary fistulas in men is scarce and therefore standardisation of treatment does not exist. We present two cases of recurrent subareolar abscesses with draining fistulas. Both patients were successfully treated by complete excision of the lactiferous duct fistula, and continue to do well with no evidence of disease recurrence. When male patients present with a draining subareolar abscess, one should have a high index of suspicion for a mammillary fistula. Failure to identify and surgically excise the fistula may lead to recurrence of the abscess and prolonged morbidity. The most effective management of this uncommon entity includes complete excision of the lactiferous duct fistula. PMID:24706699

Male Zuska's disease.

PubMed

Johnson, Shepard P; Kaoutzanis, Christodoulos; Schaub, George A

2014-04-04

Subareolar abscess of the male breast is a rare condition, which can be complicated by a fistula from the areolar skin into a lactiferous duct. In 1951, Zuska et al first characterised this entity in women. Literature on mammillary fistulas in men is scarce and therefore standardisation of treatment does not exist. We present two cases of recurrent subareolar abscesses with draining fistulas. Both patients were successfully treated by complete excision of the lactiferous duct fistula, and continue to do well with no evidence of disease recurrence. When male patients present with a draining subareolar abscess, one should have a high index of suspicion for a mammillary fistula. Failure to identify and surgically excise the fistula may lead to recurrence of the abscess and prolonged morbidity. The most effective management of this uncommon entity includes complete excision of the lactiferous duct fistula.

Stable gastric pentadecapeptide BPC 157 heals rectovaginal fistula in rats.

PubMed

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

2016-03-01

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

[Congenital preauricular fistula infection: a histopathology observation].

PubMed

Hua, Na; Wei, Lai; Jiang, Tao; Guo, Ying; Wang, Meiyi; Wang, Zhiqiang

2014-08-01

To investigate the pathology characteristics of congenital preauricular fistula with infection, in order to reduce the recurrence rate after surgery and improve operative technique. Twenty-five patients diagnosed as congenital preauricular fistula with infection were analyzed. There were 14 patients in infection history group, 9 in infective stage group, and 2 in recurrence group respectively. The whole piece of fistula and scar tissue was completely excised during operation. The specimens were observed by naked eye and serial tissue sections were analyzed. (1) Macroscopically, in infection history group, initial morphology can be maintained near the fistula orifice, but the distal tissue was dark red scar tissue. In infective stage group, the distal tissue of the specimens was granulation tissue and cicatricial tissue. The granulation tissue was crisp and bright red. In recurrence group, multicystic lesions with severe edema was observed, with a classical dumb-bell appearence. (2) Microscopically, in infection history group and recurrence group, we can see that the distal fistula tissue was discontinuous and was separated by scar tissue. In infective stage group, we can find neo-angiogenesis and infiltration of plasma cells, lymphocytes, neutrophil between interrupted fistula tissues. (3) All patients were followed up for 6-12 month, without recurrence. The fistula tissue of congenital preauricular fistula with infection was divided by the scar tissue, and they did not communicate with each other. Complete delineation of fistula is hardly achieved by methylene blue staining. Radical excision of the fistula and scar tissue may help to avoid leaving viable squamous epithelial remnants and reduce the recurrence rate.

Arteriovenous fistula complicating iliac artery pseudo aneurysm: diagnosis by CT angiography.

PubMed

Huawei, L; Bei, D; Huan, Z; Zilai, P; Aorong, T; Kemin, C

2002-01-01

Fistula formation to the inferior vena cava is a rare complication of aortic aneurysm which is often misdiagnosed clinically. In one hundred of reported arteriocaval fistulae, none was originating from the right common iliac artery. We report a case of ileo-caval fistula due to a iatrogenic pseudoaneurysm. High resolution 3D imaging using breath-hold CT angiography is highly specific in identifying the location, extent of the aortocaval fistula as well as the neighbouring anatomic structures.

Hydrocephalus in a patient with an unruptured pial arteriovenous fistula: hydrodynamic considerations, endovascular treatment, and clinical course.

PubMed

Morales-Gómez, Jesús A; Garza-Oyervides, Vicente V; Arenas-Ruiz, José A; Mercado-Flores, Mariana; Elizondo-Riojas, C Guillermo; Boop, Frederick A; de León, Ángel Martínez-Ponce

2017-03-01

Intracranial pial arteriovenous fistulas, also known as nongalenic fistulas, are rare vascular malformations affecting predominantly the pediatric population. Hydrocephalus is an unusual presentation in which the exact pathophysiology is not fully understood. The aim of treatment in these cases is occlusion of the fistula prior to considering ventricular shunting. Here, the authors describe the hydrodynamic considerations of the paravascular pathway and the resolution of hydrocephalus with endovascular treatment of the fistula.

Superficial temporal arteriovenous fistula as a complication of rhytidectomy.

PubMed

Kominami, Shushi; Watanabe, Akira; Akimoto, Masahiro; Kobayashi, Shiro; Teramoto, Akira

2012-03-01

A 67-year-old woman who had undergone rhytidectomy 5 years before her presentation experienced increasing pulsatile tinnitus on the left side that had begun 2 years earlier. Angiography revealed a direct arteriovenous fistula between the superficial temporal artery and superficial temporal vein in front of her left ear. There was a scar from the earlier cosmetic surgery at the site. The fistula was embolized with N-butyl cyanoacrylate, and her tinnitus disappeared. We posit that the fistula was a complication of rhytidectomy and that a small arteriovenous fistula formed at the time of surgery and enlarged over time. This case indicates that arteriovenous fistulae can occur as a delayed complication of cosmetic surgery.

Successful surgical treatment of left atrioesophageal fistula following atrial ablation.

PubMed

Takahashi, Toru; Mohara, Jun; Ogawa, Hiroomi; Igarashi, Takamichi; Motegi, Yoko

2018-01-23

A 69-year-old male had catheter-based ablation for atrial fibrillation. He was admitted with high fever and had neurological disorder; he was diagnosed with atrioesophageal fistula by CT scan. Intraoperative findings showed that the fistula existed adjacent to the left lower pulmonary vein with a vegetation. The esophageal fistula was repaired, and the left atrial fistula was closed. A nasogastric tube tip was placed in the esophagus for decompression and advanced into the stomach for nutritional support. After vomiting, the patient showed loss of consciousness and left hemiplegia. CT scan revealed a micro-air embolism to the brain. The nasogastric tube tip was pulled back into the esophagus. Gastrointestinal fiberscopy showed a pinhole at the fistula, and a percutaneous endoscopic gastrostomy was made. After conservative treatment, the esophageal fistula was closed and mediastinitis was improved. He was discharged with a little neurological deficit.

Diagnosis and endoscopic treatment of esophago-bronchial fistula due to gastric heterotopy.

PubMed

Katsanos, Konstantinos H; Christodoulou, Dimitrios K; Kamina, Sevasti; Maria, Kosmidou; Lambri, Evangelia; Theodorou, Stavroula; Tsampoulas, Konstantinos; Vasiliki, Mitsi; Tsianos, Epameinondas V

2010-04-16

Heterotopic gastric mucosa patches are congenital gastrointestinal abnormalities and have been reported to occur anywhere along the gastrointestinal tract from mouth to anus. Complications of heterotopic gastric mucosa include dysphagia, upper gastrointestinal bleeding, upper esophageal ring stricture, adenocarcinoma and fistula formation. In this case report we describe the diagnosis and treatment of the first case of esophago-bronchial fistula due to heterotopic gastric mucosa in mid esophagus. A 40-year old former professional soccer player was referred to our department for treatment of an esophago-bronchial fistula. Microscopic examination of the biopsies taken from the esophageal fistula revealed the presence of gastric heterotopic mucosa. We decided to do a non-surgical therapeutic endoscopic procedure. A sclerotherapy catheter was inserted through which 1 mL of ready to use synthetic surgical glue was applied in the fistula and it closed the fistula opening with excellent results.

Urethrocutaneous fistula following fracture penis.

PubMed

Mahapatra, Raj Kumar Sinha; Ray, Rajendra Prasad; Mishra, Swetank; Pal, Dilip Kumar

2014-10-01

Penile fracture is an emergency in urology. Early surgical management is recommended, to prevent long term complications. Although urethrocavernosal fistula is one of the described complications following fracture penis repair in literature, no case of urethrocuteneous fistula has been reported till now. Here we report the first case of urethrocutaneous fistula following repair of fracture penis.

[Clinical analysis of nasal resistance and pulmonary function testing in patients with chronic nasal-sinusitis and nasal polyps].

PubMed

Liao, Hua; Shen, Ying; Wang, Pengjun

2015-05-01

To study the pulmonary function and nasal resistance characteristics of patients with chronic nose-sinusitis and nasal polyps (CRSwNP), to explore the evaluation role of nasal resistance in nasal ventilation function and the effect of endoscopic sinus surgery on pulmonary function in patients with CRSwNP. Fifty CRSwNP patients that met the study criteria were selected . The patients were performed endoscopic surgeries according to Messerklinger surgical procedures under general anesthesia. Extent of surgery was based on preoperative CT showing the range of the lesion of disease and endoscopic findings. Perioperative treatments contained intranasal corticosteroids, cephalosporin or penicillin antibiotics, nasal irrigation and other treatments. Main outcome measures included visual analog scale (VAS), endoscopic Lind-Kennedy scores, nasal resistence, pulmonary function in patientsone week before and after surgery, three months and six months after surgery. Pulmonary function includes forced expiratory volume in one second (FEV1), forced vital capacity FEV1/FVC and peak expiratory flow (PEF). The study found that there were significantly positive correlations among VAS score, Lund-Kennedy score and nasal resistance (P < 0.05) in CRSwNP patients, but there is a significantly negative correlation between VAS score, Lund-Kennedy score, nasal resistance and pulmonary function indexes of FEV1, FVC and PEF (P < 0.05). The VAS score, Lund-Kennedy score and nasal resistance values of CRSwNP patients were decreased significantly after comprehensive treatments with nasal endoscopic operation as the major one, the difference was statistically different (P < 0.05). And the pulmonary function indexs (FEV1, FVC, PEF) were significantly increased after surgery in CRSwNP patients. The nasal resistance can objectively and reliably reflect the degree of nasal congestion and the recovery of nasal function in CRSwNP patients after endoscopic sinus surgery. The detection method of nasal resistance is simple. Functional endoscopic sinus surgery can effectively improve the pulmonary ventilation function in CRSwNP patients, providing some clinical references about the prevention and treatment of CRS related lower respiratory disease.

Clinical application of oral meglumine diatrizoate esophagogram in screening esophageal fistula during radiotherapy for esophageal cancer.

PubMed

Geng, Lidan; Wu, Rong; Hu, He; Zhao, Yu; Fan, Lingli; Zhao, Zhenhua; Liao, Dongbiao; Li, Musheng; Xiang, Miao; Ma, Ying; Du, Xiaobo

2018-05-01

Esophageal fistula is a serious and common complication of radiotherapy for esophageal cancer. Therefore, early diagnosis and treatment is necessary. Because of side effect of barium esophagography, it cannot be used to screening esophageal fistula during radiotherapy. Meglumine diatrizoate is an ionic contrast agent, its adverse reactions were rarely seen when it was used in the body cavity. The purpose of this trial is identified the sensitivity and specificity of oral meglumine diatrizoate in an esophagogram for screening esophageal fistula during radiotherapy. This trial was a prospective, multicenter, diagnostic clinical trial. A total of 105 patients with esophageal cancer will swallowed meglumine diatrizoate and underwent a radiographic examination weekly during radiotherapy, medical personnel observed the esophageal lesions to determine whether an esophageal fistula formed. If an esophageal fistula was observed, esophagofiberoscopy and/or computer tomography was used to further confirm the diagnosis. And the sensitivity and specificity of meglumine diatrizoate should be calculated for screening esophageal fistula during radiotherapy. To our knowledge, this study protocol is the first to identify the sensitivity and specificity of oral meglumine diatrizoate in an esophagogram for screening esophageal fistula during radiotherapy. If oral meglumine diatrizoate can be used to screening esophageal fistula, more patients will benefit from early detection and treatment.

Panzi score as a parsimonious indicator of urogenital fistula severity derived from Goh and Waaldijk classifications.

PubMed

Mukwege, Denis; Peters, Lisa; Amisi, Christine; Mukwege, Alain; Smith, Abigail R; Miller, Janis M

2018-04-28

To derive a comprehensive system that allows a single score to define relative fistula severity. The present observational study included women with urogenital fistula treated at the Panzi Hospital, Democratic Republic of Congo, or its outreach clinics across the Democratic Republic of Congo between September 1, 2013, and December 31, 2014. Fistula severity was assessed by Goh and Waaldijk classifications and surgical success was ascertained. Logistic regression was used to select fistula characteristics predictive of surgical failure, and to preliminarily verify the newly derived Panzi score. Overall, 837 women were included in the analysis. Goh or Waaldijk fistula descriptors associated with a higher probability of poor surgical outcomes in the unadjusted bivariate analysis were circumferential defect (P=0.007), proximity to the external urethral orifice (P=0.001), and size (P=0.001). These fistula characteristics were used to construct the Panzi score, which varied from 3 (most severe) to 0 (minor fistula). For each increase above 0, the odds of surgical failure increase by a factor of 1.65 (P<0.001). The Panzi score of urogenital fistula provided a data-driven, simple, comprehensive, and parsimonious score. It could be used to report group data, to provide continuous level data for use in higher order statistics, and to resolve issues such as the cut-off point for referring women to hospital in accordance with fistula complexity. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol.

PubMed

Byamugisha, Josaphat; El Ayadi, Alison; Obore, Susan; Mwanje, Haruna; Kakaire, Othman; Barageine, Justus; Lester, Felicia; Butrick, Elizabeth; Korn, Abner; Nalubwama, Hadija; Knight, Sharon; Miller, Suellen

2015-12-18

Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65-95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.

Serum transferrin as a prognostic indicator of spontaneous closure and mortality in gastrointestinal cutaneous fistulas.

PubMed Central

Kuvshinoff, B W; Brodish, R J; McFadden, D W; Fischer, J E

1993-01-01

OBJECTIVE: This study determined whether there are any laboratory or other features that will enable prediction of spontaneous closure in patients with gastrointestinal cutaneous fistulas. SUMMARY BACKGROUND DATA: Although the anatomic criteria for spontaneous closure of gastrointestinal cutaneous fistulas have been presented by several authors, less than 50% of such fistulas tend to close, even in the most recent series. METHODS: A group of patients with gastrointestinal cutaneous fistulas with anatomical features favorable to study were investigated with respect to a series of parameters including the usual demographic parameters, plus fistula output, number of blood transfusions, presence of sepsis, as well as metabolic parameters including serum transferrin, retinol-binding protein, thyroxin-binding prealbumin, and serum albumin. RESULTS: Of 79 patients with 116 fistulas, 16 (20.3%) died. Causes of death were uncontrolled sepsis in eight patients and cancer in five patients. Postoperative fistulas constituted 80% of the group. The presence of local sepsis, systemic sepsis, remote sepsis (such as pneumonia or line sepsis), the number of fistulas, fistula output, and the number of blood transfusions were not predictive of spontaneous closure, whereas serum transferrin was predictive of spontaneous closure. Serum transferrin, retinol-binding protein, and thyroxin-binding prealbumin were predictive of mortality. CONCLUSIONS: Serum transferrin does not appear to be an entirely independent variable, but seems to identify those patients with significant remote sepsis, systemic sepsis, and neoplasia in whom these processes are clinically significant. The results, if confirmed, and provided that nutritional needs are met, suggest that short-turnover proteins, particularly serum transferrin, might be useful in predicting which patients with gastrointestinal cutaneous fistulas should undergo surgery despite anatomic criteria favorable for spontaneous closure. PMID:8507110

Serum albumin level in the management of postoperative enteric fistula for gastrointestinal cancer patients.

PubMed

Lu, Chien-Yu; Wu, Deng-Chyang; Wu, I-Chen; Chu, Koung-Shing; Sun, Li-Chu; Shih, Ying-Ling; Chen, Fang-Ming; Hsieh, Jan-Sing; Wang, Jaw-Yuan

2008-01-01

Postoperative enteric fistula is a serious complication and cause of death following gastrointestinal (GI)-tract surgery. Many reports have demonstrated the effectiveness of parenteral nutrition in the spontaneous closure of enteric fistula. Our study was aimed at analyzing the prognostic factors of parenteral nutritional support in the treatment of enteric fistula for patients with GI-tract cancer following surgery. GI-tract cancer patients receiving surgical interventions, which then unfortunately developed enteric fistula, were included in our study. All of them had to have received parenteral nutrition soon after leakages were recognized, and they were subsequently divided into successful and unsuccessful (classified as "failure") groups according to spontaneous closure of fistula or not, respectively. The studied patients' laboratory data were collected to identify the clinically relevant prognostic factors. Fifty-three primary GI-tract cancer patients with postoperative enteric fistulas were enrolled into our study. Of these, 33 patients were considered as successful parenteral nutritional therapy (successful group) and the other 20 patients (failure group) were not. After a period of parenteral nutritional therapy, serum total bilirubin, creatinine, C-reactive protein (CRP), hemoglobin, and albumin were significantly different between these two groups (all p < .05). Using a multivariate logistic regression analysis, it was determined that increased serum albumin level was an independent predictive factor of successful management for enteric fistula (p = .029), in addition to the well-known lower drainage amount (< 500 mL/day) from the enteric fistula (p = .013). Our observations show that both serum albumin levels and drainage amounts from the enteric fistula can be potentially used as important prognostic predictors of healing enteric fistula under total parenteral nutrition in patients following surgery for GI-tract malignancies.

Community-based screening for obstetric fistula in Nigeria: a novel approach

PubMed Central

2014-01-01

Background Obstetric fistula continues to have devastating effects on the physical, social, and economic lives of thousands of women in many low-resource settings. Governments require credible estimates of the backlog of existing cases requiring care to effectively plan for the treatment of fistula cases. Our study aims to quantify the backlog of obstetric fistula cases within two states via community-based screenings and to assess the questions in the Demographic Health Survey (DHS) fistula module. Methods The screening sites, all lower level health facilities, were selected based on their geographic coverage, prior relationships with the communities and availability of fistula surgery facilities in the state. This cross-sectional study included women who presented for fistula screenings at study facilities based on their perceived fistula-like symptoms. Research assistants administered the pre-screening questionnaire. Nurse-midwives then conducted a medical exam. Univariate and bivariate analyses are presented. Results A total of 268 women attended the screenings. Based on the pre-screening interview, the backlog of fistula cases reported was 75 (28% of women screened). The backlog identified after the medical exam was 26 fistula cases (29.5% of women screened) in Kebbi State sites and 12 cases in Cross River State sites (6.7%). Verification assessment showed that the DHS questionnaire had 92% sensitivity, 83% specificity with 47% positive predictive value and 98% negative predictive value for identifying women afflicted by fistula among women who came for the screenings. Conclusions This methodology, involving effective, locally appropriate messaging and community outreach followed up with medical examination by nurse-midwives at lower level facilities, is challenging, but represents a promising approach to identify the backlog of women needing surgery and to link them with surgical facilities. PMID:24456506

Living with constant leaking of urine and odour: thematic analysis of socio-cultural experiences of women affected by obstetric fistula in rural Tanzania.

PubMed

Mselle, Lilian T; Kohi, Thecla W

2015-11-24

Obstetric fistula is a worldwide problem that affects women and girls mostly in Sub Saharan Africa. It is a devastating medical condition consisting of an abnormal opening between the vagina and the bladder or rectum, resulting from unrelieved obstructed labour. Obstetric fistula has devastating social, economic and psychological effect on the health and wellbeing of the women living with it. This study aimed at exploring social-cultural experiences of women living with obstetric fistula in rural Tanzania. Women living with obstetric fistula were identified from the fistula ward at CCBRT hospital. Sixteen individual semi structured interviews and two (2) focus group discussions were conducted among consenting women. Interviews were transcribed verbatim and transcripts analysed independently by two researchers using a thematic analysis approach. Themes related to the experiences of living with obstetric fistula were identified. Four themes illustrating the socio-cultural experiences of women living with obstetric fistula emerged from the analysis of women experiences of living with incontinence and odour. These were keeping clean and neat, earning an income, maintaining marriage, and keeping association. Women experiences of living with fistula were largely influenced by perceptions of people around them basing on their cultural understanding of a woman. Living with fistula reveals women's day-to-day experiences of social discrimination and loss of control due to incontinence and odour. They cannot work and contribute to the family income, cannot satisfy their husband's sexual needs and or bear children, and cannot interact with members of the community in social activities. Women experience of living with fistula was influenced by perceptions of people around them. In the eyes of these people, women who leak urine were of less value since they were not capable of carrying out ascribed social roles.

Revisiting an ancient treatment for transphincteric fistula-in-ano ‘There is nothing new under the sun’ Ecclesiastes 1v9

PubMed Central

Sturgeon, G; Hargest, R

2015-01-01

Objective The history of treatments for fistula-in-ano can be traced back to ancient times. Current treatment of transphincteric fistulae is controversial, with many options available. We reviewed the history of treatment using cutting setons and present our series of transphincteric fistulae in the light of the series in the literature. Design Literature review and case series. Setting Hospital based coloproctology service Participants 140 consecutive patients presenting with fistula-in-ano were included. Main Outcome Measures The literature pertaining to treatment of transphincteric fistula was reviewed, along with the outcome of various treatment methods for this condition. Data were collected for 140 consecutive patients presenting with fistula- in-ano were assessed for fistula healing, recurrence and complications. Results A total of 140 consecutive patients with fistula-in-ano were identified, of which 111 were cryptoglandular (79.3%). Eighty-one of these 111 were transphincteric (73.0%). At a median follow-up of 35 months (range, 2–83 months), 70 transphincteric fistulae had healed (86.4%), 10 were still undergoing treatment (12.3%) and one patient was lost to follow-up prior to treatment (1.2%). Two patients in this group required a stoma (2.5%), six patients developed recurrence (7.4%); three ‘true’ recurrences (3.7%). One (1.2%) developed a chronic fissure. There were no reported cases of incontinence. Conclusions The management of transphincteric fistula-in-ano is complex and controversial, for which no clear surgical procedure has gained acceptance as the gold standard. This study demonstrates that transphincteric fistulae can be successfully treated using cutting setons. A high healing rate (86.4%), low recurrence rate (7.4%) and a low complication rate (3.7%) are shown, which compares favourably with published rates over a long follow-up. PMID:26152674

'I stayed with my illness': a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya.

PubMed

Khisa, Anne M; Omoni, Grace M; Nyamongo, Isaac K; Spitzer, Rachel F

2017-09-29

Obstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women's health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing? We used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya. Emergent themes contributed to generation of substantive theory and a conceptual framework on the health seeking behaviour of fistula patients. We recruited 121 participants aged 17 to 62 years whose treatment pathways are presented. Participants delayed health seeking, living with fistula illness after their first encounter with unresponsive hospitals. The health seeking trajectory is characterized by long episodes of staying home with illness for decades and consulting multiple actors. Staying with fistula illness entailed health seeking through seven key actions of staying home, trying home remedies, consulting with private health care providers, Non-Governmental organisations, prayer, traditional medicine and formal hospitals and clinics. Long treatment trajectories at hospital resulted from multiple hospital visits and surgeries. Seeking treatment at hospital is the most popular step for most women after recognizing fistula symptoms. We conclude that the formal health system is not responsive to women's needs during fistula illness. Women suffer an illness with a chronic trajectory and seek alternative forms of care that are not ideally placed to treat fistula illness. The results suggest that a robust health system be provided with expertise and facilities to treat obstetric fistula to shorten women's treatment pathways.

An investigation of the relationship between autonomy, childbirth practices, and obstetric fistula among women in rural Lilongwe District, Malawi.

PubMed

Kaplan, Julika Ayla; Kandodo, Jonathan; Sclafani, Joseph; Raine, Susan; Blumenthal-Barby, Jennifer; Norris, Alison; Norris-Turner, Abigail; Chemey, Elly; Beckham, John Michael; Khan, Zara; Chunda, Reginald

2017-06-19

Obstetric fistula is a childbirth injury caused by prolonged obstructed labor that results in destruction of the tissue wall between the vagina and bladder. Although obstetric fistula is directly caused by prolonged obstructed labor, many other factors indirectly increase fistula risk. Some research suggests that many women in rural Malawi have limited autonomy and decision-making power in their households. We hypothesize that women's limited autonomy may play a role in reinforcing childbirth practices that increase the risk of obstetric fistula in this setting by hindering access to emergency care and further prolonging obstructed labor. A medical student at Baylor College of Medicine partnered with a Malawian research assistant in July 2015 to conduct in-depth qualitative interviews in Chichewa with 25 women living within the McGuire Wellness Centre's catchment area (rural Central Lilongwe District) who had received obstetric fistula repair surgery. This study assessed whether women's limited autonomy in rural Malawi reinforces childbearing practices that increase risk of obstetric fistula. We considered four dimensions of autonomy: sexual and reproductive decision-making, decision-making related to healthcare utilization, freedom of movement, and discretion over earned income. We found that participants had limited autonomy in these domains. For example, many women felt pressured by their husbands, families, and communities to become pregnant within three months of marriage; women often needed to seek permission from their husbands before leaving their homes to visit the clinic; and women were frequently prevented from delivering at the hospital by older women in the community. Many of the obstetric fistula patients in our sample had limited autonomy in several or all of the aforementioned domains, and their limited autonomy often led both directly and indirectly to an increased risk of prolonged labor and fistula. Reducing the prevalence of fistula in Malawi requires a broad understanding of the causes of fistula, so we recommend that the relationship between women's autonomy and fistula risk undergo further investigation.

Crestal Sinus Augmentation in the Presence of Severe Sinus Mucosal Thickening: A Report of 3 Cases.

PubMed

Fang, Yiqin; An, Xueyin; Jeong, Seung-Mi; Choi, Byung-Ho

2018-06-01

In the presence of severe sinus mucosal thickening, the ostium can be blocked when the sinus membrane is lifted, causing drainage disturbances and sinusitis. Here, we present 3 cases in which maxillary sinus floor elevation was performed using a crestal approach in the presence of severe sinus mucosal thickening (>10 mm). The effects of maxillary sinus floor elevation using the crestal approach technique on sinus mucosal thickening and bone formation in the sinus were evaluated using cone beam computed tomography. None of the patients exhibited an increase in sinus membrane thickness. No complications were encountered during the follow-up periods, and bone formation was observed around the implants at the sinus floor. All implants were functioning successfully. Maxillary sinus floor elevation using the crestal approach technique in the presence of severe sinus mucosal thickening allows for minimally invasive sinus grafting and simultaneous implant placement and does not increase sinus membrane thickness.

Primary and secondary arterial fistulas during chronic Q fever.

PubMed

Karhof, Steffi; van Roeden, Sonja E; Oosterheert, Jan J; Bleeker-Rovers, Chantal P; Renders, Nicole H M; de Borst, Gert J; Kampschreur, Linda M; Hoepelman, Andy I M; Koning, Olivier H J; Wever, Peter C

2018-04-20

After primary infection with Coxiella burnetii, patients may develop acute Q fever, which is a relatively mild disease. A small proportion of patients (1%-5%) develop chronic Q fever, which is accompanied by high mortality and can be manifested as infected arterial or aortic aneurysms or infected vascular prostheses. The disease can be complicated by arterial fistulas, which are often fatal if they are left untreated. We aimed to assess the cumulative incidence of arterial fistulas and mortality in patients with proven chronic Q fever. In a retrospective, observational study, the cumulative incidence of arterial fistulas (aortoenteric, aortobronchial, aortovenous, or arteriocutaneous) in patients with proven chronic Q fever (according to the Dutch Chronic Q Fever Consensus Group criteria) was assessed. Proven chronic Q fever with a vascular focus of infection was defined as a confirmed mycotic aneurysm or infected prosthesis on imaging studies or positive result of serum polymerase chain reaction for C. burnetii in the presence of an arterial aneurysm or vascular prosthesis. Of 253 patients with proven chronic Q fever, 169 patients (67%) were diagnosed with a vascular focus of infection (42 of whom had a combined vascular focus and endocarditis). In total, 26 arterial fistulas were diagnosed in 25 patients (15% of patients with a vascular focus): aortoenteric (15), aortobronchial (2), aortocaval (4), and arteriocutaneous (5) fistulas (1 patient presented with both an aortocaval and an arteriocutaneous fistula). Chronic Q fever-related mortality was 60% for patients with and 21% for patients without arterial fistula (P < .0001). Primary fistulas accounted for 42% and secondary fistulas for 58%. Of patients who underwent surgical intervention for chronic Q fever-related fistula (n = 17), nine died of chronic Q fever-related causes (53%). Of patients who did not undergo any surgical intervention (n = 8), six died of chronic Q fever-related causes (75%). The proportion of patients with proven chronic Q fever developing primary or secondary arterial fistulas is high; 15% of patients with a vascular focus of infection develop an arterial fistula. This observation suggests that C. burnetii, the causative agent of Q fever, plays a role in the development of fistulas in these patients. Chronic Q fever-related mortality in patients with arterial fistula is very high, in both patients who undergo surgical intervention and patients who do not. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Enterocutaneous fistula: are treatments improving?

PubMed

Draus, John M; Huss, Sara A; Harty, Niall J; Cheadle, William G; Larson, Gerald M

2006-10-01

We studied the etiology, treatment, and outcome of enterocutaneous fistulas in 106 patients to evaluate our current practice and the impact of newer therapies-octreotide, wound vacuum-assisted closure (VAC), and fibrin glue-on clinical outcomes. Review of the literature and our own 1990 study indicate a mortality rate of 5% to 20% for enterocutaneous fistula, and a healing rate of 75% to 85% after definitive surgery. We reviewed all cases of gastrointestinal-cutaneous fistula from 1997 to 2005 at 2 large teaching hospitals. We identified 106 patients with enterocutaneous fistula; patients with irritable bowel disease and anorectal fistulas were excluded. The origin of the fistula was the small bowel in 67 patients, colon in 26, stomach in 8, and duodenum in 5. The etiology of the fistula was previous operation in 81 patients, trauma in 15, hernia mesh erosion in 6, diverticulitis in 2, and radiation in 2. Of the 106 patients in the study, 31 had a high output fistula (greater than 200 mL/day), 44 had a low output fistula, and, in 31 patients, the fistula output was low but there was no record of volume. Initial treatment was nonoperative except for patients with an abscess who needed urgent drainage. In 24 patients, the effect of octreotide was monitored: in 8 patients, fistula output declined; in 16 patients, octreotide was of no benefit. Fibrin glue was used in 8 patients and was of benefit to 1. The wound VAC was used in 13 patients: 12 patients still required operative repair of the fistula, whereas the fistula was healed in 1 patient. The main benefit of the VAC system was improved wound care in all patients before definitive surgery. Total parenteral nutrition was used in most patients to provide nutritional support. Operative repair was performed in 77 patients and was successful in 69 (89%), failing in 6 patients with persistent cancer or infection. Nonoperative treatment was used in 29 patients and resulted in healing in 60%. Of 106 patients, 7 (7%) died of fistula complications. The cause of death was persistence or recurrence of cancer in 4 patients and persistent sepsis in 3. Enterocutaneous fistula continues to be a serious surgical problem. The wound VAC and fibrin glue had anecdotal successes (n = 2), and one-third of patients responded to octreotide. We believe that octreotide should be tried in most patients and that the wound VAC has a role in selected patients. Although 7% overall mortality is lower than in previous studies, the number managed without operation (27%) remains the same. In addition to early control of sepsis, nutritional support, and wound care, a well-timed operation was the most effective treatment.

Current practices in treatment of female genital fistula: a cross sectional study.

PubMed

Arrowsmith, Steven D; Ruminjo, Joseph; Landry, Evelyn G

2010-11-10

Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub-Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials. Self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address the following issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair. The results provide a glimpse into current practices in fistula treatment and care across a wide swath of geographic, economic, and organizational considerations. There is consensus in treatment in some areas (routine use of prophylactic antibiotics, limited bed rest until the catheter is removed, nonsurgical treatment for postsurgical incontinence), while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence). These findings are based on a small sample and do not allow for recommending changes in clinical care, but they point to issues for possible clinical trial research that would contribute to more efficient and effective fistula care. The findings from the survey allowed us to consider clinical practices most influential in the cost, efficacy, and safety of fistula treatment. These considerations led us to formulate recommendations for eight randomized controlled trials on the following subjects: 1) Efficacy/safety of short-term catheterization; 2) efficacy of surgical and nonsurgical therapies for urinary incontinence; 3) technical measures during fistula repair to reduce the incidence of post-surgery incontinence; 4) identification of predictive factors for "incurable fistula"; 5) usefulness of urodynamic studies in the management of urinary incontinence; 6) incidence and significance of multi-drug resistant bacteria in the fistula population; 7) primary management of small, new fistulas by catheter drainage; and 8) antibiotic prophylaxis in fistula repair.

Coronary artery fistula

MedlinePlus

Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... attaches to one of the chambers of the heart (the atrium or ventricle) or another blood vessel ( ...

Optimal treatment of coronary-to-pulmonary artery fistula: surgery, coil or stent graft?

PubMed Central

Lipiec, Piotr; Peruga, Jan Zbigniew; Jaszewski, Ryszard; Pawłowski, Witold; Kasprzak, Jarosław

2013-01-01

We report a case of a 57-year-old man with typical angina due to a coronary artery-to-pulmonary artery fistula, which was evident on transthoracic and transesophageal echocardiography with color Doppler flow mapping. The diagnosis was confirmed by coronary angiography. The patient underwent surgical ligation of the fistula. However, repeated transesophageal echocardiography and coronary angiography revealed persistence of the fistula with significant left-to-right shunt. The orifice of the fistula was then obliterated by stent-graft implantation, which was proven successful by angiography and echocardiography. PMID:24570733

Treatment Options in Gastrointestinal Cutaneous Fistulas

PubMed Central

Ashkenazi, Itamar; Turégano-Fuentes, Fernando; Olsha, Oded; Alfici, Ricardo

2017-01-01

Enterocutaneous fistulas occur most commonly following surgery. A minority of them is caused by a myriad of other etiologies including infection, malignancy, and radiation. While some fistulas may close spontaneously, most patients will eventually need surgery to resolve this pathology. Successful treatment entails adoption of various methods of treatment aimed at control of sepsis, protection of surrounding skin and soft tissue, control of fistula output, and maintenance of nutrition, with eventual spontaneous or surgical closure of the fistula. The aim of this article is to review the various treatment options in their appropriate context. PMID:28825016

Pancreaticoatmospheric fistula following severe acute necrotising pancreatitis

PubMed Central

Simoneau, Eve; Chughtai, Talat; Razek, Tarek; Deckelbaum, Dan L

2014-01-01

Severe acute necrotising pancreatitis is associated with numerous local and systemic complications. Abdominal compartment syndrome requiring urgent decompressive laparotomy is a potential complication of this disease process and is associated with increased morbidity and mortality. We describe the case of a pancreaticoatmospheric fistula following decompressive laparotomy in a patient with severe acute necrotising pancreatitis. While this fistula was managed successfully using the current standard of care for pancreatic fistulas, the wound care for in this patient with drainage of the fistula through an open abdomen, is a significant challenge. PMID:25519860

[Hepatobronchial Fistula and Lung Abscess after Transarterial Chemoembolization].

PubMed

Lee, Kwanjoo; Song, Jeong Eun; Jeong, Hyang Sook; Kim, Do Young

2017-05-25

Transarterial chemoembolization (TACE) is a common treatment modality to locally manage hepatocellular carcinoma. Liver abscess and bile duct injury are common complications of TACE. However, hepatobronchial fistula is a rare complication. Herein, we report a case of lung abscess due to hepatobronchial fistula after TACE. A 67-year-old man, who had underwent TACE 6 months ago, presented cough and bile-colored sputum. He was diagnosed with lung abscess and hepatobronchial fistula. We performed endoscopic retrograde cholangiopancreatography; however, there was no improvement in his symptoms. Thereafter, partial hepatectomy and repair of fistula were successively conducted.

Obstetric fistula: what about gender power?

PubMed

Roush, Karen; Kurth, Ann; Hutchinson, M Katherine; Van Devanter, Nancy

2012-01-01

Despite over 40 years of research there has been little progress in the prevention of obstetric fistula and women continue to suffer in unacceptable numbers. Gender power imbalance has consistently been shown to have serious implications for women's reproductive health and is known to persist in regions where obstetric fistula occurs. Yet, there is limited research about the role gender power imbalance plays in childbirth practices that put women at risk for obstetric fistula. This information is vital for developing effective maternal health interventions in regions affected by obstetric fistula.

Osteotome-Mediated Sinus Lift without Grafting Material: A Review of Literature and a Technique Proposal

PubMed Central

Taschieri, Silvio; Corbella, Stefano; Saita, Massimo; Tsesis, Igor; Del Fabbro, Massimo

2012-01-01

Implant rehabilitation of the edentulous posterior maxilla may be a challenging procedure in the presence of insufficient bone volume for implant placement. Maxillary sinus augmentation with or without using grafting materials aims to provide adequate bone volume. The aim of the present study was to systematically review the existing literature on transalveolar maxillary sinus augmentation without grafting materials and to propose and describe an osteotome-mediated approach in postextraction sites in combination with platelet derivative. The systematic review showed that high implant survival rate (more than 96% after 5 years) can be achieved even without grafting the site, with a low rate of complications. Available alveolar bone height before surgery was not correlated to survival rate. In the described case report, three implants were placed in posterior maxilla after extraction of two teeth. An osteotome-mediated sinus lifting technique was performed with the use of platelet derivative (PRGF); a synthetic bone substitute was used to fill the gaps between implant and socket walls. No complications occurred, and implants were successfully in site after 1 year from prosthetic loading. The presented technique might represent a viable alternative for the treatment of edentulous posterior maxilla with atrophy of the alveolar bone though it needs to be validated by studies with a large sample size. PMID:22792108

Is the Keros classification alone enough to identify patients with the 'dangerous ethmoid'? An anatomical study.

PubMed

Skorek, Andrzej; Tretiakow, Dmitry; Szmuda, Tomasz; Przewozny, Tomasz

2017-02-01

By means of three-dimensional display of the critical measurements, the authors suggest a novel definition of 'dangerous ethmoid'. Parallel to Keros type III, the proposed determining factors include: olfactory fossa width >6 mm, its distance to the medial nasal concha (turbinate) <20 mm and to the orbit interval of <10 mm. Clinical evaluation of these preliminary criteria based only on radiological data is required and underway. Detailed pre-operative assessment of sinus computer tomography (CT) scans reduces the frequency of severe complications in patients undergoing endoscopic sinus surgery (ESS). The authors aimed to identify a sub-set of anatomical features pre-disposing to major post-operative complications. Sinus computer tomography (CT) scans of patients of a single institution qualified for ESS were examined. Besides the Keros classification, authors focused on the anatomic measurements as follows: the olfactory fossa depth, width, and its distance from the medial nasal concha and the medial wall of the orbit (referred to as 'critical measurements'). The sample comprised 120 consecutive CT exams, without clinical validation. Keros type I, II, and III was noted in 9.2%, 75.8%, and 15.0% of cases, respectively. Despite some statistically significant correlations, it was not possible to identify the patient age, sex, and side of body clearly correlating with the critical measurements.

Changes of renal sinus fat and renal parenchymal fat during an 18-month randomized weight loss trial.

PubMed

Zelicha, Hila; Schwarzfuchs, Dan; Shelef, Ilan; Gepner, Yftach; Tsaban, Gal; Tene, Lilac; Yaskolka Meir, Anat; Bilitzky, Avital; Komy, Oded; Cohen, Noa; Bril, Nitzan; Rein, Michal; Serfaty, Dana; Kenigsbuch, Shira; Chassidim, Yoash; Sarusi, Benjamin; Thiery, Joachim; Ceglarek, Uta; Stumvoll, Michael; Blüher, Matthias; Haviv, Yosef S; Stampfer, Meir J; Rudich, Assaf; Shai, Iris

2018-08-01

Data regarding the role of kidney adiposity, its clinical implications, and its dynamics during weight-loss are sparse. We investigated the effect of long-term weight-loss induced intervention diets on dynamics of renal-sinus-fat, an ectopic fat depot, and %renal-parenchymal-fat, lipid accumulation within the renal parenchyma. We randomized 278 participants with abdominal obesity/dyslipidemia to low-fat or Mediterranean/low-carbohydrate diets, with or without exercise. We quantified renal-sinus-fat and %renal-parenchymal-fat by whole body magnetic-resonance-imaging. Participants (age = 48 years; 89% men; body-mass-index = 31 kg/m 2 ) had 86% retention to the trial after 18 months. Both increased renal-sinus-fat and %renal-parenchymal-fat were directly associated with hypertension, and with higher abdominal deep-subcutaneous-adipose-tissue and visceral-adipose-tissue (p of trend < 0.05 for all) after adjustment for body weight. Higher renal-sinus-fat was associated with lower estimated-glomerular-filtration-rate and with higher microalbuminuria and %HbA1C beyond body weight. After 18 months of intervention, overall renal-sinus-fat (-9%; p < 0.05 vs. baseline) but not %renal-parenchymal-fat (-1.7%; p = 0.13 vs. baseline) significantly decreased, and similarly across the intervention groups. Renal-sinus-fat and %renal-parenchymal-fat changes were correlated with weight-loss per-se (p < 0.05). In a model adjusted for age, sex, and visceral-adipose-tissue changes, 18 months reduction in renal-sinus-fat associated with decreased pancreatic, hepatic and cardiac fats (p < 0.05 for all) and with decreased cholesterol/high-density lipoprotein-cholesterol (HDL-c) (β = 0.13; p = 0.05), triglycerides/HDL-c (β = 0.13; p = 0.05), insulin (β = 0.12; p = 0.05) and gamma glutamyl transpeptidase (β = 0.24; p = 0.001), but not with improved renal function parameters or blood pressure. Decreased intake of sodium was associated with a reduction in %renal-parenchymal-fat, after adjustment for 18 months weight-loss (β = 0.15; p = 0.026) and hypertension (β = 0.14; p = 0.04). Renal-sinus-fat and renal-parenchymal-fat are fairly related to weight-loss. Decreased renal-sinus-fat is associated with improved hepatic parameters, independent of changes in weight or hepatic fat, rather than with improved renal function or blood pressure parameters. CLINICALTRIALS. NCT01530724. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients.

PubMed

P B, Sabitha; Khakha, D C; Mahajan, S; Gupta, S; Agarwal, M; Yadav, S L

2008-10-01

Pain during areteriovenous fistula (AVF) cannulation remains a common problem in hemodialysis (HD) patients. This study was undertaken to assess the effect of cryotherapy on pain due to arteriovenous fistula puncture in hemodialysis patients. A convenience sample of 60 patients (30 each in experimental and control groups) who were undergoing hemodialysis by using AVF, was assessed in a randomized control trial. Hemodialysis patients who met the inclusion criteria, were randomly assigned to experimental and control groups using a randomization table. Objective and subjective pain scoring was done on two consecutive days of HD treatment (with cryotherapy for the experimental and without cryotherapy for the control group). The tools used were a questionnaire examining demographic and clinical characteristics, an observation checklist for assessing objective pain behavior, and a numerical rating scale for subjective pain assessment. Descriptive statistics were used as deemed appropriate. Chi square, two-sample and paired t-tests, the Mann Whitney test, Wilcoxon's signed rank test, the Kruskal Wallis test, and Spearman's and Pearson's correlations were used for inferential statistics. We found that the objective and subjective pain scores were found to be significantly (P = 0.001) reduced within the experimental group with the application of cryotherapy. This study highlights the need for adopting alternative therapies such as cryotherapy for effective pain management in hospital settings.

Stable gastric pentadecapeptide BPC 157 heals rat colovesical fistula.

PubMed

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

2016-06-05

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

Fistula rates after salvage laryngectomy: comparing pectoralis myofascial and myocutaneous flaps.

PubMed

Khan, Nabeel A; Medina, Jesus E; Sanclement, Jose A; Krempl, Greg A

2014-07-01

Salvage laryngectomy after failed organ preservation often has a high complication rate, pharyngocutaneous fistulas being the most common. These fistulas increase morbidity, prolong hospitalization, and potentially delay adjuvant treatment. Fistula rates in the literature range from 3% to 65%. Use of the pectoralis flap to prevent fistula formation has been adopted as a common practice at our institution. A review of our experience using the overlay myofascial showed a higher than desired complication rate. The aim of this study is to assess whether the use of integrated myocutaneous flap results in a lower fistula rate. A retrospective review of 30 patients followed by a pilot study of 10 patients. All underwent salvage laryngectomy after failed organ preservation. The operation notes of 40 laryngectomy patients were analyzed. The patient/tumor characteristics, pretreatment, neck dissection, flap type, and fistula rate were documented. The patient sample was 25% female. All patients received prior radiotherapy, but only 37.5% received prior chemoradiation. Neck dissections were performed in 80% of these patients, 76% of the myocutaneous group, and 84% of the myofascial group. Advanced tumor stage was found in 42% of the myofascial group and 52% of the myocutaneous group. Five of the 19 myofascial patients developed a fistula, whereas seven of the 21 myocutaneous patients developed a fistula. The use of the pectoralis myocutaneous flap (PMCF) in this pilot series did not show a lower rate of fistula; other alternatives should be pursued to decrease this complication. 4. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

A case-control study of the risk factors for obstetric fistula in Tigray, Ethiopia.

PubMed

Lewis Wall, L; Belay, Shewaye; Haregot, Tesfahun; Dukes, Jonathan; Berhan, Eyoel; Abreha, Melaku

2017-12-01

We tested the null hypothesis that there were no differences between patients with obstetric fistula and parous controls without fistula. A unmatched case-control study was carried out comparing 75 women with a history of obstetric fistula with 150 parous controls with no history of fistula. Height and weight were measured for each participant, along with basic socio-demographic and obstetric information. Descriptive statistics were calculated and differences between the groups were analyzed using Student's t test, Mann-Whitney U test where appropriate, and Chi-squared or Fisher's exact test, along with backward stepwise logistic regression analyses to detect predictors of obstetric fistula. Associations with a p value <0.05 were considered significant. Patients with fistulas married earlier and delivered their first pregnancies earlier than controls. They had significantly less education, a higher prevalence of divorce/separation, and lived in more impoverished circumstances than controls. Fistula patients had worse reproductive histories, with greater numbers of stillbirths/abortions and higher rates of assisted vaginal delivery and cesarean section. The final logistic regression model found four significant risk factors for developing an obstetric fistula: age at marriage (OR 1.23), history of assisted vaginal delivery (OR 3.44), lack of adequate antenatal care (OR 4.43), and a labor lasting longer than 1 day (OR 14.84). Our data indicate that obstetric fistula results from the lack of access to effective obstetrical services when labor is prolonged. Rural poverty and lack of adequate transportation infrastructure are probably important co-factors in inhibiting access to needed care.

Vesicovaginal fistula: a review of nigerian experience.

PubMed

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

2010-01-01

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

Fistuloclysis: An Interprofessional Approach to Nourishing the Fistula Patient.

PubMed

Willcutts, Kate; Mercer, David; Ziegler, Jane

2015-01-01

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

Early application of an intermittent pneumatic compression device is safe and results in proximal arteriovenous fistula enlargement.

PubMed

Desai, Sanjay; Mitra, Amit; Arkans, Ed; Singh, Tej M

2018-05-01

Delays in arteriovenous fistula maturation can cause care delays and increased costs. Increased distention pressure and intermittent wall shear stress may dilate veins based on prior research. Early use of non-invasive devices may help assist clinical arteriovenous fistula dilation. This was an Institutional Review Board approved study. After arteriovenous fistula creation, a novel, intermittent pneumatic compression device (Fist Assist ® ) was applied 15 cm proximal to arteriovenous fistula enabling 60 mmHg of cyclic compression for 6 h daily for 30 days. Among the patients who completed 1 month follow-up, 30 (n = 30) arteriovenous fistula patients were in the study arm to test vein dilation with Fist Assist. Controls (n = 16) used a sham device. Vein size was measured and recorded at baseline and after 30 days by duplex measurement. Clinical results (percentage increase) were recorded and tested for significance. No patients experienced thrombosis or adverse effects. Patient compliance and satisfaction was high. After 1 month, the mean percentage increase in vein diameter in the Fist Assist treatment group was significantly larger (p = 0.026) than controls in the first 5 mm segment of the fistula after the anastomosis. All fistulas treated with Fist Assist are still functional with no reported thrombosis or extravasations. Early application of an intermittent pneumatic compression device may assist in arteriovenous fistula dilation and are safe. Non-invasive devices like Fist Assist may have clinical utility to help fistulae development and decrease costs as they may eventually assist maturation.

Risk Factors for Esophageal Fistula Associated With Chemoradiotherapy for Locally Advanced Unresectable Esophageal Cancer

PubMed Central

Tsushima, Takahiro; Mizusawa, Junki; Sudo, Kazuki; Honma, Yoshitaka; Kato, Ken; Igaki, Hiroyasu; Tsubosa, Yasuhiro; Shinoda, Masayuki; Nakamura, Kenichi; Fukuda, Haruhiko; Kitagawa, Yuko

2016-01-01

Abstract Esophageal fistula is a critical adverse event in patients treated with chemoradiotherapy (CRT) for locally advanced esophageal cancer. However, risk factors associated with esophageal fistula formation in patients receiving CRT have not yet been elucidated. We retrospectively analyzed data obtained from 140 patients who were enrolled in a phase II/III trial comparing low-dose cisplatin with standard-dose cisplatin administered in combination with 5-flurouracil and concomitant radiotherapy. Inclusion criteria were performance status (PS) 0 to 2 and histologically proven thoracic esophageal cancer clinically diagnosed as T4 and/or unresectable lymph node metastasis for which definitive CRT was applicable. Risk factors for esophageal fistula were examined with univariate analysis using Fisher exact test and multivariate analysis using logistic regression models. Esophageal fistula was observed in 31 patients (22%). Of these, 6 patients developed fistula during CRT. Median time interval between the date of CRT initiation and that of fistula diagnosis was 100 days (inter quartile range, 45–171). Esophageal stenosis was the only significant risk factor for esophageal fistula formation both in univariate (P = 0.026) and in multivariate analyses (odds ratio, 2.59; 95% confidence interval, 1.13–5.92, P = 0.025). Other clinicopathological factors, namely treatment arm, age, sex, PS, primary tumor location, T stage, lymph node invasion to adjacent organs, blood cell count, albumin level, and body mass index, were not risk factors fistula formation. Esophageal stenosis was a significant risk factor for esophageal fistula formation in patients treated with CRT for unresectable locally advanced thoracic esophageal squamous cell carcinoma. PMID:27196482

Easy clip to treat anal fistula tracts: a word of caution.

PubMed

Gautier, M; Godeberge, P; Ganansia, R; Bozio, G; Godart, B; Bigard, M A; Barthet, M; Siproudhis, L

2015-05-01

Closing the internal opening by a clip ovesco has been recently proposed for healing the fistula tract, but, to date, data on benefit are poorly analyzed. The aim was to report a preliminary multicenter experience. Retrospective study was undertaken in six different French centers: surgical procedure, immediate complications, and follow-up have been collected. Nineteen clips were inserted in 17 patients (M/F, 4/13; median age, 42 years [29-54]) who had an anal fistula: 12 (71%) high fistulas (including 4 rectovaginal fistulas), 5 (29%) lower fistulas (with 3 rectovaginal fistulas), and 6 (35%) Crohn's fistulas. Out of 17 patients, 15 had a seton drainage beforehand. The procedure was easy in 8 (47%) patients and the median operative time was 27.5 min (20-36.5). Postoperative period was painful for 11 (65%) patients. A clip migration was noted in 11 patients (65%) after a median follow-up of 10 days (5.5-49.8). Eleven patients (65%) who failed had reoperation including 10 new drainages within the first month (0.5-5). After a mean follow-up of 4 months (2-7),, closing the tract was observed in 2 patients (12%) following the first insertion of the clip and in another one after a second insertion. Treatment of anal fistula by placing a clip on the internal opening is disappointing and deleterious for some patients. A better assessment before dissemination is recommended.

[Nutrition therapy in enterocutaneous fistula; from physiology to individualized treatment].

PubMed

Rodríguez Cano, Ameyalli Mariana

2014-01-01

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

Mechanical Thrombectomy of Occluded Hemodialysis Native Fistulas and Grafts Using a Hydrodynamic Thrombectomy Catheter: Preliminary Experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sahni, Vikram, E-mail: vassahni@hotmail.com; Kaniyur, Sunil; Malhotra, Anmol

2005-12-15

The purpose of this study was to evaluate the efficacy and safety of a new hydrodynamic percutaneous thrombectomy catheter in the treatment of thrombosed hemodialysis fistulas and grafts. Twenty-two patients (median age: 47 years; range: 31-79 years) underwent mechanical thrombectomy for thrombosed hemodialysis fistulas or polytetrafluoroethylene (PTFE) grafts. In all cases, an Oasis hydrodynamic catheter was used. Five patients had native fistulas and 17 had PTFE grafts. Six patients required repeat procedures. All patients with native fistulas and 15 of the 17 with PTFE grafts also underwent angioplasty of the venous limb following the thrombectomy. Major outcome measures included technicalmore » success, clinical success, primary and secondary patency, and complication rates. Twenty-eight procedures were performed in total. The technical success rate was 100% and 90% and clinical success was 86% and 76% for native fistulas and grafts, respectively. The primary patency at 6 months was 50% and 59% for fistulas and grafts, respectively, and the secondary patency at 6 months was 75% and 70% for fistulas and grafts, respectively. Two patients died of unrelated causes during the follow-up period. The Oasis catheter is an effective mechanical device for the percutaneous treatment of thrombosed hemodialysis access. Our initial success rate showed that the technique is safe in the treatment of both native fistulas and grafts.« less

Rectourethral fistula following LDR brachytherapy.

PubMed

Borchers, Holger; Pinkawa, Michael; Donner, Andreas; Wolter, Timm P; Pallua, Norbert; Eble, Michael J; Jakse, Gerhard

2009-01-01

Modern LDR brachytherapy has drastically reduced rectal toxicity and decreased the occurrence of rectourethral fistulas to <0.5% of patients. Therefore, symptoms of late-onset sequelae are often ignored initially. These fistulas cause severe patient morbidity and require interdisciplinary treatment. We report on the occurrence and management of a rectourethral fistula which occurred 4 years after (125)I seed implantation. Copyright 2009 S. Karger AG, Basel.

Anopenile urethral fistula.

PubMed

Ohno, Koichi; Nakamura, Tetsuro; Azuma, Takashi; Yoshida, Tatsuyuki; Yamada, Hiroto; Hayashi, Hiroaki; Masahata, Kazunori

2008-04-01

A newborn male weighing 3,650 g was born without an anal opening and a perineal fistula. However, an invertography showed rectal gas below the ischium. At the age of 1 day, the patient underwent colostomy. Based on colonourethrography that revealed a fistula between the rectum and the spongy urethra, the patient was diagnosed with an anopenile urethral fistula (APUF). At the age of 7 months, the patient underwent anterior sagittal anorectoplasty (ASARP). The sphincter muscles were divided at the midline. After ligating the fistula, the rectum was pulled through to the anal dimple. At the age of 11 months, a colostomy closure was performed. Consequently, the fistula in the corpus spongiosum penis was not removed. It has been 14 years since the operation was performed, and the patient has had no problems with regard to urination and defecation. According to the embryological studies of the anorectum, APUF could occur due to the following reasons: incomplete descent of the urorectal septum, failed disappearance of the dorsal cloacal membrane, and excessive elongation of the urorectal septum in the phallus. The ASARP provides a superior operative field to identify the fistula and the sphincter muscles. Complete removal of the fistula in the corpus spongiosum penis is unnecessary.

Incidence of oronasal fistula formation after nasoalveolar molding and primary cleft repair.

PubMed

Dec, Wojciech; Shetye, Pradip R; Grayson, Barry H; Brecht, Lawrence E; Cutting, Court B; Warren, Stephen M

2013-01-01

The incidence of postoperative complications in cleft care is low. In this 19-year retrospective analysis of cleft lip and palate patients treated with preoperative nasoalveolar molding, we examine the incidence of postoperative oronasal fistulae. The charts of 178 patients who underwent preoperative nasoalveolar molding by the same orthodontist/prosthodontist team and primary cleft lip/palate repair by the same surgeon over a 19-year period were reviewed. Millard, Mohler, Cutting, or Mulliken-type techniques were used for cleft lip repairs. Oxford-, Bardach-, or von Langenbeck-type techniques were used for cleft palate repairs. One nasolabial fistula occurred after primary cleft lip repair (0.56% incidence) and was repaired surgically. Four palatal fistulae (3 at the junction between soft and hard palate and 1 at the right anterior palate near the incisive foramen) occurred, but 3 healed spontaneously. Only 1 palatal fistula (0.71%) required surgical repair. All 5 fistulae occurred within the first 8 years of the study period, with 4 (80%) of 5 occurring within the first 3 years. Although fistula rate may be related to surgeon experience and the evolution of presurgical techniques, nasoalveolar molding in conjunction with nasal floor closure contributes to a low incidence of oronasal fistulae.

Managing complex, high-output, enterocutaneous fistulas: a case study.

PubMed

Hahler, Barbara; Schassberger, Debra; Novakovic, Rachel; Lang, Stephanie

2009-10-15

Gastrointestinal (GI) fistulas are an uncommon but serious complication. Following diagnosis, management strategies may have to be adapted frequently to address changes in fistula output, surrounding skin or wound condition, overall patient clinical and nutritional status, mobility level, and body contours. Following a motor vehicle accident, a 49-year-old man with a body mass index of 36.8 and a history of multiple previous surgeries, including gastric bypass, experienced excessive output from a fistula within a large open abdominal wound measuring 45 cm x 40 cm x 5 cm. Abdominal creases and the need to protect a split-thickness skin graft of the wound surrounding his fistula complicated wound management. During his prolonged 4-month hospital stay, the patient underwent several surgical procedures, repeated wound debridement, and various nutritional support interventions; a wide variety of wound and fistula management systems were utilized. One year after the initial trauma, the fistula was surgically closed. One week later, the patient died from a cardiac event. This case study confirms that GI fistulas increase costs of care and hospital length of stay and require the experience and expertise of a wide array of patient support staff members and clinicians.

Management of Fistula-In-Ano with Special Reference to Ligation of Intersphincteric Fistula Tract.

PubMed

Khadia, Mohanlal; Muduli, Iswar Chandra; Das, Sushanta Kumar; Mallick, Sworupa Nanda; Bag, Laxman; Pati, Manas Ranjan

2016-01-01

The surgical management of fistula-in-ano is still debatable and no clear recommendations have been made available until now. The present study analyses the results of ligation of intersphincteric fistula tract (LIFT) technique in treating fistula-in-ano in particular with recurrence, healing time, and continence status. LIFT in the management of patients of fistula-in-ano of cryptoglandular origin. Prospective study. This is a prospective study of 52 patients admitted from September 2012 to August 2014. Patients were managed with LIFT technique and results of LIFT technique were compared with other studies in terms of recurrence rate, incontinence rate, and other postoperative complications. A total of 52 patients were studied. Median follow-up was 24 weeks. Primary healing was achieved in 32 (71.11%) patients. Thirteen patients (28.88%) had a recurrence. No patient reported any subjective decrease incontinence after the procedure. LIFT technique is simple and easy to learn. With this method fistula-in-ano could be easily treated even at primary health care level. LIFT technique is a simple and novel modified approach for the treatment of fistula-in-ano with rapid healing rate and without any resultant incontinence.

Gurya cutting and female genital fistulas in Niger: ten cases.

PubMed

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

2018-03-01

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

The diagnosis and management of recurrent tracheoesophageal fistulas.

PubMed

Bruch, Steven W; Hirschl, Ronald B; Coran, Arnold G

2010-02-01

This review provides a blueprint to deal with the diagnosis and management of recurrent tracheoesophageal fistulas. A retrospective review over 27 years found 26 recurrent tracheoesophageal fistulas. Descriptive statistical analyses were performed. In this cohort of 26 patients, 18 had a leak after their primary operation; and 22 had respiratory symptoms leading to the discovery of the recurrent fistula. The diagnosis was made by contrast study in 24. The repairs entailed placing a catheter through the fistula; separating the trachea and esophagus using sharp dissection; and placing tissue, preferably pericardium, between the suture lines. Postoperative complications included 7 anastamotic leaks, 4 strictures, and 3 recurrent fistulas. Long-term follow-up (median of 84 months) showed that 21 took all of their nutrition by mouth, 3 were tube fed, and 2 required a combination. Of the 23 patients with growth chart data, 16 fell in the first quartile of the growth chart, whereas none fell between the 75th and 100th percentile. This series, the largest to date, describes characteristics of recurrent tracheoesophageal fistulas, including techniques to make the diagnosis and provide a secure closure of the fistula, and the long-term outcomes of these patients. Copyright 2010. Published by Elsevier Inc.

Vacuum effects over the closing of enterocutaneous fistulae: a mathematical modeling approach.

PubMed

Cattoni, D I; Chara, O

2008-01-01

Enterocutaneous fistulae are pathological communications between the intestinal lumen and the abdominal skin. Under surgery the mortality of this pathology is very high, therefore a vacuum applying system has been carried previously on attempting to close these fistulae. The objective of this article is the understanding of how these treatments might work through deterministic mathematical modelling. Four models are here proposed based on several assumptions involving: the conservation of the flow in the fistula, a low enough Reynolds number justifying a laminar flow, the use of Poiseuille law to model the movement of the fistulous liquid, as well as phenomenological equations including the fistula tissue and intermediate chamber compressibility. Interestingly, the four models show fistulae closing behaviour during experimental time (t<60 sec). To compare the models, both, simulations and pressure measurements, carried out on the vacuum connected to the patients, are performed. Time course of pressure are then simulated (from each model) and fitted to the experimental data. The model which best describes actual measurements shows exponential pumping flux kinetics. Applying this model, numerical relationship between the fistula compressibility and closure time is presented. The models here developed would contribute to clarify the treatment mechanism and, eventually, improve the fistulae treatment.

Delayed Diagnosis of Vesicouterine Fistula After Treatment for Mixed Urinary Incontinence: Menstrual Cup Management and Diagnosis.

PubMed

Goldberg, Leah; Elsamra, Sammy; Hutchinson-Colas, Juana; Segal, Saya

2016-01-01

A vesicouterine fistula is a rare form of urogenital fistula, yet there is increasing prevalence in the United States because of the rising rate of cesarean deliveries. Vesicouterine fistulas have various presentations including menouria, hematuria, or urinary incontinence. A 39-year-old multiparous woman presented with urine leakage after her third cesarean delivery. She had been treated for mixed urinary incontinence with overactive bladder medications and a midurethral sling with continued complaints of urine leakage. The patient noticed her symptoms of urine leakage improved during menses when she used a menstrual cup. After confirmation of vesicouterine fistula, the patient underwent robotic-assisted surgery and her symptoms of insensible urine leakage resolved. When evaluating women with urinary incontinence and a history of cesarean deliveries, use of menstrual cup may aid in the diagnosis of vesicouterine fistula. Robotic-assisted laparoscopic repair with tissue interposition flap is an efficacious minimally invasive method for treatment of vesicouterine fistula.

Protective effect of Cassia fistula fruit extract on bromobenzene-induced nephrotoxicity in mice.

PubMed

Kalantari, Heibatullah; Jalali, Mohammadtaha; Jalali, Amir; Salimi, Abobakr; Alhalvachi, Foad; Varga, Balazs; Juhasz, Bela; Jakab, Anita; Kemeny-Beke, Adam; Gesztelyi, Rudolf; Tosaki, Arpad; Zsuga, Judit

2011-10-01

The efficacy of a crude hydro-alcoholic extract of Cassia fistula (golden shower tree) fruit to protect the kidney against bromobenzene-induced toxicity was studied. Negative control mice received normal saline; positive control mice were given 460 mg/kg of bromobenzene; Cassia fistula treated mice received 200, 400, 600 and 800 mg/kg of Cassia fistula fruit extract followed by 460 mg/kg bromobenzene (daily by oral gavage for 10 days). On the 11th day, the mice were sacrificed, blood samples were obtained to assess blood urea nitrogen (BUN) and creatinine levels, and kidneys were removed for histological examination. We found that bromobenzene induced significant nephrotoxicity reflected by an increase in levels of BUN and creatinine that was dose dependently prevented by the Cassia fistula fruit extract. The nephroprotective effect of the Cassia fistula fruit extract was confirmed by the histological examination of the kidneys. To the best of our knowledge, this is the first study to demonstrate the protective effect of Cassia fistula in nephrotoxicity.

Use of buccal mucosa patch graft for recurrent large urethrocutaneous fistula after hypospadias repair.

PubMed

Kiss, András; Pirót, László; Karsza, Levente; Merksz, Miklós

2004-01-01

To assess the effectiveness of buccal mucosa patch graft in the treatment of recurrent large urethrocutaneous fistula after hypospadias repair. A free graft of buccal mucosa was used for closure in 7 boys (mean age 4.8 years) with large (>4 mm) urethocutaneous fistula. Four fistulas were in the midshaft, 2 of them penoscrotal and 1 coronal type. All patients had undergone at least two previous unsuccessful fistula repairs, and 3 of them had undergone three attempts for closure. Fistula repairs were similar in all cases. The repair was successful in 6 out of 7 cases, and in these cases the urinary stream was good after the removal of the catheter. The unsuccessful case was the coronal one. Based on our experience it seems that in cases with recurrent large fistula after hypospadias reconstruction, the use of buccal mucosa patch graft for closure is a good treatment choice. Copyright 2004 S. Karger AG, Basel

Autologous Mesenchymal Stem Cells, Applied in a Bioabsorbable Matrix, for Treatment of Perianal Fistulas in Patients With Crohn's Disease.

PubMed

Dietz, Allan B; Dozois, Eric J; Fletcher, Joel G; Butler, Greg W; Radel, Darcie; Lightner, Amy L; Dave, Maneesh; Friton, Jessica; Nair, Asha; Camilleri, Emily T; Dudakovic, Amel; van Wijnen, Andre J; Faubion, William A

2017-07-01

In patients with Crohn's disease, perianal fistulas recur frequently, causing substantial morbidity. We performed a 12-patient, 6-month, phase 1 trial to determine whether autologous mesenchymal stem cells, applied in a bioabsorbable matrix, can heal the fistula. Fistula repair was not associated with any serious adverse events related to mesenchymal stem cells or plug placement. At 6 months, 10 of 12 patients (83%) had complete clinical healing and radiographic markers of response. We found placement of mesenchymal stem cell-coated matrix fistula plugs in 12 patients with chronic perianal fistulas to be safe and lead to clinical healing and radiographic response in 10 patients. ClinicalTrials.gov Identifier: NCT01915927. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Pharyngeal airway space and frontal and sphenoid sinus changes after maxillomandibular advancement with counterclockwise rotation for class II anterior open bite malocclusions

PubMed Central

Prado, FB; Rossi, AC; Freire, AR; Groppo, FC; De Moraes, M; Caria, PHF

2012-01-01

Objectives The purpose of this study was to cephalometrically evaluate the pharyngeal airway space and frontal and sphenoid sinus changes after maxillomandibular advancement counterclockwise rotation for class II anterior open bite malocclusion. Methods The study included 49 patients (98 lateral teleradiographs; 36 females and 13 males) who were analysed in the pre-operative (1 week before surgery) and post-operative (6 months after surgery) periods. In each lateral teleradiography, the dimensions of the inferior and superior pharyngeal airway space, TB-PhW1 [the point between the posterior aspect of the tongue to the dorsal pharyngeal wall (oropharynx) (TB) and the point on the dorsal pharyngeal wall closest to TB (PhW1)] and UP-PhW2 [and the point between the posterior aspect of the soft palate to the dorsal pharyngeal wall (nasopharynx) (UP) (PhW2)] measurements were evaluated, as well as the dimensions of the frontal and sphenoid sinuses. The differences between the two operative times were evaluated by Student's t-test. Results All measurements showed excellent reproducibility for the intraclass correlation coefficient (ICC > 0.9; p < 0.0001). There was an increase in the measurements TB-PhW1 and UP-PhW2 and a decrease in the dimensions of the frontal and sphenoid sinuses after orthognathic surgery. Conclusions The morphology of the superior and inferior pharyngeal airway space and frontal and sphenoid sinuses changes after 6 months of maxillomandibular advancement counterclockwise rotation for class II anterior open bite malocclusion. PMID:22116128

Failed Deglutitive Upper Esophageal Sphincter Relaxation Is a Risk Factor for Aspiration in Stroke Patients with Oropharyngeal Dysphagia.

PubMed

Lee, Taeheon; Park, Jung Ho; Sohn, Chongil; Yoon, Kyung Jae; Lee, Yong-Taek; Park, Jung Hwan; Jung, Il Seok

2017-01-30

We attempted to examine the relationship between abnormal findings on high-resolution manometry (HRM) and videofluoroscopic swallowing study (VFSS) of the pharynx and upper esophageal sphincter (UES), and to identify the risk factors for aspiration. We performed VFSS and HRM on the same day in 36 ischemic stroke patients (mean age, 67.5 years) with dysphagia. Pressure (basal, median intra bolus, and nadir), relaxation time interval of the UES, and mesopharyngeal and hypopharyngeal contractility (as a contractile integral) were examined using HRM. The parameters of VFSS were vallecular residue, pyriform sinus residue, vallecular overflow, penetration, and aspiration. The association between the parameters of VFSS and HRM was analyzed by the Student's t test. Three (8.3%) and 4 (11.1%) stroke patients with dysphagia had pyriform sinus residue and vallecular sinus residue, respectively, and 5 (13.8%) patients showed aspiration. Mesopharyngeal and hypopharyngeal contractile integrals in patients with residue in the pyriform sinus were significantly lower than those in patients without residue in the pyriform sinus ( P < 0.05). Relaxation time intervals in patients with aspiration were significantly shorter than those in patients without aspiration ( P < 0.05), and multivariate regression analysis revealed a shorter relaxation time interval as the main risk factor for aspiration (OR, 0.03; 95% CI, 0.01-0.65; P < 0.05). Manometric measurements of the pharynx and UES were well correlated with abnormal findings in the VFSS, and a shorter relaxation time interval of the UES during deglutition is an important parameter for the development of aspiration.

Association of magnetic resonance imaging findings and histologic diagnosis in dogs with nasal disease: 78 cases (2001-2004).

PubMed

Miles, Macon S; Dhaliwal, Ravinder S; Moore, Michael P; Reed, Ann L

2008-06-15

OBJECTIVE-To determine whether magnetic resonance imaging (MRI) features correlated with histologic diagnosis in dogs with nasal disease. DESIGN-Retrospective case series. ANIMALS-78 Dogs undergoing MRI for evaluation of nasal disease. PROCEDURES-Medical records and MRI reports of dogs were reviewed to identify MRI features associated with histologic diagnosis. Features evaluated were presence of a mass effect, frontal sinus involvement, sphenoid sinus involvement, maxillary recess involvement, nasopharyngeal infiltration by soft tissue, nasal turbinate destruction, vomer bone lysis, paranasal bone destruction, cribriform plate erosion, and lesion extent (ie, unilateral vs bilateral). RESULTS-33 Dogs had neoplastic disease, 38 had inflammatory rhinitis, and 7 had fungal rhinitis. Lesion extent was not significantly associated with histologic diagnosis. Absence of a mass effect was significantly associated with inflammatory disease. However, presence of a mass was not specific for neoplasia. In dogs with evidence of a mass on magnetic resonance (MR) images, nasal turbinate destruction, frontal sinus invasion, and maxillary recess invasion were not useful in distinguishing neoplastic from nonneoplastic disease, but cribriform plate erosion, vomer bone lysis, paranasal bone destruction, sphenoid sinus invasion, and nasopharyngeal invasion were. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggested that in dogs with nasal disease, the lack of a mass effect on MR images was significantly associated with inflammatory disease. In dogs with a mass effect on MR images, vomer bone lysis, cribriform plate erosion, paranasal bone destruction, sphenoid sinus invasion by a mass, and nasopharyngeal invasion by a mass were significantly associated with a diagnosis of neoplasia.

IROA: International Register of Open Abdomen, preliminary results.

PubMed

Coccolini, Federico; Montori, Giulia; Ceresoli, Marco; Catena, Fausto; Ivatury, Rao; Sugrue, Michael; Sartelli, Massimo; Fugazzola, Paola; Corbella, Davide; Salvetti, Francesco; Negoi, Ionut; Zese, Monica; Occhionorelli, Savino; Maccatrozzo, Stefano; Shlyapnikov, Sergei; Galatioto, Christian; Chiarugi, Massimo; Demetrashvili, Zaza; Dondossola, Daniele; Yovtchev, Yovcho; Ioannidis, Orestis; Novelli, Giuseppe; Nacoti, Mirco; Khor, Desmond; Inaba, Kenji; Demetriades, Demetrios; Kaussen, Torsten; Jusoh, Asri Che; Ghannam, Wagih; Sakakushev, Boris; Guetta, Ohad; Dogjani, Agron; Costa, Stefano; Singh, Sandeep; Damaskos, Dimitrios; Isik, Arda; Yuan, Kuo-Ching; Trotta, Francesco; Rausei, Stefano; Martinez-Perez, Aleix; Bellanova, Giovanni; Fonseca, Vinicius Cordeiro; Hernández, Fernando; Marinis, Athanasios; Fernandes, Wellington; Quiodettis, Martha; Bala, Miklosh; Vereczkei, Andras; Curado, Rafael L; Fraga, Gustavo Pereira; Pereira, Bruno M; Gachabayov, Mahir; Chagerben, Guillermo Perez; Arellano, Miguel Leon; Ozyazici, Sefa; Costa, Gianluca; Tezcaner, Tugan; Ansaloni, Luca

2017-01-01

No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org. Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male; Mean BMI: 36±5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p <0.0001) and with the fistula development (Pearson = 0.146 p = 0.016). Pediatric patients: 33 patients. Mean age: 5.91±(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(±3.09) days. Temporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogotà-bag seem to improve results. ClinicalTrials.gov NCT02382770.

Spontaneous obliteration of spontaneous vertebral arteriovenous fistula associated with fibromuscular dysplasia after partial surgery: A case report.

PubMed

Iampreechakul, Prasert; Siriwimonmas, Somkiet

2016-12-01

We describe a patient with spontaneous obliteration of spontaneous vertebral arteriovenous fistula (VAVF) associated with fibromuscular dysplasia (FMD) after partial surgery. A 52-year-old hypertensive female woke up one morning with left shoulder pain and weakness of the left upper extremity. A few days later, she developed left-sided audible bruit. She was treated for left frozen shoulder and supportive treatment for audible bruit for four years. She was referred from her general physician to a neurosurgeon because of left arm weakness. Physical examination showed signs of cervical radiculomyelopathy. Magnetic resonance imaging (MRI) showed an extradural mass on the left side of the cervical spinal canal from level C2 to C6. Provisional diagnosis was epidural vascular tumour. Laminectomy and partial removal of the mass was performed at level C5 to C6. Pathological report revealed suspected vascular malformation. Postoperative MRI showed thrombosed epidural vascular structure. Angiography showed dysplastic changes of both vertebral arteries representing FMD with VAVF of the left vertebral artery at level C1-C2. Two years after surgery, follow-up MRI demonstrated complete spontaneous resolution of the large thrombosed epidural vein. Disappearance of her audible bruit immediately after surgery and gradual improvement of her cervical radiculomyelopathy were observed after two years of clinical follow-up. From the literature, we found another 11 patients with 12 VAVFs who had spontaneous obliteration or cure of their fistulas. In the present case, spontaneous obliteration of the fistula seems to correlate with surgery inducing closure of the epidural venous exit leading to thrombosis of the enlarged epidural draining vein. © The Author(s) 2016.

Recent developments in the surgical management of perianal fistula for Crohn’s disease

PubMed Central

Geltzeiler, Cristina B.; Wieghard, Nicole; Tsikitis, Vassiliki L.

2014-01-01

Perianal manifestations of Crohn’s disease (CD) are common and, of them, fistulas are the most common. Perianal fistulas can be extremely debilitating for patients and are often very challenging for clinicians to treat. CD perianal fistulas usually require multidisciplinary and multimodality treatment, including both medical and surgical approaches. The majority of patients require multiple surgical interventions. CD patients with perianal fistulas have a high rate of primary non-healing, surgical morbidity, and high recurrence rates. This has led to constant efforts to improve surgical management of this disease process. PMID:25331917

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

PubMed

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

2017-11-01

Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28·0 months (IQR 14·6-36·6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56·5-89·3) and an incidence proportion of 18·4% (14·8-22·8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23·1 per 1000 person-years (14·0-36·2), and corresponding to 10·3% (5·2-19·6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106·0 per 1000 person-years, corresponding to 28·4% (22·8-35·0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. Recurrence of female genital fistula and adverse pregnancy-related maternal and child health outcomes were frequent in women after fistula repair in Guinea. Interventions are needed to safeguard the health of women after fistula repair. Belgian Development Cooperation (DGD), Institute of Tropical Medicine of Antwerp (ITM), and Maferinyah Training and Research Center in Rural Health (Guinea). Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Does regional compared to local anaesthesia influence outcome after arteriovenous fistula creation?

PubMed

Macfarlane, Alan James Robert; Kearns, Rachel Joyce; Aitken, Emma; Kinsella, John; Clancy, Marc James

2013-08-19

An arteriovenous fistula is the optimal form of vascular access in patients with end-stage renal failure requiring haemodialysis. Unfortunately, approximately one-third of fistulae fail at an early stage. Different anaesthetic techniques can influence factors associated with fistula success, such as intraoperative blood flow and venous diameter. A regional anaesthetic brachial plexus block results in vasodilatation and improved short- and long-term fistula flow compared to the infiltration of local anaesthetic alone. This, however, has not yet been shown in a large trial to influence long-term fistula patency, the ultimate clinical measure of success.The aim of this study is to compare whether a regional anaesthetic block, compared to local anaesthetic infiltration, can improve long-term fistula patency. This study is an observer-blinded, randomised controlled trial. Patients scheduled to undergo creation of either brachial or radial arteriovenous fistulae will receive a study information sheet, and consent will be obtained in keeping with the Declaration of Helsinki. Patients will be randomised to receive either: (i) an ultrasound guided brachial plexus block using lignocaine with adrenaline and levobupivicaine, or (ii) local anaesthetic infiltration with lignocaine and levobupivicaine.A total of 126 patients will be recruited. The primary outcome is fistula primary patency at three months. Secondary outcomes include primary patency at 1 and 12 months, secondary patency and fistula flow at 1, 3 and 12 months, flow on first haemodialysis, procedural pain, patient satisfaction, change in cephalic vein diameter pre- and post-anaesthetic, change in radial or brachial artery flow pre- and post-anaesthetic, alteration of the surgical plan after anaesthesia as guided by vascular mapping with ultrasound, and fistula infection requiring antibiotics. No large randomised controlled trial has examined the influence of brachial plexus block compared with local anaesthetic infiltration on the long-term patency of arteriovenous fistulae. If the performance of brachial plexus block increases fistulae patency, this will have significant clinical and financial benefits as the number of patients able to commence haemodialysis when planned should increase, and the number of "redo" or revision procedures should be reduced. This study has been approved by the West of Scotland Research Ethics Committee 5 (reference no. 12/WS/0199) and is registered with the ClinicalTrials.gov database (reference no. NCT01706354).

Rectovaginal Fistula

MedlinePlus

... rectovaginal fistula may result from: Injury during childbirth Crohn's disease or other inflammatory bowel disease Radiation treatment or ... the rectum that help you hold in stool. Crohn's disease. The second most common cause of rectovaginal fistulas, ...

Gastrointestinal fistula

MedlinePlus

... Other causes include: Blockage in the intestine Infection Crohn disease Radiation to the abdomen (most often given as ... medicines if the fistula is a result of Crohn disease Surgery to remove the fistula and part of ...

A rare case of complete second arch branchial fistula in a 7-year-old child.

PubMed

Shankar, Venkateswara Gomathi; Babu, Thirunavukkarasu Arun; Swami, Hartimath Basavanand

2012-07-01

Branchial fistulae are formed due to the abnormal persistence of the embryonic branchial clefts. Complete branchial fistula with internal and external opening is extremely rare. We report a rare case of complete second arch branchial fistulae in a 7-year-old boy, which was confirmed by a fistulogram. The tract was completely excised and the patient was successfully treated.

Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice.

PubMed

Delamou, Alexandre; Delvaux, Therese; Beavogui, Abdoul Habib; Toure, Abdoulaye; Kolié, Delphin; Sidibé, Sidikiba; Camara, Mandian; Diallo, Kindy; Barry, Thierno Hamidou; Diallo, Moustapha; Leveque, Alain; Zhang, Wei-Hong; De Brouwere, Vincent

2016-11-08

The prevention and treatment of obstetric fistula still remains a concern and a challenge in low income countries. The objective of this study was to estimate the overall proportions of failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identify its associated factors. This was a retrospective cohort study using data extracted from medical records of fistula repairs between 1 January 2012 and 30 September 2013. The outcome was the failure of fistula closure and incontinence at hospital discharge evaluated by a dye test. A sub-sample of women with vesicovaginal fistula was used to identify the factors associated with these outcomes. Overall, 109 women out of 754 (14.5 %; 95 % CI:11.9-17.0) unsuccessful repaired fistula at discharge and 132 (17.5 %; 95 % CI:14.8-20.2) were not continent. Failure of fistula closure was associated with vaginal delivery (AOR: 1.9; 95 % CI: 1.0-3.6), partially (AOR: 2.0; 95 % CI: 1.1-5.6) or totally damaged urethra (AOR: 5.9; 95 % CI: 2.9-12.3) and surgical repair at Jean Paul II Hospital (AOR: 2.5; 95 % CI: 1.2-4.9). Women who had a partially damaged urethra (AOR: 2.5; 95 % CI: 1.5-4.4) or a totally damaged urethra (AOR: 6.3; 95 % CI: 3.0-13.0) were more likely to experience post-repair urinary incontinence than women who had their urethra intact. At programmatic level in Guinea, caution should be paid to the repair of women who present with a damaged urethra and those who delivered vaginally as they carry greater risks of experiencing a failure of fistula closure and incontinence.

Management of vesicovaginal fistula: An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach

PubMed Central

Kapoor, Rakesh; Ansari, M. S.; Singh, Pratipal; Gupta, Parag; Khurana, Naval; Mandhani, Anil; Dubey, Deepak; Srivastava, Aneesh; Kumar, Anant

2007-01-01

Purpose: We aim to present our experience for the repair of vesicovaginal fistula (VVF) with special reference to surgical approach. Materials and Methods: From January 1999 to June 2005, 52 VVF patients with mean age of 32 years underwent operative treatment. Fistulas were divided into two groups, simple and complex, depending on site, size, etiology and associated anomalies. Simple VVFs were approached through the vaginal route and complex VVFs via the transabdominal route. Patients were evaluated at two to three weeks initially, three-monthly twice and later depending on symptoms. Results: Thirty-two (61.5%) had simple fistulas and 20 (38.5%) complex fistulas. The most common etiology was obstetric trauma in 31 (59.6%) patients, while the second most common cause was post hysterectomy VVF. Thirty-two (61.5%) patients were managed by transvaginal route, of which 17 had supratrigonal and 15 trigonal fistulas. Twenty (38.5%) patients with complex fistulas were managed by abdominal route. The mean blood loss, postoperative pain and mean hospital stay were shorter in transvaginal repair. Eleven (21.2%) patients required ancillary procedures for various other associated anomalies at the time of fistula repair. Three patients failed repair giving a success rate of 94.2%. At a mean follow-up of three years 48 women were sexually active, of these 10 (19.2%) complained of mild to moderate dyspareunia. Conclusion: Most of the simple fistulas irrespective their locations are easily accessible transvaginally while in complex fistulas we recommend the transabdominal approach. Depending on the clinical context both the approaches achieved comparable success rates. PMID:19718291

An experience with video-assisted anal fistula treatment (VAAFT) with new insights into the treatment of anal fistulae.

PubMed

Seow-En, I; Seow-Choen, F; Koh, P K

2016-06-01

The aim of this retrospective study was to assess our experience of 41 patients with anal fistulae treated with video-assisted anal fistula treatment (VAAFT). Forty-one consecutive patients with cryptoglandular anal fistulae were included. Patients with low intersphincteric anal fistulae or those with gross perineal abscess were excluded. Eleven (27 %) patients had undergone prior fistula surgery with 5 (12 %) having had three or more previous operations. All patients underwent the diagnostic phase as well as diathermy and curettage of the fistula tracts during VAAFT. Primary healing rate was 70.7 % at a median follow-up of 34 months. Twelve patients recurred or did not heal and underwent a repeat VAAFT procedure utilising various methods of dealing with the internal opening. There was a secondary healing rate of 83 % with two recurrences. Overall, stapling of the internal opening had a 22 % recurrence rate, while anorectal advancement flap had a 75 % failure rate. There was no recurrence seen in six cases after using the over-the-scope-clip (OTSC(®)) system to secure the internal opening. VAAFT is useful in the identification of fistula tracts and enables closure of the internal opening. Adequate closure is essential with the method used to close large or fibrotic internal openings being the determining factor for success or failure. The OTSC system delivered the most consistent result without leaving a substantial perianal wound. Ensuring thorough curettage and drainage of the tract during VAAFT is also important to facilitate healing. We believe that this understanding will bring about a decrease in the high recurrence rates currently seen in many series of anal fistulae.

Characterization of the upper pouch tracheo-oesophageal fistula in oesophageal atresia.

PubMed

Summerour, Virginia; Stevens, Paul S; Lander, Anthony D; Singh, Michael; Soccorso, Giampiero; Arul, G Suren

2017-02-01

A small proportion of infants with oesophageal atresia (OA) are thought to have a proximal tracheoesophageal fistula (TOF). Failure to recognize these can hamper mobilization of the upper pouch and lead to life-threatening episodes of aspiration once oral feeding starts. We reviewed our experience of upper pouch fistulae to identify characteristic features of proximal TOF. A retrospective review of TOF/OA patient notes and bronchoscopy photographs and videos, identified from our database from 01/01/2006 to 12/31/2015, was performed. Eight (6.1%) infants were identified (M:F 5:3) from a total population of 131 newly diagnosed TOF/OA infants during the period. Their median gestational age was 33 (range 28-39) weeks, and median birth weight was 1647g (range 1100-3400g). Five were initially diagnosed with pure OA and 3 with a distal TOF. All patients underwent rigid bronchoscopy at the initial surgery but only one proximal fistula was identified. The 7 missed proximal fistulae were subsequently found either during on-table oesophagograms for gap assessment (n=2), at the time of thoracotomy when mobilizing the upper pouch (n=3), or during subsequent bronchoscopy for symptoms post OA repair (n=2). Two patients needed a further operation to divide the fistula. Review of the bronchoscopy videos identified four characteristic differences between upper and lower pouch fistulae. Proximal fistulae are found just distal to the vocal cords, are very small, often no more than a pit, do not open and close with ventilation, and are best identified by insufflation of the esophagus. Upper pouch fistulae are relatively easy to miss because of different characteristics compared with H-type or distal fistulae that have not previously been mentioned in the literature. level IV. Copyright © 2016. Published by Elsevier Inc.

Malignant transformation in perianal fistulas of Crohn's disease: a systematic review of literature.

PubMed

Thomas, Mathew; Bienkowski, Robert; Vandermeer, Thomas J; Trostle, Douglas; Cagir, Burt

2010-01-01

Malignant transformation of perineal fistula in Crohn's disease has rarely been reported. The aim of this study is to define the patient's characteristics and clinical presentation of this rare disease. A systematic review of case series and reports published in English language between 1950 and 2008 was conducted. All cases with malignancy in low pelvic/perineal fistula in patients with Crohn's disease were included. All selected cases were then analyzed with respect to age, gender, duration of Crohn's disease and fistula, location of fistula, presenting symptoms, method of diagnosis, delay in diagnosis, histopathology, treatment, and outcome. Data analyses were done using chi-squared or Fisher's exact test and the Mann-Whitney test. Literature review revealed 61 cases of carcinomas arising in perineal fistulas in Crohn's disease. Sixty-one percent (37) of the patients were females. Females were significantly younger than males at the time of diagnosis of cancer (47 vs. 53 years, P < 0.032). Males were also noted to have significantly longer duration of Crohn's disease compared to females (24 vs. 18 years, P = 0.005). However, females were noted to have the fistula for significantly shorter duration prior to cancer transformation when compared to males (8.3 vs. 16 years, P = 0.0035). On initial examination, malignancy was suspected and proven only in 20% of patients (n = 12). Adenocarcinoma was the most common histology (59%, n = 36), followed by squamous cell carcinoma (31%, n = 19). In most patients (59%, n = 36), the fistula was rectal in origin. A high suspicion for malignancy in chronic perineal fistulas associated with Crohn's disease should be maintained in spite of negative biopsies. Especially in women, the shorter duration of Crohn's fistulas prior to malignant degeneration necessitates an aggressive approach to rule out cancer.

Atrioesophageal Fistula: Considerations for the neurological clinician.

PubMed

Zima, Laura A; Fornoff, Linden E; Surdell, Daniel L

2018-04-27

Atrioesophageal fistula (AEF) is a rare complication of cardiac ablation for atrial fibrillation. It can present in many ways, but neurological signs and symptoms are common initial signs sometimes resulting in neurosurgeons and neurologists first evaluating patients with the condition. We present a case report of at 68-year-old female who presented with acute stroke symptoms and multifocal hemorrhages on MRI who was worked up through our neurosurgery department and diagnosed with AEF. This case highlights three clues to alert neurological clinicians to AEF as a possible diagnosis; clinical worsening of neurological symptoms in correlation to episodes of emesis, septic emboli on CT/MRI, and bacteremia caused by a gram positive oral or GI flora. If neurological clinicians encounter these red flags, an immediate CT of the chest and abdomen and consultation with cardiothoracic surgery may be life-saving. Copyright © 2018 Elsevier B.V. All rights reserved.

Gel-Sinuplasty for Chronic Rhinosinusitis With and Without Nasal Polyposis

ClinicalTrials.gov

2018-03-13

Chronic Sinusitis, Ethmoidal; Chronic Sinusitis - Ethmoidal Anterior; Chronic Sinusitis; Chronic Sinusitis - Ethmoidal, Posterior; Chronic Sinusitis, Sphenoidal; Chronic Sinusitis - Frontoethmoidal; Nasal Polyps; Nasal Polyp - Posterior

Transperineal ultrasonography in perianal Crohn disease: A valuable imaging modality.

PubMed

Wright, Emily K; Novak, Kerri L; Lu, Cathy; Panaccione, Remo; Ghosh, Subrata; Wilson, Stephanie R

2015-01-01

Aims of treatment for Crohn disease have moved beyond the resolution of clinical symptoms to objective end points including endoscopic and radiological normality. Regular re-evaluation of disease status to safely, readily and reliably detect the presence of inflammation and complications is paramount. Improvements in sonographic technology over recent years have facilitated a growing enthusiasm among radiologists and gastroenterologists in the use of ultrasound for the assessment of inflammatory bowel disease. Transabdominal intestinal ultrasound is accurate, affordable and safe for the assessment of luminal inflammation and complications in Crohn disease, and can be performed with or without the use of intravenous contrast enhancement. Perianal fistulizing disease is a common, complex and often treatment-refractory complication of Crohn disease, which requires regular radiological monitoring. Endoanal ultrasound is invasive, uncomfortable and yields limited assessment of the perineal region. Although magnetic resonance imaging of the pelvis is established, timely access may be a problem. Transperineal ultrasound has been described in small studies, and is an accurate, painless and cost-effective method for documenting perianal fluid collections, fistulas and sinus tracts. In the present article, the authors review the literature regarding perineal ultrasound for the assessment of perianal Crohn disease and use case examples to illustrate its clinical utility.

Fatigue correlates with the decrease in parasympathetic sinus modulation induced by a cognitive challenge

PubMed Central

2014-01-01

Background It is known that enhancement of sympathetic nerve activity based on a decrease in parasympathetic nerve activity is associated with fatigue induced by mental tasks lasting more than 30 min. However, to measure autonomic nerve function and assess fatigue levels in both clinical and industrial settings, shorter experimental durations and more sensitive measurement methods are needed. The aim of the present study was to establish an improved method for inducing fatigue and evaluating the association between it and autonomic nerve activity. Methods Twenty-eight healthy female college students participated in the study. We used a kana pick-out test (KPT) as a brief verbal cognitive task and recorded electrocardiography (ECG) to measure autonomic nerve activity. The experimental design consisted of a 16-min period of ECG: A pre-task resting state with eyes open for 3 min and eyes closed for 3 min, the 4-min KPT, and a post-task resting state with eyes open for 3 min and eyes closed for 3 min. Results Baseline fatigue sensation, measured by a visual analogue scale before the experiment, was associated with the decrease in parasympathetic sinus modulation, as indicated the by ratio of low-frequency component power (LF) to high-frequency component power (HF), during the KPT. The LF/HF ratio during the post-KPT rest with eyes open tended to be greater than the ratio during the KPT and correlated with fatigue sensation. Fatigue sensation was correlated negatively with log-transformed HF, which is an index of parasympathetic sinus modulation, during the post-KPT rest with eyes open. Conclusions The methods described here are useful for assessing the association between fatigue sensation and autonomic nerve activity using a brief cognitive test in healthy females. PMID:25069864

Long-Term Endocrine Outcomes Following Endoscopic Endonasal Transsphenoidal Surgery for Acromegaly and Associated Prognostic Factors.

PubMed

Babu, Harish; Ortega, Alicia; Nuno, Miriam; Dehghan, Aaron; Schweitzer, Aaron; Bonert, H Vivien; Carmichael, John D; Cooper, Odelia; Melmed, Shlomo; Mamelak, Adam N

2017-08-01

Long-term remission rates from endoscopic transsphenoidal surgery for acromegaly and their relationship to prognostic indicators of disease aggressiveness are not well documented. To investigate long-term remission rates in patients with acromegaly after endoscopic transsphenoidal surgery, and correlate this with molecular and radiographic markers of disease aggressiveness. We identified all patients undergoing endoscopic transsphenoidal surgery for acromegaly from 2005 to 2013 at Cedars-Sinai Pituitary Center. Hormonal remission was established by normal insulin-like growth factor (IGF)-1, basal serum growth hormone <2.5 ng/mL, and growth hormone suppression to <1 ng/mL following oral glucose tolerance test. Oral glucose tolerance test was performed at 3 months after surgery, and then as indicated. IGF-1 was measured at 3 months and then at least annually. We evaluated tumor granularity, nuclear expression of p21, Ki67 index, and extent of cavernous sinus invasion, and correlated these with remission status. Fifty-eight patients that underwent surgery had follow-up from 38 to 98 months (mean 64 ± 32.2 months). There were 21 microadenomas and 37 macroadenomas. Three months after surgery 40 of 58 patients (69%) were in biochemical remission. Four additional patients were in remission at 6 months after surgery, and 1 patient had recurrence within the first year after surgery. At last follow-up, 43 of 44 (74.1%) of patients remained in remission. Cavernous sinus invasion by tumor predicted failure to achieve remission. Prognostic markers of disease aggressiveness other than cavernous sinus invasion did not correlate with surgical outcome. Long-term remission after surgery alone was achieved in 74% of patients, indicating long-term efficacy of endoscopic surgery. Copyright © 2017 by the Congress of Neurological Surgeons

Renal Sinus Fat Invasion and Tumoral Thrombosis of the Inferior Vena Cava-Renal Vein: Only Confined to Renal Cell Carcinoma

PubMed Central

Harman, Mustafa; Guneyli, Serkan; Sen, Sait; Elmas, Nevra

2014-01-01

Epithelioid angiomyolipoma (E-AML), accounting for 8% of renal angiomyolipoma, is usually associated with tuberous sclerosis (TS) and demonstrates aggressive behavior. E-AML is macroscopically seen as a large infiltrative necrotic tumor with occasional extension into renal vein and/or inferior vena cava. However, without history of TS, renal sinus and venous invasion E-AML would be a challenging diagnosis, which may lead radiologists to misinterpret it as a renal cell carcinoma (RCC). In this case presentation, we aimed to report cross-sectional imaging findings of two cases diagnosed as E-AML and pathological correlation of these aforementioned masses mimicking RCC. PMID:25506021

Renal sinus fat invasion and tumoral thrombosis of the inferior vena cava-renal vein: only confined to renal cell carcinoma.

PubMed

Acar, Turker; Harman, Mustafa; Guneyli, Serkan; Sen, Sait; Elmas, Nevra

2014-01-01

Epithelioid angiomyolipoma (E-AML), accounting for 8% of renal angiomyolipoma, is usually associated with tuberous sclerosis (TS) and demonstrates aggressive behavior. E-AML is macroscopically seen as a large infiltrative necrotic tumor with occasional extension into renal vein and/or inferior vena cava. However, without history of TS, renal sinus and venous invasion E-AML would be a challenging diagnosis, which may lead radiologists to misinterpret it as a renal cell carcinoma (RCC). In this case presentation, we aimed to report cross-sectional imaging findings of two cases diagnosed as E-AML and pathological correlation of these aforementioned masses mimicking RCC.

Sigmoid-vaginal fistula during bevacizumab treatment diagnosed by fistulography.

PubMed

Hayashi, C; Takada, S; Kasuga, A; Shinya, K; Watanabe, M; Kano, H; Takayama, T

2016-12-01

There have been several reports describing rectovaginal fistula development after bevacizumab treatment, and these fistulas were diagnosed by CT scan or colonoscopy. We report a case of sigmoid-vaginal fistula diagnosed by fistulography. The case is a 53-year-old woman who was treated for chronic myelogenous leukaemia and gynaecological cancers 8 years previously. At 52 years of age, she was diagnosed with colon cancer and had a partial colectomy performed. One year after surgery, colon cancer recurred, and she was treated with anticancer agents, including bevacizumab. During chemotherapy, she complained of a foul smelling discharge from the vagina. Fistulography revealed a sigmoid-vaginal fistula. This is the first report of vaginal fistulography performed on a patient who was treated with bevacizumab. Fistulography may be useful for detecting sigmoid-vaginal fistula. © 2016 John Wiley & Sons Ltd.

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

Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center

PubMed Central

Badrasawi, Manal MH; Shahar, Suzana; Sagap, Ismail

2014-01-01

Enterocutaneous fistula is a challenging clinical condition with serious complications and considerable morbidity and mortality. Early nutritional support has been found to decrease these complications and to improve the clinical outcome. Location of the fistula and physiological status affect the nutrition management plan in terms of feeding route, calories, and protein requirements. This study investigated the nutritional management procedures at the Universiti Kebangsaan Malaysia Medical Center, and attempted to determine factors that affect the clinical outcome. Nutritional management was evaluated retrospectively in 22 patients with enterocutaneous fistula seen over a 5-year period. Medical records were reviewed to obtain data on nutritional status, biochemical indices, and route and tolerance of feeding. Calories and protein requirements are reported and categorized. The results show that surgery was the predominant etiology and low output fistula was the major physiological category; anatomically, the majority were ileocutaneous. The spontaneous healing rate was 14%, the total healing rate was 45%, and the mortality rate was 22%, with 14% due to fistula-associated complications. There was a significant relationship between body mass index/serum albumin levels and fistula healing; these parameters also had a significant relationship with mortality. Glutamine was used in 50% of cases; however, there was no significant relationship with fistula healing or mortality rate. The nutritional status of the patient has an important impact on the clinical outcome. Conservative management that includes nutrition support is very important in order to improve nutritional status before surgical repair of the fistula. PMID:25187726

Likelihood of Starting Dialysis after Incident Fistula Creation

PubMed Central

Quinn, Robert R.; Garg, Amit X.; Kim, S. Joseph; Wald, Ron; Paterson, J. Michael

2012-01-01

Summary Background and objectives Guidelines promote early fistula creation to avoid central venous catheter use. This practice may lead to fistula creations in patients who never receive dialysis. The objective of this study was to estimate the risk of fistula nonuse with long-term follow-up. Design, setting, participants, & measurements Administrative health data identified 1929 predialysis adults who had their first fistula creation between April of 2002 and March of 2006. Patients were followed for a minimum of 2 years or until they began dialysis, received a kidney transplant, or died. Results The median follow-up times in patients who started dialysis, died without receiving dialysis, and remained in predialysis were 6.1, 11.5, and 38.7 months, respectively. Eighty-one percent of patients initiated dialysis; 9% of patients died without receiving dialysis, and 10% of patients remained predialysis. Forty percent of patients had their first fistula creation 3–12 months before initiating dialysis (the recommended window). Thirty percent were created within 90 days of starting dialysis; 30% were created more than 1 year before starting dialysis, and 10% were created more than 2 years before starting dialysis. Older patients, females, and patients with less comorbidity were not as likely to initiate dialysis after incident fistula creation. Conclusions Most patients who underwent fistula creation before starting dialysis eventually received dialysis with extended follow-up, but the risk was significantly modified by age, sex, and comorbidity. Many patients had fistula creations earlier or later than recommended. PMID:22344512

[Social integration of women operated for obstetric urogenital fistula].

PubMed

Diarra, A; Tembely, A; Berthe, H J G; Diakité, M L; Traoré, B; Ouattara, K

2013-10-01

To study the social integration of women supported in the urology department of the University Hospital of Point G for obstetric urogenital fistula. Prospective study conducted over a period of 13 months from June 2008 to June 2009 in the Department of Urology at the University Hospital of Point G. The study included all patients who have been operated on at least twice for obstetric fistula genitourinary. Records of surgical, medical records and tracking sheets for each patient were the media database. Situation before treatment: before surgical treatment, 76.92% of patients were rejected by their spouses. The family attended the patient in 84.62% of cases. Situation after treatment: after treatment, 90.31% of women with fistula lived in the matrimonial home or family. The resumption of business activity was announced by 11.2% of patients. Among the women, 93.7% participated in housework. The number of patient intervention ranged from two to five. Healing (fistula closed and no sphincter dysfunction) was complete in 50% of cases. Among the women, 11.54% had sphincter dysfunction after closure of the fistula, which makes a total of fistula closed more than 61% after at least two attempts. The urogenital fistulas are not a fatal disease but is a real handicap for women who suffer to conduct a socio-cultural and economic mainstream. Generally excluded from the ongoing operations of the company, these women are more integrated after successful surgical treatment of the fistula. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Haziness in X-Ray Paranasal Sinus Water's View in Sinusitis: A Fact or Fiction.

PubMed

Gujrathi, Aatish; Wakode, P T

2013-08-01

It is a clinical dilemma whether patients having no symptoms of sinusitis but sinus haziness in X-ray should be considered as sinusitis or not and patients clinically having sinusitis and do not have radiological evidence should be considered as case of sinusitis or not. This study is an attempt to discuss this issue in details. To study diagnostic efficacy of conventional X-ray para nasal sinus water's view in sinusitis. To study the proportion of asymptomatic individuals showing haziness in conventional X-ray para nasal sinus water's view. Sensitivity and specificity of sinus X-ray in combination (conventional + digital) is 95 and 44%, respectively. Proportion of asymptomatic individuals showing haziness in conventional X-ray and digital X-ray paranasal sinus water's view are 52.4 and 75%, respectively. X-ray paranasal sinus water's view undoubtedly yields valuable information regarding sinus pathology. However it should not be accepted as a diagnosis in itself, but considered in the light of patient's history and clinical findings.

A rare case of complete second arch branchial fistula in a 7-year-old child

PubMed Central

Shankar, Venkateswara Gomathi; Babu, Thirunavukkarasu Arun; Swami, Hartimath Basavanand

2012-01-01

Branchial fistulae are formed due to the abnormal persistence of the embryonic branchial clefts. Complete branchial fistula with internal and external opening is extremely rare. We report a rare case of complete second arch branchial fistulae in a 7-year-old boy, which was confirmed by a fistulogram. The tract was completely excised and the patient was successfully treated. PMID:23833506

Large left circumflex coronary artery with a fistula to superior vena cava: Diagnosis by echocardiography.

PubMed

Liu, Yunqi; Liu, Yanqiu; Xiong, Mai; Li, Hanzhao; Liu, Donghong; Zhang, Xi

2017-04-01

The left circumflex coronary artery associated with a fistula to superior vena cava is a rare entity. We describe a 7-year-old girl who presented with a cardiac murmur and was diagnosed with a coronary artery fistula between the left circumflex artery and superior vena cava by echocardiography. The surgical occlusion of the fistula was successful. © 2017, Wiley Periodicals, Inc.

Iatrogenic Aorto-Cisterna Chyli Fistula During Percutaneous Balloon Aortoplasty in a Patient with Takayasu's Arteritis: A Case Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hwang, Hye Sun; Shin, Sung Wook, E-mail: swshin@smc.samsung.co.kr; Kim, Eun Hui

2007-04-15

We present a case of iatrogenic aorto-cisterna chyli fistula that developed during percutaneous transluminal aortoplasty in a 16-year old girl with Takayasu's arteritis. The aorto-cisterna chyli fistula was angiographically confirmed and treated using a stent-graft, which successfully occluded the fistula. Her claudication then improved, although follow-up CT angiography at 10 months revealed mild recurrent aortic stenosis.

Prenatal diagnosis of left pulmonary artery-to-pulmonary vein fistula and its successful surgical repair in a neonate.

PubMed

Ostras, Oleksii; Kurkevych, Andrii; Bohuta, Lyubomyr; Yalynska, Tetyana; Raad, Tammo; Lewin, Mark; Yemets, Illya

2015-04-01

Pulmonary arteriovenous fistula is a rare disease. To the best of our knowledge, prenatal diagnosis of a fistula between the left pulmonary artery and the left pulmonary vein has not been described in the medical literature. We report a case of the prenatal diagnosis of a left pulmonary artery-to-pulmonary vein fistula, followed by successful neonatal surgical repair.

Prenatal Diagnosis of Left Pulmonary Artery-to-Pulmonary Vein Fistula and Its Successful Surgical Repair in a Neonate

PubMed Central

Kurkevych, Andrii; Bohuta, Lyubomyr; Yalynska, Tetyana; Raad, Tammo; Lewin, Mark; Yemets, Illya

2015-01-01

Pulmonary arteriovenous fistula is a rare disease. To the best of our knowledge, prenatal diagnosis of a fistula between the left pulmonary artery and the left pulmonary vein has not been described in the medical literature. We report a case of the prenatal diagnosis of a left pulmonary artery-to-pulmonary vein fistula, followed by successful neonatal surgical repair. PMID:25873833

Vaginal approach to vesicovaginal fistula and vaginal vault prolapse preserving sexual function by Latzko repair and sacrospinous suspension

PubMed Central

Crosby, Erin C.; Berger, Mitchell B.; DeLancey, John O. L.

2014-01-01

The combination of vesicovaginal fistula and complete vaginal vault prolapse is rare. The only published treatment recommendations concern partial colpocleisis; an option that precludes intercourse. In this case report, we describe successful repair of this problem with a Latzko fistula repair and concomitant Michigan four-wall sacrospinous ligament suspension: curing the fistula, correcting the prolapse and preserving sexual function. PMID:22983277

A novel model of acellular dermal matrix plug for anal fistula treatment. Report of a case and surgical consideration based on first utility in Poland.

PubMed

Bobkiewicz, Adam; Krokowicz, Łukasz; Borejsza-Wysocki, Maciej; Banasiewicz, Tomasz

2017-08-31

Anal fistula (AF) is a pathological connection between anus and skin in its surroundings. The main reason for the formation of anal fistula is a bacterial infection of the glands within the anal crypts. One of the modern techniques for the treatment of fistulas that do not interfere with the sphincters consists in implantation of a plug made from collagen material. We are presenting the first Polish experience with a new model of biomaterial plug for the treatment of anal fistula. We also point out key elements of the procedure (both preoperative and intraoperative) associated with this method. In the authors' opinion, the method is simple, safe and reproducible. Innovative shape of the plug minimizes the risk of its migration and rotation. It also perfectly blends with and adapts to the course and shape of the fistula canal, allowing it to become incorporated and overgrown with tissue in the fistula canal. The relatively short operation time, minor postoperative pain and faster convalescence are with no doubt additional advantages of the method. Long-term observation involving more patients is essential for evaluation of the efficacy of the treatment of fistulas with the new type of plug.

The two sides of the coin: Similarities and differences in the pathomechanisms of fistulas and stricture formations in irritable bowel disease.

PubMed

Scharl, Michael; Bruckner, Ramona S; Rogler, Gerhard

2016-08-01

Fistulas and fibrosis or strictures represent frequent complications in irritable bowel disease (IBD) patients. To date, treatment options for fistulas are limited and surgery is often required. Similarly, no preventive treatment for fibrosis and stricture formation has been established. Frequently, stricture formation and fibrosis precede fistula formation, indicating that both processes may be connected or interrelated. Knowledge about the pathology of both processes is limited. A crucial role for the epithelial-to-mesenchymal transition (EMT) in fistula development has been demonstrated. Of note, EMT also plays a major role in the pathogenesis of fibrosis in many organs, and most likely also plays that role in the intestine. In addition, aberrant matrix remodeling, as well as soluble factors such as tumor necrosis factor (TNF), interleukin 13 (IL-13) and tumor growth factor beta (TGFβ) were involved, both in the onset of the fistula and fibrosis formation. Both fistulas and fibrosis may occur due to deregulated wound healing mechanisms from chronic and severe intestinal inflammation; however, further research is required to obtain a better understanding of the complex pathophysiology of fistula and intestinal fibrosis formation, to allow the development of new and more effective preventive treatment options for those important disease complications.

Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania

PubMed Central

Dennis, Alexis C; Wilson, Sarah M; Mosha, Mary V; Masenga, Gileard G; Sikkema, Kathleen J; Terroso, Korrine E; Watt, Melissa H

2016-01-01

Objective An obstetric fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with obstetric fistula in the periods immediately preceding obstetric fistula repair surgery and following reintegration. Patients and methods The study used a mixed-methods design to analyze cross-sectional surveys (n=59) and in-depth interviews (n=20). Results Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their fistula care and relationship needs. Conclusion Our data suggest that while some women endure negative social experiences following an obstetric fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic care for patients. PMID:27660492

Percutaneous Creation of a Central Iliac Arteriovenous Anastomosis for the Treatment of Arterial Hypertension.

PubMed

Bertog, Stefan C; Sobotka, Nathan A; Sobotka, Paul A; Lobo, Melvin D; Sievert, Kolja; Vaskelyte, Laura; Sievert, Horst; Schmieder, Roland E

2018-03-19

Provision of a summary on the physiologic effects of arteriovenous fistula creation and description of previously published human data on the efficacy of a percutaneously implanted device creating an arteriovenous fistula. Though antihypertensive therapy is effective, some patient's blood pressure remains poorly controlled despite adherence to optimal medical therapy. Moreover, some patients are not compliant with recommended medical therapy due to side effects or personal decision. This has prompted exploration of alternative, device-based antihypertensive therapies including, among others, the percutaneous creation of an arteriovenous fistula. An arteriovenous fistula is accompanied by a number of favorable physiologic changes that may lower blood pressure. These physiologic changes, conduction of the procedure, and previously published human experience are summarized in this review article. The results of a recently published trial comparing arteriovenous fistula creation and standard antihypertensive therapy versus standard antihypertensive therapy alone are summarized. Creation of an arteriovenous fistula is accompanied by a significant blood pressure reduction likely related to a reduction in total arterial resistance, perhaps blood volume reduction, inhibition of the baroreceptor reflex, and release of natriuretic peptides. These findings foster further interest in studying the impact of an arteriovenous fistula and arterial blood pressure. The design of a large randomized trial comparing arteriovenous fistula creation to sham control is outlined.

Comparison of Endoanal Ultrasound with Clinical Diagnosis in Anal Fistula Assessment.

PubMed

Sirikurnpiboon, Siripong; Phadhana-anake, Oradee; Awapittaya, Burin

2016-02-01

Anal fistula anatomy and its relationship with anal sphincters are important factors influencing the results of surgical management. Pre-operative definitions of fistulous track(s) and the internal opening play a primary role in minimizing damage to the sphincters and recurrence of the fistula. To evaluate the relative accuracy of digital examination and endoanal ultrasound for pre-operative assessment of anal fistula by comparing operative findings. A retrospective review was conducted of all patients with anal fistula admitted to the surgical unit between May 2008 and May 2012. Physical examination and hydrogen peroxide-enhanced endoanal ultrasound (utilising a 10 MHz endoprobe, HITACHI: EUB-7500), were performed in 142 consecutive patients. Results were matched with surgical features to establish their accuracy in preoperative anal fistula assessment. A total of 142 patients (107 men, 35 women), 28 of whom had had previous surgery, were included in the study. Their mean age was 40 (range 18-71) years and their mean BMI was 26.37 (range 17.30-36.11) kg/m². The majority of the fistulas were transphincteric (90.4%) and the rest were intersphincteric (9.6%). The accuracy rates of clinical examination and endoanal ultrasound were 55.63 and 95.07 percent (p < 0.01), respectively. Endoanal ultrasound is superior to digital examination for pre-operative classification of anal fistula

Fitsari 'dan Duniya. An African (Hausa) praise song about vesicovaginal fistulas.

PubMed

Wall, L Lewis

2002-12-01

The vesicovaginal fistula from prolonged obstructed labor is a condition that is no longer seen in the affluent, industrialized world, yet it continues to exist in epidemic proportions in sub-Saharan Africa, where several million women are estimated to suffer from this condition. The unremitting urinary incontinence that is produced by a fistula causes these women to become social outcasts. The problem is particularly acute in Nigeria, where the Federal Ministry of Women's Affairs estimates that there may be as many as 800,000 unrepaired fistula cases. Because of the social stigma attached to their condition, fistula victims have often been subjected to major psychosocial trauma. Finding ways to help such patients reintegrate into social networks is an important part of their treatment. When fistula patients meet one another, they realize that they are not alone in their suffering. This article describes the use of a "praise song" by a group of Nigerian fistula patients as a vehicle for building group identity as part of a "sisterhood of suffering." A transcription and translation of a Hausa praise song about vesicovaginal fistulas is presented, along with a commentary on the text that sheds new light on a problem that is unfamiliar to most Western obstetrician-gynecologists.

Correlation between the extent of pneumatization of Agger agger Nasi nasi cells and the anterior-to-posterior length of the frontal recess: A a computer-assisted anatomical study.

PubMed

Altıntaş, Ahmet; Çelik, Mustafa; Yegin, Yakup; Canpolat, Sinan; Olgun, Burak; Tülin Kayhan, Fatma

2017-06-30

To explore the correlation between the volume of the aAgger nNasi (AN) cell bulge and the A-P length of the frontal recess (FR). In total, 120 patients, who underwent septoplasty, were included. All patients underwent preoperative paranasal sinus computed tomography of the paranasal sinuses (PNS CT) imaging. In total, CT data on of all 120 PNSs patients were analyzed in terms of thewith respect to the extent of pneumatization of the AN cell bulge and the A-P dimensions of the FR. Each side was analyzed separately. We included 120 patients,: 78 (65.0%) females and 42 (35.0 %) males. Their average age was 33.7 ± 11.6 years (range: 18-65 years). The mean volume of the AN cell bulge was 0.26 ± 0.4 mm3 on both the right and left sides. The A-P length of the FR was 7.7 ± 2.2 mm. No significant between-side difference in the mean volume of the AN cell bulge was apparent observed (p=0.906). This volume did not differ significantly by age or sex (p=0.844 and p=0.971, respectively). We found no correlation between the volume of the AN cell bulge and the A-P length of the FR (r = 0.098, p=0.192). In the present study, no correlation between AN cell volume and the A-P length of the FR was found. When studying the anatomical complexity of the FR, it is essential to consider the AN cell volume. We suggest that preoperative CT imaging is critical when endoscopic sinus surgery is planned. However, further studies with larger numbers of patients are needed to explore the relationship between AN cell pneumatization and the anatomy of the FR.

Novel Surgical Technique for Coronary Fistulas With Proximal Origin.

PubMed

Uchida, Tetsuro; Hamasaki, Azumi; Kuroda, Yoshinori; Ohba, Eiichi; Yamashita, Atsushi; Sadahiro, Mitsuaki

2017-09-01

Postoperative residual shunting is a significant concern in patients with coronary arteriovenous fistulas, especially in fistulas originating from the proximal left coronary artery, because of the limited surgical field. We report a case of fistulas originating from the proximal coronary artery in a 63-year-old woman in whom the ascending aorta and pulmonary artery were transected to obtain good surgical exposure. After complete transection of both great arteries, fistulas arising from the left main trunk were ligated externally, and their intracardiac openings were closed internally. Postoperative examination revealed no residual shunt flow. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Transarterial Embolization of a Spontaneous Intraorbital Arteriovenous Fistula With n-BCA Glue.

PubMed

Konstas, Angelos A; Rootman, Daniel B; Quiros, Peter A; Ross, Ian B

Arteriovenous fistulae of the orbit are exceedingly rare. They are high-flow vascular malformations involving a fistula from the ophthalmic artery to one of the draining ophthalmic veins. Presenting symptoms can mimic those of carotid cavernous fistulae or of ophthalmic venous varices, and include diplopia, proptosis, chemosis, decreased visual acuity, and retro-orbital pain. Very few case reports are published on the treatment of this aggressive vascular malformation, and they uniformly describe techniques involving a transvenous access for the embolization of the fistula. To the best of authors' knowledge, they report the first case of transarterial embolization of an intraorbital AVF.

[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. Sociedad Argentina de Pediatría.

[Conservative management of upper tract urinary fistulae using ureteral trans-vesico-parietal stent].

PubMed

Le Guilchet, T; Audenet, F; Hurel, S; Beaugerie, A; Fontaine, E; Terrier, N; Timsit, M O; Mejean, A

2016-03-01

Ureteral stents and ureteral catheters externalized through the urethra are not ideal solutions to manage complicated upper urinary tract fistulae. We sought an effective method of drainage, minimally invasive, reproducible allowing a rapid patient's discharge. Between November 2013 and February 2015, an ureteral stent was exteriorized in trans-vesico-parietal by an endoscopic and percutaneous access in patients with complicated upper urinary tract fistulae. Monitoring of tolerance, complications and urinary fistula healing was performed. Nine consecutive patients had an ureteral stent exteriorized in trans-vesico-parietal to manage complicated upper urinary tract fistulae. There was no failure in introducing the catheter, or postoperative complication. Catheters were left in place on average 36.1days (24-55). The patients were able to return home with the catheter in place in 77.8% of cases. The tolerance of the catheter was good. All fistulae were able to be treated conservatively at the end of the drainage period. Trans-vesico-parietal ureteral catheters enable efficient and reproducible conservative treatment of upper tract urinary fistulae regardless of their cause. 5. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Spontaneous right hepatic artery branch gallbladder fistula revealed by haemobilia and upper cataclysmic gastrointestinal bleeding.

PubMed

Landolsi, Sana; Landolsi, Manel; Mannai, Saber

2018-01-03

Spontaneous right hepatic artery branch gallbladder fistula is a rare condition. Our case reported a spontaneous fistula between the right branch of the hepatic artery and the gall bladder. It constitutes a rare cause of haemobilia. In fact, the most common aetiology of haemobilia is traumatic or iatrogenic secondary to hepatobiliary surgery or interventions. Diagnosis of vascular-biliary fistula is not easy. The gallbladder endoluminal clot can mimic a mass, as in our patient. Selective arterial angiography is helpful in identifying the source of gastrointestinal haemorrhage. It can demonstrate the presence of arteriobiliary fistula. The differential diagnosis is arterial pseudoaneurysm in the vicinity of the vessel. Mini-invasive treatment of this fistula constitutes the best treatment. We here report a case of haemobilia with upper cataclysmic gastrointestinal bleeding revealing a spontaneous fistula between the right branch of the hepatic artery and the gall bladder. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Experiences of women seeking medical care for obstetric fistula in Eritrea: implications for prevention, treatment, and social reintegration.

PubMed

Turan, Janet Molzan; Johnson, Khaliah; Polan, Mary Lake

2007-01-01

This article presents findings from qualitative interviews with women seeking medical care for obstetric fistula in Eritrea. The interviews were designed to inform programme design for the prevention and treatment of obstetric fistula. Interviews were conducted with 11 new fistula repair patients, 15 women returning for follow-up for their fistula repairs, and five accompanying family members at Massawa Hospital in the Northern Red Sea Zone of Eritrea during November-December 2004. The women described long delays in accessing emergency obstetric care due to delayed recognition of the seriousness of the problem and lack of transportation from remote villages. Follow-up patients described improvements in their conditions, but many continued to have problems with incontinence and sexual health. Both new and returning patients lacked specific information about their condition, what to expect in terms of treatment and recovery, and how to care for themselves. The findings point to a need for community mobilization and education on safe motherhood for prevention of fistula, as well as for improved information, counselling, follow-up, and social services for women who develop obstetric fistulas.

[Surgical treatment of anal fistula].

PubMed

Zeng, Xiandong; Zhang, Yong

2014-12-01

Anal fistula is a common disease. It is also quite difficult to be solved without recurrence or damage to the anal sphincter. Several techniques have been described for the management of anal fistula, but there is no final conclusion of their application in the treatment. This article summarizes the history of anal fistula management, the current techniques available, and describes new technologies. Internet online searches were performed from the CNKI and Wanfang databases to identify articles about anal fistula management including seton, fistulotomy, fistulectomy, LIFT operation, biomaterial treatment and new technology application. Every fistula surgery technique has its own place, so it is reasonable to give comprehensive individualized treatment to different patients, which may lead to reduced recurrence and avoidance of damage to the anal sphincter. New technologies provide promising alternatives to traditional methods of management. Surgeons still need to focus on the invention and improvement of the minimally invasive techniques. Besides, a new therapeutic idea is worth to explore that the focus of surgical treatment should be transferred to prevention of the formation of anal fistula after perianal abscess.

Cardiac Iodine-123-Meta-Iodo-Benzylguanidine Uptake in Carotid Sinus Hypersensitivity.

PubMed

Tan, Maw Pin; Murray, Alan; Hawkins, Terry; Chadwick, Thomas J; Kerr, Simon R J; Parry, Steve W

2015-01-01

Carotid sinus syndrome is the association of carotid sinus hypersensitivity with syncope, unexplained falls and drop attacks in generally older people. We evaluated cardiac sympathetic innervation in this disorder in individuals with carotid sinus syndrome, asymptomatic carotid sinus hypersensitivity and controls without carotid sinus hypersensitivity. Consecutive patients diagnosed with carotid sinus syndrome at a specialist falls and syncope unit were recruited. Asymptomatic carotid sinus hypersensitivity and non-carotid sinus hypersensitivity control participants recruited from a community-dwelling cohort. Cardiac sympathetic innervation was determined using Iodine-123-metaiodobenzylguanidine (123-I-MIBG) scanning. Heart to mediastinal uptake ratio (H:M) were determined for early and late uptake on planar scintigraphy at 20 minutes and 3 hours following intravenous injection of 123-I-MIBG. Forty-two subjects: carotid sinus syndrome (n = 21), asymptomatic carotid sinus hypersensitivity (n = 12) and no carotid sinus hypersensitivity (n = 9) were included. Compared to the non- carotid sinus hypersensitivity control group, the carotid sinus syndrome group had significantly higher early H:M (estimated mean difference, B = 0.40; 95% confidence interval, CI = 0.13 to 0.67, p = 0.005) and late H:M (B = 0.32; 95%CI = 0.03 to 0.62, p = 0.032). There was, however, no significant difference in early H:M (p = 0.326) or late H:M (p = 0.351) between the asymptomatic carotid sinus hypersensitivity group and non- carotid sinus hypersensitivity controls. Cardiac sympathetic neuronal activity is increased relative to age-matched controls in individuals with carotid sinus syndrome but not those with asymptomatic carotid sinus hypersensitivity. Blood pressure and heart rate measurements alone may therefore represent an over simplification in the assessment for carotid sinus syndrome and the relative increase in cardiac sympathetic innervation provides additional clues to understanding the mechanisms behind the symptomatic presentation of carotid sinus hypersensitivity.

High rate of allergies among women with endometriosis.

PubMed

Matalliotakis, I; Cakmak, H; Matalliotakis, M; Kappou, D; Arici, A

2012-04-01

Women with endometriosis frequently suffer from autoimmune inflammatory diseases, allergies and asthma. This study was conducted to examine whether the prevalence of allergies is higher in patients with endometriosis than in the control group, and to show potential correlation with endometriosis stages. We evaluated the medical files of 501 women with laparoscopically-diagnosed endometriosis and 188 women without endometriosis enrolled in Yale University Hospital. Main outcome measures used were allergy on medications, complaints of sinus or perennial allergic rhinitis, asthma, family history of allergic disease, and correlation with stages of endometriosis. Our results indicated that the overall risk of women with endometriosis and positive history of allergies was 4.28 (95% CI, 2.9-6.3) (p < 0.001). Significant excesses were identified for medications, sinus allergic rhinitis, and asthma; also, women with endometriosis were significantly more likely to report a positive family history of allergies. Overall, our study indicated a link between endometriosis and increased risk of allergic autoimmune disorders that should further be explored.

Sex Estimation from Human Cranium: Forensic and Anthropological Interest of Maxillary Sinus Volumes.

PubMed

Radulesco, Thomas; Michel, Justin; Mancini, Julien; Dessi, Patrick; Adalian, Pascal

2018-05-01

Sex estimation is a key objective of forensic science. We aimed to establish whether maxillary sinus volumes (MSV) could assist in estimating an individual's sex. One hundred and three CT scans were included. MSV were determined using three-dimensional reconstructions. Two observers performed three-dimensional MSV reconstructions using the same methods. Intra- and interobserver reproducibility were statistically compared using the intraclass correlation coefficient (ICC) (α = 5%). Both intra- and interobserver reproducibility were perfect regarding MSV; both ICCs were 100%. There were no significant differences between right and left MSV (p = 0.083). No correlation was found between age and MSV (p > 0.05). We demonstrated the existence of sexual dimorphism in MSV (p < 0.001) and showed that MSV measurements gave a 68% rate of correct allocations to sex group. MSV measurements could be useful to support sex estimation in forensic medicine. © 2017 American Academy of Forensic Sciences.

Sinuses / Sinusitis / Rhinosinusitis

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[Comparative analysis on data of nasal sinus between helicopter and(strike) fighter pilots under physical examination for change to new-type aircraft].

PubMed

Xu, Xianrong; Ma, Xiaoli; Zhang, Yang; Xiong, Wei

2012-01-01

To comparatively analyze the disease data of nasal sinus between helicopter and (strike) fighter pilots under flying qualification, and then to provide references for aeromedical support as a significant part of new logistics service union in army, The CT data of nasal sinus in 138 pilots who accepted physical examination for change to new-type aircraft, were collected included 46 cases of helicopter pilots and 92 cases of (strike)fighter pilots). The incidence of chronic sinusitis and cyst of nasal sinus were computed respectively in helicopter pilots and (strike)fighter pilots. (1) Fourteen cases suffered from chronic sinusitis (6 cases of maxillary sinusitis, 4 cases of ethmoiditis and 4 cases of maxillary sinusitis and ethmoiditis) in helicopter pilots whose incidence rate of chronic sinusitis was 30.4% (14/46). Of which, 3 cases of antracele were treated. Twelve cases suffered from chronic sinusitis (8 cases of maxillary sinusitis, 1 case of ethmoiditis, 3 cases of maxillary sinusitis and ethmoiditis) in (strike)fighter pilots whose incidence of chronic sinusitis was 13.0% (12/92). Of which, 1 case of antracele was treated. The incidence of chronic sinusitis was higher in helicopter pilots than (strike) fighters pilots (Chi2 = 6.07, P < 0.05). (2) Four cases suffered from unilateral mucosa cysts in maxillary sinus in helicopter pilots whose incidence of cyst of nasal sinus was 8.7% (4/46). Ten cases suffered from mucosa cysts in maxillary sinus (unilateral 8 cases and bilateral 2 cases) in (strike) fighters pilots whose incidence of cyst of nasal sinus was 10.87% (10/92). The difference of the incidence of cyst of nasal sinus was not statistically significant between the helicopter pilots and(strike)fighters pilots. The cysts of nasal sinus did not need treatment in 14 cases of this group data. The incidence of symptomless chronic sinusitis and cyst of nasal sinus are high in pilots. It is related with repeatedly changes of atmosphere pressure during flying. But most chronic sinusitis and cyst of nasal sinus do not need treatment. The incidence of chronic sinusitis is higher in helicopter pilots than(strike)fighter pilots. It may be related with the environment of helicopter which have unclosed cockpit and load other aircrew.

The complete branchial fistula: A case report.

PubMed

Shekhar, C; Kumar, R; Kumar, R; Mishra, S K; Roy, M; Bhavana, K

2005-10-01

The incomplete branchial fistula is not an uncommon congenital anomaly of branchial apparatus but a complete one is rare. Here we report a case of complete congenital branchial fistula with an internal opening near the tonsillar fossa.

Vaginal Fistula

MedlinePlus

Vaginal fistula Overview A vaginal fistula is an abnormal opening that connects your vagina to another organ, such as your bladder, colon or rectum. Your ... describe the condition as a hole in your vagina that allows stool or urine to pass through ...

Island palatal mucoperiosteal flap for repair of oronasal fistula in a dog.

PubMed

Smith, M M

2001-09-01

A two-year-old neutered/male mixed-breed dog had received partial maxillectomy for fibrosarcoma. An oronasal fistula occurred as a complication of the surgical procedure. An island palatal mucoperiosteal flap was developed and rotated to repair the oronasal fistula. Acute (1-month) and long-term (8-months) follow-up indicated appropriate healing of the transposed island palatal mucoperiosteal flap with resolution of clinical signs indicative of oronasal fistula.

[A case of anterior tibial arteriovenous fistula after closed fracture of the leg].

PubMed

Touzard, R C

1975-01-01

This case permits one to emphasize the great rareness of arteriovenous fistula after closed fractures of the shaft of the tibia. Fistulas in this anterior tibial position are remarkably latent, cause no symptoms below the fistula nor symptoms of heart failure. Treatment by several ligatures, permitted this patient to return to work 15 days after operation without any further treatment. The patient no longer has any symptoms.

Comparison of pharyngocutaneous fistula closure with and without bacterial cellulose in a rat model.

PubMed

Demir, Berat; Sarı, Murat; Binnetoglu, Adem; Yumusakhuylu, Ali Cemal; Filinte, Deniz; Tekin, İshak Özel; Bağlam, Tekin; Batman, Abdullah Çağlar

2018-04-01

The present study aimed to compare the effects of bacterial cellulose used for closure of pharyngocutaneous fistulae, a complication of total laryngectomy, with those of primary sutures in a rat model. Thirty female Sprague-Dawley underwent experimental pharyngoesophagotomy and were grouped depending on the material used for pharyngocutaneous fistula closure: group I, which received primary sutures alone, group II, which received bacterial cellulose alone; and group III, which received both. After 7 days, the rats were sacrificed. Pharyngocutaneous fistula development was assessed, the gross wound was inspected, and histological examination was conducted. Pharyngocutaneous fistulae developed in 12 rats (41%) in all: 6 from group I (21%), 4 from group II (14%) and 2 from group III (7%). Fibroblast density and inflammatory cell infiltration were significantly greater in group III than group I. We concluded that bacterial cellulose may be useful for pharyngocutaneous fistula closure. Copyright © 2017 Elsevier B.V. All rights reserved.

Cyclosporine and ketoconazole for the treatment of perianal fistulas in dogs.

PubMed

Patricelli, Alison J; Hardie, Robert J; McAnulty, Jonathan E

2002-04-01

To evaluate efficacy and cost of using cyclosporine and ketoconazole for the treatment of perianal fistulas in dogs. Clinical trial. 12 dogs with perianal fistulas. Dogs received cyclosporine and ketoconazole orally (target whole blood trough cyclosporine concentrations of 400 to 600 ng/ml). Study endpoints were resolution of clinical signs, remission, and recurrence of disease. Adverse effects and cost of medications were reported. Results were compared with those from previous studies in humans and in dogs in which single agent cyclosporine treatment for perianal fistulas was used. All dogs had resolution of clinical signs. Eight dogs went into remission; however, 5 of those 8 had recurrence of fistulas. Adverse effects of treatment were minimal and well tolerated. Cost of treatment was comparable to traditional surgical options and less than single agent cyclosporine treatment. Administration of cyclosporine with ketoconazole is an effective and cost-comparable treatment for perianal fistulas in dogs.

[Nutritional treatment for bronchopleural fistula-promising effect of arginine as a pharmaconutrient].

PubMed

Inoue, Mari; Kinoshita, Kahori; Isogawa, Naoto; Hino, Nao; Sano, Fumiyasu; Kobayashi, Mizuho; Yasuda, Shigeo; Komatsu, Teruya; Takahashi, Koji; Fujinaga, Takuji

2013-12-01

Pharmaconutrition, which is a supportive nutritional care of surgical patients, has been proven to shorten hospital stay, decrease the incidence of infection, and reduce hospital costs in selected groups of patients. Arginine, one of the most essential pharmaconutrients, has also been proven to enhance would healing process. In severely malnourished patients like bronchopleural fistula with resultant empyema, aggressive nutritional approach should be mandatory. And management of the fistula is also important in stabilizing the ongoing infection. Our hypothesis was that basic nutritional support enhanced with arginine would be effective in not only improving the general condition including nutritional status but also in healing the fistula. We report a case of major bronchopleural fistula in which arginine-supplemented diet as well as aggressive nutritional support could accelerate the postoperative recovery after open thoracic window, ultimately leading to the healing of the fistula.

Predictors of salivary fistula after total laryngectomy.

PubMed

Sousa, Alexandre de Andrade; Porcaro-Salles, José Maria; Soares, João Marcos Arantes; de Moraes, Gustavo Meyer; Carvalho, Jomar Rezende; Silva, Guilherme Souza; Savassi-Rocha, Paulo Roberto

2013-01-01

To evaluate the incidence of pharyngocutaneous fistula after total laryngectomy and try to identify its predictors. From May 2005 to April 2010, 93 patients underwent total laryngectomy. We evaluated complications during and after surgery and compared them with the following variables: gender, nutritional status, previous tracheotomy, tumor location, type of surgery, TNM staging, prior treatment with chemotherapy and/or radiotherapy, use of flaps for reconstruction and surgical margin. All patients presented with advanced neoplastic disease according to TNM. 14 (15.1%) patients developed postoperative salivary fistula. The mean time to onset of salivary fistula was 3.5 days, with a standard deviation of 13.7 days. Comparing salivary fistula with TNM variables, type of operation and neck dissection, prior tracheotomy, use of flap, preoperative radio and chemotherapy and surgical margin, there was no statistically significant difference (p> 0,05). The incidence of salivary fistula was 15.1% and no predictive factor for its formation was found.

An aortoduodenal fistula as a complication of immunoglobulin G4-related disease

PubMed Central

Sarac, Momir; Marjanovic, Ivan; Bezmarevic, Mihailo; Zoranovic, Uros; Petrovic, Stanko; Mihajlovic, Miodrag

2012-01-01

Most primary aortoduodenal fistulas occur in the presence of an aortic aneurysm, which can be part of immunoglobulin G4 (IgG4)-related sclerosing disease. We present a case who underwent endovascular grafting of an aortoduodenal fistula associated with a high serum IgG4 level. A 56-year-old male underwent urgent endovascular reconstruction of an aortoduodenal fistula. The patient received antibiotics and other supportive therapy, and the postoperative course was uneventful, however, elevated levels of serum IgG, IgG4 and C-reactive protein were noted, which normalized after the introduction of steroid therapy. Control computed tomography angiography showed no endoleaks. The primary aortoduodenal fistula may have been associated with IgG4-related sclerosing disease as a possible complication of IgG4-related inflammatory aortic aneurysm. Endovascular grafting of a primary aortoduodenal fistula is an effective and minimally invasive alternative to standard surgical repair. PMID:23155348

Spacer Facial Artery Musculomucosal Flap: Simultaneous Closure of Oronasal Fistulas and Palatal Lengthening.

PubMed

Lee, Jonathan Y; Alizadeh, Kaveh

2016-01-01

In this series, the authors describe a modification of the facial artery musculomucosal flap for oronasal fistula repair. The spacer facial artery musculomucosal flap technique is characterized by a pedicle inset into the retromolar trigone and palate, obviating a second operative stage. This was performed in 14 patients with a 5.2-cm mean fistula size. Average follow-up was 4.3 years, with one partial flap necrosis but no recurrent oronasal fistula. There was a mean decrease of 18 percent in the distance between the velum and the posterior pharyngeal wall. The spacer facial artery musculomucosal flap provides a single-stage reconstruction of oronasal fistula while lengthening the palate through a pushback mechanism. Although further study of velopharyngeal function is needed, the spacer facial artery musculomucosal flap may be beneficial for patients with a short velum and an oronasal fistula. Therapeutic, IV.

Management of a complicated pulmonary fistula caused by lung cancer using a fibrin glue-soaked polyglycolic acid sheet covered with an intercostal muscle flap.

PubMed

Maniwa, Tomohiro; Kaneda, Hiroyuki; Saito, Yukihito

2009-06-01

Pulmonary fistulas caused by tumours are very fragile and difficult to suture directly. It is impossible to close pulmonary fistulas with tissue sealants when massive air leakage occurs in the low pressure of the respiratory tract. A 73-year-old man with a pneumothorax caused by lung cancer had suffered a persistent massive air leakage for more than one month. We used a fibrin glue-soaked polyglycolic acid (PGA) sheet for sealing the complicated fistula. In addition, the visceral pleura of the fistula was wrapped with the pedicle of an intercostal muscle (ICM) flap to prevent massive air leakage. The pneumothorax did not reappear after surgery. Thus, a fibrin glue-soaked PGA sheet covered with an ICM flap was effective for sealing an intractable air-leaking fistula caused by lung cancer.

Plain Language Summary: Adult Sinusitis (Sinus Infection).

PubMed

Caspersen, Leslie A; Walter, Lindsey M; Walsh, Sandra A; Rosenfeld, Richard M; Piccirillo, Jay F

2015-08-01

This plain language summary serves as an overview in explaining sinusitis (pronounced sign-you-side-tis). The purpose of this plain language summary is to provide patients with standard language explaining their condition in an easy-to-read format. This summary applies to those 18 years of age or older with sinusitis. The summary is featured as an FAQ (frequently asked question) format. The summary addresses how to manage and treat sinusitis symptoms. Adult sinusitis is often called a sinus infection. A healthcare provider may refer to a sinus infection as rhinosinusitis (pronounced rhi-no-sign-you-side-tis). This includes the nose as well as the sinuses in the name. A sinus infection is the swelling of the sinuses and nasal cavity.The summary is based on the published 2015 "Clinical Practice Guideline: Adult Sinusitis." The evidence-based guideline includes research to support more effective diagnosis and treatment of adult sinus infections. The guideline was developed as a quality improvement opportunity for managing sinus infections by creating clear recommendations to use in medical practice. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Olfactory Training in Improving Sense of Smell After Radiation Therapy in Patients With Paranasal Sinus or Nasopharyngeal Cancer

ClinicalTrials.gov

2017-07-11

Stage 0 Nasopharyngeal Carcinoma; Stage 0 Paranasal Sinus Cancer; Stage I Nasopharyngeal Carcinoma; Stage I Paranasal Sinus Cancer; Stage II Nasopharyngeal Carcinoma; Stage II Paranasal Sinus Cancer; Stage IIA Nasopharyngeal Carcinoma; Stage IIB Nasopharyngeal Carcinoma; Stage III Nasopharyngeal Carcinoma; Stage III Paranasal Sinus Cancer; Stage IV Nasopharyngeal Carcinoma; Stage IV Paranasal Sinus Cancer; Stage IVA Nasopharyngeal Carcinoma; Stage IVA Paranasal Sinus Cancer; Stage IVB Nasopharyngeal Carcinoma; Stage IVB Paranasal Sinus Cancer; Stage IVC Nasopharyngeal Carcinoma; Stage IVC Paranasal Sinus Cancer

[The treatment principles of frontal sinus tract after the frontal approach craniotomy].

PubMed

Yu, Huanxin; Li, Haiyan; Liu, Gang

2015-12-01

To investigate the causes, clinical manifestation and treatment principles of frontal sinus tract after the frontal approach craniotomy. The clinic data of 13 patients with frontal skin sinus tract after the frontal approach craniotomy were retrospectively analyzed. All of them were described in the clinical record to have undergone frontal sinus mucosa pushing down or shaving and bone wax filling in the frontal sinus during the surgery, of whom 3 cases had history of frontal abscess incision drainage. All patients were performed endoscopic frontal sinus surgery and forehead skin sinus tract excision and suture. All of the patients successfully recovered after one-stage operation, and the frontal skin sinus tract was healed. The frontal approach craniotomy with postoperative frontal sinus tract was related with the improper use of bone wax tamponade and sealing of frontal sinus. The treatment principles were to remove bone wax, remove inflammatory granulation tissue around the sinus tract, and to open frontal sinus and promote frontal sinus drainage.

The microbiology of ethmoid and maxillary sinuses in patients with chronic sinusitis.

PubMed

Aral, Murat; Keles, Erol; Kaygusuz, Irfan

2003-01-01

To investigate aerob-anaerob microorganisms growth in maxillary and ethmoid sinuses by evaluating aspiration materials from patients with chronic sinusitis. The study was performed prospectively, and there were 31 patients (23 men, 8 women; mean age, 31.4+/-14.15, between 18-65 years) who had endoscopic sinus surgery because of chronic sinusitis. During the operation, when the maxillary sinus ostium and ethmoid sinus were opened, readily aspirated materials from sinuses were evaluated regarding aerob and anaerob bacteria. Nose and throat swap samples were collected preoperatively to determine the upper respiratory tract flora and also to understand the relationship between the flora and the microorganisms aspirated from sinuses. Total aerob bacteria count, which was isolated from preoperative nasal swab cultures, was 36, and aerob-anaerob bacteria count that included cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery was 42. For each 2 samples, the most common isolated aerob bacteria were coagulase (-) staphylococci. Microorganisms were isolated in 87.0% of 27 patients, in which cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery were included. It is determined that the isolated aerob bacteria rate was 90.4%, and the isolated anaerob bacteria rate was 14.2%. All of the 6 samples in which anaerob bacteria isolated were all maxillary sinus aspiration materials. Microorganisms that isolated from the nose and the sinuses were similar with the rate of 25.8%, and microorganisms that isolated from the throat cultures and sinuses were similar with the rate of 22.5%. This study reveals the aerob and anaerob microbiology of the maxillary and ethmoid sinuses so the treatment of chronic sinusitis will be easier.

Secrecy inhibits support: A grounded theory of community perspectives of women suffering from obstetric fistula, in Kenya.

PubMed

Lavender, T; Wakasiaka, S; McGowan, L; Moraa, M; Omari, J; Khisa, W

2016-11-01

this study aimed to gain understanding of the views of community members in relation to obstetric fistula. a qualitative, grounded theory approach was adopted. Data were collected using in-depth interviews with 45 community members. The constant comparison method enabled generation of codes and subsequent conceptualisations, from the data. participants were from communities served by two hospitals in Kenya; Kisii and Kenyatta. Interviews took place either in the home, place of work, or hospital. the core category (central concept) is 'secrecy hinders support'. This was supported by three themes: 'keeping fistula hidden', 'treatment being a lottery' and 'multiple barriers to support.' These themes represent the complexities around exposure of individual fistula sufferers and the impact that lack of information and women's status can have on treatment. Keeping fistula secret reinforces uncertainties around fistula, which in itself fuels myths and ignorance regarding causes and treatments. Lack of openness, at an individual level, prevents support being sought or offered. A multi-layered strategy is required to support women with fistula. At a societal level, the status of women in LMIC countries needs elevation to a level that provides equity in health services. At a national level, laws need to protect vulnerable women from mistreatment as a direct result of fistula. Furthermore, resources should be available to ensure provision of timely management, as part of routine services. At community level, awareness and education is required to actively engage members to support women locally. Peer support before and after fistula repair may be beneficial, but requires further research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Use of an Amplatzer Device for Endoscopic Closure of a Large Bronchopleural Fistula following Lobectomy for a Stage I Squamous Cell Carcinoma.

PubMed

Ottevaere, A; Slabbynck, H; Vermeersch, P; Rogiers, P; Galdermans, D; De Droogh, E; Bedert, L

2013-01-01

Bronchopleural fistulas can occur as a rare but severe complication after pulmonary resection. Established guidelines for the proper treatment of patients with bronchopleural fistulas do not exist. Apart from attempts to close the fistula, emphasis is placed on preventive measures, early treatment with antibiotics, drainage of the empyema and aggressive nutritional and rehabilitative support. For inoperable patients, endoscopic procedures are the only therapeutic option. Unfortunately, large (>8 mm) or central bronchopleural fistulas are usually not suitable for such endoscopic management. Recently, some groups have published a few case reports about a novel technique for the endobronchial closure of bronchopleural fistulas, using an Amplatzer device, originally designed for transcatheter closure of cardiac septal defects. We applied the same technique as a life-saving treatment in a ventilated patient who was considered inoperable due to a high oxygen need. The operation was successful. The patient could be weaned from ventilation and was eventually discharged from the hospital to a rehabilitation facility several weeks after the insertion of the device. Until now, endoscopic techniques have only been useful for the treatment of small, peripheral, bronchopleural fistulas and even then only as a bridge to surgery in high-risk surgical patients. In this case report, we demonstrate that the use of an Amplatzer device can expand the importance of endoscopic techniques in the treatment of bronchopleural fistulas. An Amplatzer device, for endobronchial closure, can indeed be administered for large and central bronchopleural fistulas. Moreover, it can be considered as a definite alternative to surgery in inoperable patients.

Endovascular Treatment of Autogenous Radiocephalic Fistulas with the 'Eighth Note' Deformity for Hemodialysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weng Meijui; Chen, Matt Chiung-Yu, E-mail: jjychen@gmail.co; Chi Wenche

2010-02-15

The purpose of this paper is to describe a unique 'eighth note' deformity of the autogenous radiocephalic fistula for hemodialysis and to retrospectively evaluate the efficacy and safety of its endovascular treatment. Over 3 years, a total of 808 patients and 558 autogenous radiocephalic fistulas were treated for vascular access dysfunction or thrombosis. These included 14 fistulas in 14 patients (9 men, 5 women; mean age, 58.2 {+-} 2.8 years; range 27-79 years) whose fistulograms before treatment resembled a musical note, the eighth note. Endovascular treatment sought to remodel the deformed vascular access to a classic radiocephalic fistula and increasemore » the number of cannulation sites available for hemodialysis. The technical and clinical success rates were each 92.8% (13/14). Fistula remodeling was successful in 13 patients. The postintervention primary patency was 100% at 90 days, 91.7 {+-} 0.8% at 120 days, 78.6 {+-} 13.9% at 180 days, 62.9 {+-} 17.9% at 360 days, 31.4 {+-} 24.0% at 540 days, and 0% at 720 days. The postintervention secondary patency was 100% at 90 days, 100% at 120 days, 100% at 180 days, 85.7 {+-} 13.2% at 360 days, and 85.7 {+-} 13.2% at 720 days. No major complications were noted. Minor complications were found in 71.4% of patients, all of which resolved spontaneously. In conclusion, endovascular treatment of fistulas with the eighth note deformity can effectively increase the number of available cannulation sites, facilitate fistula maturation, and facilitate thromboaspiration after fistula thrombosis.« less

Peak nasal inspiratory flow correlates with quality of life in functional endoscopic sinus surgery.

PubMed

Whitcroft, K L; Andrews, P J; Randhawa, P S

2017-12-01

Whilst nasal function and airflow improve subjectively following functional endoscopic sinus surgery (FESS), a clinically useful and objective tool for quantifying such improvement is lacking. The peak nasal inspiratory flow (PNIF) metre offers convenient and objective measures of nasal patency. However, it has not yet been established whether changes in PNIF after surgery reflect changes in subjective disease burden. In this study we aimed to determine whether changes in PNIF correlate with commonly used subjective symptom and quality of life outcome measures following FESS for chronic rhinosinusitis (CRS). Prospective cohort. Royal National Throat Nose and Ear Hospital. Thirty-seven patients undergoing FESS for CRS, with or without polyps (21 male, mean age 48.8). PNIF, "SNOT-22", "NOSE" and "VAS" questionnaires were performed before and after surgery. In all patients, there was a strong negative correlation between change in PNIF and change in "SNOT-22" score following surgery (Pearson r=-.64, P<.0001). Strong negative correlations were also seen during subgroup analysis of patients with and without polyps (r=-.57, P=.006 and r=-.67, P=.005, respectively). Change in PNIF correlated significantly with change in "NOSE" score following surgery in all patients and those without polyps (r=-.54, P=.0005 and r=-.68, P=.003). There were no significant correlations between PNIF and VAS (nasal obstruction). Changes in PNIF after FESS appear to best reflect improvements in quality of life in CRS as measured using the "SNOT-22" questionnaire. © 2017 John Wiley & Sons Ltd.

Correlation between C-Reactive Protein in Peripheral Vein and Coronary Sinus in Stable and Unstable Angina

PubMed Central

Leite, Weverton Ferreira; Ramires, José Antonio Franchini; Moreira, Luiz Felipe Pinho; Strunz, Célia Maria Cassaro; Mangione, José Armando

2015-01-01

Background High sensitivity C-reactive protein (hs-CRP) is commonly used in clinical practice to assess cardiovascular risk. However, a correlation has not yet been established between the absolute levels of peripheral and central hs-CRP. Objective To assess the correlation between serum hs-CRP levels (mg/L) in a peripheral vein in the left forearm (LFPV) with those in the coronary sinus (CS) of patients with coronary artery disease (CAD) and a diagnosis of stable angina (SA) or unstable angina (UA). Methods This observational, descriptive, and cross-sectional study was conducted at the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, and at the Hospital Beneficência Portuguesa de Sao Paulo, where CAD patients referred to the hospital for coronary angiography were evaluated. Results Forty patients with CAD (20 with SA and 20 with UA) were included in the study. Blood samples from LFPV and CS were collected before coronary angiography. Furthermore, analysis of the correlation between serum levels of hs-CRP in LFPV versus CS showed a strong linear correlation for both SA (r = 0.993, p < 0.001) and UA (r = 0.976, p < 0.001) and for the entire sample (r = 0.985, p < 0.001). Conclusion Our data suggest a strong linear correlation between hs-CRP levels in LFPV versus CS in patients with SA and UA. PMID:25494014

Immediate Single-Stage Reconstruction of Complex Frontofaciobasal Injuries: Part I

PubMed Central

Awadalla, Akram Mohamed; Ezzeddine, Hichem; Fawzy, Naglaaa; Saeed, Mohammad Al; Ahmad, Mohammad R.

2014-01-01

Objective To determine if immediate (within 6 hours of adequate resuscitation) single-stage repair of complex craniofacial injuries could be accomplished with acceptable morbidity and mortality taking into consideration the cosmetic appearance of the patient. Patients and Methods A total of 26 patients (19 men, 7 women) ranging in age from 8 to 58 years with Glasgow Coma Scale scores of 5 to 15 all had a combined single-stage repair of their complex craniofacial injuries within 6 hours of their admission. After initial assessment and adequate resuscitation, they were evaluated with three-dimensional computed tomography of the face and head. Coronal skin flap was used for maximum exposure for frontal sinus exenteration as well as dural repair, cortical debridement, calvarial reconstruction, and titanium mesh placement. Results Neurosurgical outcome at both the early and late evaluations was judged as good in 22 of 26 patients (85%), moderate in 3 of 26 (11%), and poor in 1 of the 26 (3.8%). Cosmetic surgical outcome at the early evaluation showed 17 of 26 (65%) to be excellent, 4 of 26 (15.5%) to be good, 4 patients (15.5%) to be fair, and 1 patient (3.8%) to be poor. At the late reevaluation, the fair had improved to good with an additional reconstructive procedure, and the poor had improved to fair with another surgery. There was no calvarial osteomyelitis, graft resorption, or intracranial abscess. Complications included three patients (11%): one (3.8%) had tension pneumocephaly and meningitis, one (3.8%) had delayed cerebrospinal fluid leak with recurrent attacks of meningitis, and one had a maxillary sinus infection (3.8%) secondary to front maxillary fistula. Conclusion The immediate single-stage repair of complex craniofacial injuries can be performed with acceptable results, a decreased need for reoperation, and improved cosmetic and functional outcomes. PMID:25844296

Branchial anomalies in children.

PubMed

Bajaj, Y; Ifeacho, S; Tweedie, D; Jephson, C G; Albert, D M; Cochrane, L A; Wyatt, M E; Jonas, N; Hartley, B E J

2011-08-01

Branchial cleft anomalies are the second most common head and neck congenital lesions seen in children. Amongst the branchial cleft malformations, second cleft lesions account for 95% of the branchial anomalies. This article analyzes all the cases of branchial cleft anomalies operated on at Great Ormond Street Hospital over the past 10 years. All children who underwent surgery for branchial cleft sinus or fistula from January 2000 to December 2010 were included in this study. In this series, we had 80 patients (38 female and 42 male). The age at the time of operation varied from 1 year to 14 years. Amongst this group, 15 patients had first branchial cleft anomaly, 62 had second branchial cleft anomaly and 3 had fourth branchial pouch anomaly. All the first cleft cases were operated on by a superficial parotidectomy approach with facial nerve identification. Complete excision was achieved in all these first cleft cases. In this series of first cleft anomalies, we had one complication (temporary marginal mandibular nerve weakness. In the 62 children with second branchial cleft anomalies, 50 were unilateral and 12 were bilateral. In the vast majority, the tract extended through the carotid bifurcation and extended up to pharyngeal constrictor muscles. Majority of these cases were operated on through an elliptical incision around the external opening. Complete excision was achieved in all second cleft cases except one who required a repeat excision. In this subgroup, we had two complications one patient developed a seroma and one had incomplete excision. The three patients with fourth pouch anomaly were treated with endoscopic assisted monopolar diathermy to the sinus opening with good outcome. Branchial anomalies are relatively common in children. There are three distinct types, first cleft, second cleft and fourth pouch anomaly. Correct diagnosis is essential to avoid inadequate surgery and multiple procedures. The surgical approach needs to be tailored to the type of anomaly of origin of the anomaly. Complete excision is essential for good outcomes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Retrospective analysis of risk factors and predictors of intraoperative complications in neuraxial blocks at Faculdade de Medicina de Botucatu-UNESP.

PubMed

Pereira, Ivan Dias Fernandes; Grando, Marcela Miguel; Vianna, Pedro Thadeu Galvão; Braz, José Reinaldo Cerqueira; Castiglia, Yara Marcondes Machado; Vane, Luís Antônio; Módolo, Norma Sueli Pinheiro; do Nascimento, Paulo; Amorim, Rosa Beatriz; Rodrigues, Geraldo Rolim; Braz, Leandro Gobbo; Ganem, Eliana Marisa

2011-01-01

Cardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients ≥ 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital--HCFMB-UNESP. A retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis. 32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n=4,109), sinus bradycardia (n=1,107), sinus tachycardia (n=601), and hypertension (n=466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4%, OR=2.39), ≥ 61 years of age, and female (OR=1.27). Intraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

The sinonasal communication in the horse: examinations using computerized three-dimensional reformatted renderings of computed-tomography datasets

PubMed Central

2014-01-01

Background Sinusitis is a common disease in the horse. In human medicine it is described, that obstruction of the sinonasal communication plays a major role in the development of sinusitis. To get spatial sense of the equine specific communication ways between the nasal cavity and the paranasal sinuses, heads of 19 horses, aged 2 to 26 years, were analyzed using three-dimensional (3D) reformatted renderings of CT-datasets. Three-dimensional models were generated following manual and semi-automated segmentation. Before segmentation, the two-dimensional (2D) CT-images were verified against corresponding frozen sections of cadaveric heads. Results Three-dimensional analysis of the paranasal sinuses showed the bilateral existence of seven sinus compartments: rostral maxillary sinus, ventral conchal sinus, caudal maxillary sinus, dorsal conchal sinus, frontal sinus, sphenopalatine sinus and middle conchal sinus. The maxillary septum divides these seven compartments into two sinus systems: a rostral paranasal sinus system composed of the rostral maxillary sinus and the ventral conchal sinus and a caudal paranasal sinus system which comprises all other sinuses. The generated 3D models revealed a typically configuration of the sinonasal communication ways. The sinonasal communication started within the middle nasal meatus at the nasomaxillary aperture (Apertura nasomaxillaris), which opens in a common sinonasal channel (Canalis sinunasalis communis). This common sinonasal channel ramifies into a rostral sinonasal channel (Canalis sinunasalis rostralis) and a caudo-lateral sinonasal channel (Canalis sinunasalis caudalis). The rostral sinonasal channel ventilated the rostral paranasal sinus system, the caudo-lateral sinonasal channel opened into the caudal paranasal sinus system. The rostral sinonasal channel was connected to the rostral paranasal sinuses in various ways. Whereas, the caudal channel showed less anatomical variations and was in all cases connected to the caudal maxillary sinus. Volumetric measurements of the sinonasal channels showed no statistically significant differences (P <0.05) between the right and left side of the head. Conclusions Under physiologic conditions both paranasal sinus systems are connected to the nasal cavity by equine specific sinonasal channels. To resolve sinus disease it is aimed to maintain or even reconstruct the normal anatomy of the sinonasal communication by surgical intervention. Therefore, the presented 3D analyses may provide a useful basis. PMID:24646003

Giant primary vaginal calculus secondary to vesicovaginal fistula with partial vaginal outlet obstruction in a 12-year-old girl.

PubMed

Chen, Shushang; Ge, Rong; Zhu, Lingfeng; Yang, Shunliang; Wu, Weizhen; Yang, Yin; Tan, Jianming

2011-10-01

A vesicovaginal fistula with vagina obstruction associated with vaginal calculi is an extremely rare medical condition. We report a giant primary vaginal calculus resulting from vesicovaginal fistula with partial vaginal outlet obstruction secondary to perineum trauma and surgery in a 12-year-old girl. Episiotomy was performed and the adhesive labia minora was split. After the removal of a giant calculus in the vagina, approximately 8 cm in diameter, the fistula tract was completely excised, followed by the repair of the vesicovagina fistula and the vagina. The patient was symptom-free at 6-month follow-up examination. Copyright © 2011 Elsevier Inc. All rights reserved.

[Treatment of enteric fistula in open abdomen].

PubMed

Evenson, R A; Fischer, J E

2006-07-01

Formation of enteric fistulas frequently complicates the open abdomen in patients who have sustained traumatic injury. The post-traumatic subset of patients with enterocutaneous fistula enjoy better than average recovery. To optimize this recovery, a systematic management approach is required. Patients must first be stabilized with nutritional support, control of sepsis, and special wound management systems to prevent further deterioration of the abdominal wall. Investigation of the origin, course, and characteristics of the fistula provides information about its likelihood to close without operation. Definitive operative therapy may be necessary to resolve the fistula and close the abdominal wall. Finally, healing support includes nutritional support and physical and occupational therapies to restore patients to pre-injury states.

Necrotizing fasciitis secondary to enterocutaneous fistula: three case reports.

PubMed

Gu, Guo-Li; Wang, Lin; Wei, Xue-Ming; Li, Ming; Zhang, Jie

2014-06-28

Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and potentially fatal infection of the superficial fascia and subcutaneous tissue. NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF. NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices. We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007. We followed empirically the principle of eliminating anaerobic conditions of infection, bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate. These three cases were eventually cured by debridement, antibiotics and wound management.

Effect of accessory ostia on maxillary sinus ventilation: a computational fluid dynamics (CFD) study.

PubMed

Zhu, Jian Hua; Lee, Heow Pueh; Lim, Kian Meng; Gordon, Bruce R; Wang, De Yun

2012-08-15

We evaluated, by CFD simulation, effects of accessory ostium (AO) on maxillary sinus ventilation. A three-dimensional nasal model was constructed from an adult CT scan with two left maxillary AOs (sinus I) and one right AO (sinus II), then compared to an identical control model with all AOs sealed (sinuses III and IV). Transient simulations of quiet inspiration and expiration at 15 L/min, and nasal blow at 48 L/min, were calculated for both models using low-Reynolds-number turbulent analysis. At low flows, ventilation rates in sinuses with AOs (I ≈ 0.46 L/min, II ≈ 0.54 L/min), were both more than a magnitude higher than sinuses without AOs (II I ≈ 0.019 L/min, IV ≈ 0.020 L/min). Absence of AO almost completely prevented sinus ventilation. Increased ventilation of sinuses with AOs is complex. Under high flow conditions mimicking nose blowing, in sinuses II, III, and IV, the sinus flow rate increased. In contrast, the airflow direction through sinus I reversed between inspiration and expiration, while it remained almost constant throughout the respiration cycle in sinus II. CFD simulation demonstrated that AOs markedly increase maxillary sinus airflow rates and alter sinus air circulation patterns. Whether these airflow changes impact maxillary sinus physiology or pathophysiology is unknown. Copyright © 2012 Elsevier B.V. All rights reserved.

Atmospheric pressure as a force that fills developing bones with marrow and air.

PubMed

Kurbel, Sven; Radić, Radivoje; Kristek, Branka; Ivezić, Zdravko; Selthofer, Robert; Kotromanović, Zeljko

2004-01-01

Many theories try to explain the existence and function of paranasal sinuses. This paper is an attempt to correlate process of paranasal sinus development in human with bone pneumatization processes in animals. It is here proposed that this mechanism starts in utero and continues after birth. During endochondral development, a solid hyaline cartilage model transforms into long bones. Central chondrocytes hypertrophy and their lacunae become confluent. Dissolving of the cartilage intercellular matrix forms a primitive marrow cavity. It is soon invaded by the periostal bud. Once circulation is established in the developing bone, the dissolved hyaline matrix can be slowly washed away from the bone cavity. Circulation in the bone cavity can develop slight subatmospheric pressures, similar to negative interstitial pressures in subcutaneous tissues. The amniotic fluid conducts atmospheric pressure to the fetal body. The pressure is trying to fill enlarging bone cavities through the existing vascular openings, or to create new openings. Bone walls of developing paranasal bones are to weak to resist the pressure gradient on their walls. New openings form on the weakest spots allowing airway mucosa to form initial paranasal sinuses. The enlarging cavities of long bones that are remote from the body surface and airway also develop a slightly subatmospheric pressure that fills them with cellular elements. These elements enter bone through the feeding vessels and form bone marrow. During after birth skeletal growth, bone remodeling shapes paranasal sinuses in a process of slow evolution that do not require measurable pressure gradients. When two sinuses come in vicinity, their growth rate declines, since the remaining thin and fragile bone lamella between them does not retract anymore.

Failed Deglutitive Upper Esophageal Sphincter Relaxation Is a Risk Factor for Aspiration in Stroke Patients with Oropharyngeal Dysphagia

PubMed Central

Lee, Taeheon; Park, Jung Ho; Sohn, Chongil; Yoon, Kyung Jae; Lee, Yong-Taek; Park, Jung Hwan; Jung, Il Seok

2017-01-01

Background/Aims We attempted to examine the relationship between abnormal findings on high-resolution manometry (HRM) and videofluoroscopic swallowing study (VFSS) of the pharynx and upper esophageal sphincter (UES), and to identify the risk factors for aspiration. Methods We performed VFSS and HRM on the same day in 36 ischemic stroke patients (mean age, 67.5 years) with dysphagia. Pressure (basal, median intra bolus, and nadir), relaxation time interval of the UES, and mesopharyngeal and hypopharyngeal contractility (as a contractile integral) were examined using HRM. The parameters of VFSS were vallecular residue, pyriform sinus residue, vallecular overflow, penetration, and aspiration. The association between the parameters of VFSS and HRM was analyzed by the Student’s t test. Results Three (8.3%) and 4 (11.1%) stroke patients with dysphagia had pyriform sinus residue and vallecular sinus residue, respectively, and 5 (13.8%) patients showed aspiration. Mesopharyngeal and hypopharyngeal contractile integrals in patients with residue in the pyriform sinus were significantly lower than those in patients without residue in the pyriform sinus (P < 0.05). Relaxation time intervals in patients with aspiration were significantly shorter than those in patients without aspiration (P < 0.05), and multivariate regression analysis revealed a shorter relaxation time interval as the main risk factor for aspiration (OR, 0.03; 95% CI, 0.01–0.65; P < 0.05). Conclusions Manometric measurements of the pharynx and UES were well correlated with abnormal findings in the VFSS, and a shorter relaxation time interval of the UES during deglutition is an important parameter for the development of aspiration. PMID:27510474

The Medial Extra-Sellar Corridor to the Cavernous Sinus: Anatomic Description and Clinical Correlation.

PubMed

Theodosopoulos, Philip V; Cebula, Helene; Kurbanov, Almaz; Cabero, Arnau Benet; Osorio, Joseph A; Zimmer, Lee A; Froelich, Sebastien C; Keller, Jeffrey T

2016-12-01

The zenith of surgical interest in the cavernous sinus peaked in the 1980s, as evidenced by reports of 10 surgical triangles that could access the contents of the lateral sellar compartment (LSC). However, these transcranial approaches later became marginalized, first by radiosurgery's popularity and lower morbidity, and then by clinical potential of endoscopic corridors noted in several qualitative studies. Our anatomic study, taking a contemporary look at the medial extra-sellar corridor, gives a detailed qualitative-quantitative analysis for its use with increasingly popular endoscopic endonasal approaches to the cavernous sinus. In 20 cadaveric specimens, we re-examined the anatomic landmarks of the medial corridor into the LSC with qualitative descriptions and measurements. An illustrative case highlights a recurrent symptomatic pituitary adenoma that invaded the cavernous sinus approached through the medial corridor. The corridor's shape varied from tetrahedron to hexahedron. Comparing right and left sides, width averaged 3.6 ± 4.5 mm and 4.0 ± 4.4 mm, and height averaged 2.3 mm and 2.1 mm, respectively. About 35% of sides showed ample space for access into the cavernous sinus. Our case report of successful outcome lends support for the safety and efficacy of this endoscopic approach. Our re-examination of this particular surgical access into the LSC refines the understanding of the medial extra-sellar corridor as a main endoscopic access route to this compartment. Achieving safe access to the contents of the LSC, this 11th triangle is clinically relevant and potentially superior for select lesions in this region. Copyright © 2016 Elsevier Inc. All rights reserved.