Iatrogenic arteriovenous fistula of the internal mammary artery. Transcatheter intravascular coil occlusion.

We encountered a case of right internal mammary artery to innominate vein fistula following subclavian vein catheterization and the projection of the coil spring was projected after transcatheter intravascular coil occlusion. We were worried about both distal thromboembolism from small thrombi forming on a portion of the coil spring and stenosis of the subclavian artery. However, there was no evidence of thromboembolism of the distal artery, and good patency of the right subclavian artery was shown by an angiogram performed six months later. The patient has been receiving heparin therapy during hemodialysis, which should help prevent thromboembolism of the distal artery.

Urinary incontinence. Treatment with electrical stimulation of the pelvic floor.

Electrical pelvic floor stimulation may be administered either externally by the transrectal tampon or internally with the implantable pelvic floor stimulator. This treatment modality requires intact pelvic floor innervation and therefore is unsuccessful in patients with pelvic floor denervation. Pelvic floor stimulation has been successful in patients with stress and with congenital, iatrogenic, and postoperative urinary incontinence.

The management of rectal tears in horses.

Rectal trauma in horses is usually iatrogenic and carries a high mortality. Partial thickness tears heal without surgical assistance. Full thickness tears require surgical repair through the anus or a ventral laparotomy or, if these are not possible because of difficulty in gaining access to the tear in its usual site at the pelvic inlet, a diverting colostomy to allow the rectum to heal is necessary. This paper describes the management of 15 cases of rectal injury, only 3 of which survived. Two of these were partial thickness tears not treated surgically and the third had a temporary diverting colostomy.

[Management of acute oesophageal fistulas (author's transl)]. / Die Behandlung von Verletzungen der Speiseröhre und von Speiseröhrensfisteln.

The observation of 75 patients with acute oesophageal fistulas indicate their great multiformity of etiology, pathogenesis, morphology, clinical course, complications, underlying oesophageal pathology. Most frequently the fistulas resulted from injuries inflicted during bouginage, cardiodilatation, external and intraoperative trauma. Drug therapy should be started immediately with the making of diagnosis of the suspected oesophageal injury, and then surgery is undertaken if indicated. Drug therapy proved effective only in cases of non deeply penetrating injuries. Palliative interventions as sole procedures permitted to eliminate the acute fistulas in 12 patients, to turn them into chronically behaving--in 17; in the rest of the patients they were ineffective. Twenty-one patients were operated radically, 9 of them following ineffective drug therapy and palliative surgery. The result of radical surgery depends on several factors, and especially on its technique, on the reinforcement and isolation of the sutures by the adjacent tissues with blood supply preservation--diaphragm, pericardium, pleura, muscle-pleural flap, muscles, etc.

[Treatment of iatrogenic transvenous foreign body embolism]. / Behandlung der iatrogenen transvenösen Fremdkörperembolie.

Embolization of central venous devices, such as infusion catheters, ventriculo-atrial drains for hydrocephalus or intracardial pacemaker leads, may cause fatal secondary complications. Removal of the embolized foreign bodies is therefore mandatory in the majority of cases. 26 in a series of 27 patients underwent removal procedures which have been successful in 24. The specific approach is described in the different subgroups of embolized foreign bodies. Removal has been achieved transvenously through the internal jugular vein in most instances of embolization of infusion or pressure catheters, using forceps or ureteric stone catheters. Thoracotomy was necessary in 8 patients, twice with with cardio-pulmonary bypass. There were no complications due to interventions for catheter extraction. This experience justifies an active approach to treatment once the diagnosis is established.

[Iatrogenic secondary retroperitoneal fibrosis (secondary Ormond disease) caused by contrast medium enema, and the treatment of the resulting hydronephrosis with endourethral splinting ("endoprosthesis")]. / Iatrogene sekundäre retroperitoneal Fibrosierung (sekundärer Morbus Ormond) durch Kontrastamitteleinlauf und die Behandlung der entstandenen Harnstauungsnieren mit der endoureteralen Schienung ("Endoprothese").

A case of secondary retroperitoneal fibrosis with bilateral hydronephrosis, following a barium enema is presented. The mechanism of perforation and the ways of perforation are being discussed. The importance of early surgical intervention is stressed. For treatment of the hydronephrosis an endoureterine splinting was indicated.

[Conservative treatment of ureteral lesions caused by gynecological surgery (author's transl)]. / Die konservative Therapie von Ureterverletzungen nach gynäkologischen Eingriffen.

Conservative treatment with long lasting success is possible in many cases of ureteral lesions of different etiology, esp. after complications with gynecological surgery. Both fistulas and stenoses of the ureter can be treated conservatively by placing long term indwelling PVC ureteral splints ("endoprothesis") of FR 8 or 10 with smooth surface and without hooks or the like to keep them place. In a considerable number of cases such treatment is a true and even superior alternative to open surgery with its consecutive longer lasting hospitalization, because it can be done as outpatient-care and, of course, has a lower rate of complications.

Percutaneous retrieval of foreign bodies from the cardiovascular system.

The authors retrieved percutaneously an iatrogenic foreign body from the cardiovascular system in 10 patients without any complications. The Dormia basket catcher commonly used for stone extraction from the urinary tract was used in 9 out of 10 patients. The foreign body was extracted 6 times from the right atrium and once each from the pulmonary artery, the right ventricle, the iliac vein and the iliac artery. In view of the high rate of success of the transvasal retrieval and the absence of complications, practically every foreign body carried into the cardiovascular system represents an indication for its percutaneous extraction even in the case of not being opaque.

[Therapeutic occlusion of an erroneously implanted aortocoronary venous bypass using transluminal balloon embolization]. / Therapeutischer Verschluss eines fehlimplantierten aortokoronaren Venebypass mittels transluminaler Ballonembolisation.

Today, therapeutic occlusion of blood vessels can be performed not only by surgical ligation, but also by various transluminal embolization techniques. The use of hardly steerable emboli (e.g. metal coils or gel foam) is, however, associated with the risk of embolic displacement into the circulation. The present case describes the embolization of an ACVB-graft erroneously implanted to a cardiac vein, by means of a catheter system with a detachable silicone-rubber balloon (Bard-Parker mini-balloon system).