RESUMEN
BACKGROUND Carotid-cavernous fistula (CCF) is a rare, atypical vascular shunt between the carotid arterial system and the venous channels of the cavernous sinus, classified according to the shunt's anatomy, by etiology (resulting from trauma or occurring spontaneously), or by hemodynamic characteristics (such as low- or high-flow fistulas). CASE REPORT A 62-year-old female patient with poorly controlled arterial hypertension presented with bilateral periorbital edema, conjunctival chemosis, ophthalmoplegia, diplopia, and diminished visual acuity. On magnetic resonance angiography (MRA), abnormal arterial flow along the cavernous sinuses was noted, suggestive of bilateral CCF. The diagnosis of indirect dural low-flow CCF (Barrow Type D) was later confirmed by digital subtraction angiography, with feeding arteries from intracavernous internal carotid artery branches, and meningeal branches of the external carotid artery, draining bilaterally to ophthalmic veins, the intracavernous sinus, and the inferior petrosal sinus. The patient was successfully treated with endovascular embolization. At 7-month follow-up, no residual arteriovenous shunting was detected. This case highlights the importance of non-invasive radiological methods for CCF, and presents rarely published radiological findings of bilateral Type-D dural CCFs on 3-dimensional time-of-flight MRA with post-treatment MRA follow-up. CONCLUSIONS Regardless of the patient's history of possible trauma, a patient presenting with bilateral periorbital edema, conjunctival chemosis, ophthalmoplegia, diplopia, and diminished visual acuity should have a spontaneous bilateral CCF investigated to prevent delayed treatment. Experienced neuroradiologists are needed to accurately detect indirect CCF, since this condition often does not demonstrate classic symptoms.
Asunto(s)
Fístula del Seno Cavernoso de la Carótida , Embolización Terapéutica , Fístula , Oftalmoplejía , Femenino , Humanos , Persona de Mediana Edad , Angiografía por Resonancia Magnética/efectos adversos , Diplopía/etiología , Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Fístula del Seno Cavernoso de la Carótida/terapia , Fístula/terapia , Embolización Terapéutica/métodos , Trastornos de la Visión/terapia , EdemaRESUMEN
BACKGROUND: Transvenous embolization of high-grade dural arteriovenous fistulas (dAVFs) is challenging particularly when the direct sinus access is favorable due to the complex venous anatomy which prohibits endovascular access via the transfemoral approach. METHOD: The procedure was conducted in the hybrid operating suite, where a burr hole was performed, followed by direct catheterization of the superior sagittal sinus. Coil embolization was then executed to achieve complete obliteration of the fistula. CONCLUSION: The direct puncture of the superior sagittal sinus is a safe and effective method for treating complex dAVFs. This approach grants access to the fistula channel which facilitates curative embolization.
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Malformaciones Vasculares del Sistema Nervioso Central , Embolización Terapéutica , Fístula , Humanos , Seno Sagital Superior/diagnóstico por imagen , Seno Sagital Superior/cirugía , Senos Craneales/diagnóstico por imagen , Senos Craneales/cirugía , Embolización Terapéutica/métodos , Punciones , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Fístula/terapiaRESUMEN
BACKGROUND: Hyperbaric oxygen therapy (HBOT) delivers 100% oxygen in a pressurized chamber, increasing tissue oxygen levels and regulating inflammatory pathways. Mounting evidence suggests that HBOT may be effective for inflammatory bowel disease. Our systematic review and meta-analysis aimed to quantify the efficacy and safety of HBOT in fistulizing Crohn's disease (CD). METHODS: A systematic review was conducted using the EMBASE, Web of Science, Pubmed, and Cochrane Library databases according to the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" criteria. Study bias was assessed using the Cochrane Handbook guidelines. RESULTS: Sixteen studies with 164 patients were included in the analysis. For all fistula subtypes, the pooled overall clinical response was 87% (95% CI: 0.70-0.95, I2 = 0) and the pooled clinical remission was 59% (95% CI: 0.35-0.80, I2 = 0). The overall clinical response was 89%, 84%, and 29% for perianal, enterocutaneous, and rectovaginal fistulas, respectively. On meta-regression, hours in the chamber and the number of HBOT sessions were not found to correlate with clinical response. The pooled number of adverse events was low at 51.7 per 10,000 HBOT sessions for all fistula types (95% CI: 16.8-159.3, I2 = 0). The risk of bias was observed across all studies. CONCLUSION: HBOT is a safe and potentially effective treatment option for fistulizing CD. Randomized control trials are needed to substantiate the benefit of HBOT in fistulizing CD.
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Enfermedad de Crohn , Oxigenoterapia Hiperbárica , Femenino , Humanos , Enfermedad de Crohn/terapia , Fístula/terapia , Oxigenoterapia Hiperbárica/efectos adversos , Oxígeno/uso terapéutico , Resultado del TratamientoAsunto(s)
Embolización Terapéutica , Fístula , Leiomioma , Embolización de la Arteria Uterina , Neoplasias Uterinas , Femenino , Humanos , Embolización de la Arteria Uterina/efectos adversos , Leiomioma/diagnóstico por imagen , Leiomioma/terapia , Leiomioma/irrigación sanguínea , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/terapia , Neoplasias Uterinas/irrigación sanguínea , Fístula/diagnóstico por imagen , Fístula/etiología , Fístula/terapia , Embolización Terapéutica/efectos adversos , Resultado del TratamientoRESUMEN
Intraosseous dural arteriovenous fistulas (DAVFs) are distinct in that the fistula is located within the bone rather than the dura through which the dural vessels pass. It has been stated that only fistulas within marrow should be considered as intraosseous DAVFs rather than DAVFs with traditional angioarchitecture that erode into bone or are located within a bony foramen. The ambiguity in the definition may have contributed to the oversight and scarcity of relevant cases reported in the literature. Three- or four-dimensional digital subtraction angiography is useful for determining the location of the fistula and developing treatment plans. We present an intraosseous DAVF around the pterygopalatine fossa using a transvenous approach.
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Malformaciones Vasculares del Sistema Nervioso Central , Embolización Terapéutica , Fístula , Humanos , Fosa Pterigopalatina/diagnóstico por imagen , Fosa Pterigopalatina/cirugía , Duramadre/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/terapia , Fístula/terapiaRESUMEN
A 48-year-old man developed sudden-onset haematemesis and melena after decompensated posthepatitic cirrhosis. Endoscopic variceal injectional sclerotherapy was emergently performed. However, the patient developed esophago-pleural fistula, empyema, and liver failure. He thus received symptomatic treatments and nasojejunal feedings, which failed to restore the nutrition as the gastroesophageal reflux exacerbated the hydrothorax. Percutaneous endoscopic gastro-jejunal (PEG-J) was therefore carefully performed for enteral nutrition support. The patient had recovered from the fistula at a six-month follow-up, which allowed the resumption of an oral diet. Our literature review revealed that PEG-J is a feasible approach to treating esophago-pleural fistula, a rare but lethal complication of endoscopic sclerotherapy.
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Empiema , Várices Esofágicas y Gástricas , Fístula , Enfermedades Pleurales , Masculino , Humanos , Persona de Mediana Edad , Escleroterapia/efectos adversos , Enfermedades Pleurales/terapia , Fístula/complicaciones , Fístula/terapia , Endoscopía/efectos adversos , Empiema/complicaciones , Várices Esofágicas y Gástricas/complicaciones , Várices Esofágicas y Gástricas/terapia , Hemorragia Gastrointestinal/complicacionesRESUMEN
PURPOSE: To discuss the clinical spectrum and management strategies in patients with post-traumatic canalicular fistula (PTCF). METHODS: Retrospective, interventional case series of consecutive patients diagnosed with PTCF over a 6-year study period between June 2016 and June 2022. The demographics, mode of injury, location, and communication of the canalicular fistula were noted. The outcomes of several management modalities including dacryocystorhinostomy, lacrimal gland therapies, and conservative approaches were assessed. RESULTS: Eleven cases with PTCF over the study period were included. The mean age at presentation was 23.5 years (range: 6-71 years), with male: female ratio of 8:3. The median time interval between trauma to presentation at the Dacryology clinic was 3 years (range: 1 week to 12 years). Seven had iatrogenic trauma and four had the canalicular fistula following primary trauma. Management modalities pursued include conservative approach for minimal symptoms, and dacryocystorhinostomy, dacryocystectomy, and lacrimal gland botulinum toxin injection. The mean follow-up period was 30 months (range: 3-months-6 years). CONCLUSION: PTCF is a complex lacrimal condition and the management of the PTCF needs a tailored approach guided by its nature and location and patient symptomatology.
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Dacriocistorrinostomía , Fístula , Enfermedades del Aparato Lagrimal , Aparato Lagrimal , Obstrucción del Conducto Lagrimal , Conducto Nasolagrimal , Humanos , Masculino , Femenino , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/etiología , Enfermedades del Aparato Lagrimal/terapia , Fístula/etiología , Fístula/terapia , Obstrucción del Conducto Lagrimal/diagnóstico , Obstrucción del Conducto Lagrimal/etiología , Obstrucción del Conducto Lagrimal/terapiaRESUMEN
BACKGROUND We report a case of late-onset chronic fistula in a decompensated cornea after multiple ocular surgeries and a recent phototherapeutic keratectomy (PTK). CASE REPORT A 73-year-old woman presented to our service with a past ocular history of bilateral chronic angle closure glaucoma and pseudophakic bullous keratopathy in the left eye. Given a history of long-term uncontrolled glaucoma with advanced disc cupping and poor visual potential, the patient underwent multiple palliative procedures, including, most recently, a PTK. Few years later she presented with a spontaneous late onset of slowly appearing corneal leak on fluorescein staining upon routine clinical examination. Corrected distance visual acuity was hand motion and intraocular pressure (IOP) was 40 mmHg in the affected eye. Serial anterior segment optical coherence tomography (AS-OCT) sections were obtained, which aided in understanding the current presentation and revealed distinctive multilayer corneal changes during the healing process. The patient was successfully managed with cyanoacrylate corneal gluing and ocular hypotensive medications, which halted the corneal leak. CONCLUSIONS We report a case of a rare finding of corneal fistula in an eye with multiple previous ocular surgeries, and provide an explanation of the possible etiopathogenesis. We also highlight the pivotal role of AS-OCT for evaluating such cases and stress the importance of early detection of similar subtle leaks in the setting of a formed anterior chamber, which can often be missed, carrying a risk of infection.
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Córnea , Enfermedades de la Córnea , Fístula , Láseres de Excímeros , Queratectomía Fotorrefractiva , Anciano , Femenino , Humanos , Córnea/patología , Córnea/cirugía , Láseres de Excímeros/efectos adversos , Láseres de Excímeros/uso terapéutico , Queratectomía Fotorrefractiva/efectos adversos , Queratectomía Fotorrefractiva/métodos , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Fístula/diagnóstico , Fístula/etiología , Fístula/terapia , Enfermedad Crónica , Enfermedades de la Córnea/diagnóstico , Enfermedades de la Córnea/etiología , Enfermedades de la Córnea/terapia , Oftalmopatías/cirugíaRESUMEN
BACKGROUND: Salvage cryotherapy (SCT) is widely used to treat prostate cancer (PCa) recurrence after radiotherapy (RT). We studied the intermediate oncological and functional outcomes of patients who underwent SCT following cryotherapy (CRYO-SCT) recurrence and compare it to recurrence after brachytherapy (BT-SCT). METHODS: An IRB-approved retrospective cohort study utilizing patient data from the Cryo On-Line Data Registry and the Duke PCa database between 1992 and 2016. Biochemical recurrence (BCR) using Phoenix criteria was the primary endpoint assessed at 2- and 5-years post-SCT. Secondary endpoints assessed functional outcomes including urinary continence, erectile function, and recto-urethral fistula. Association between treatment and biochemical progression-free survival was assessed using inverse probability weighted (IPTW) Cox proportional hazards regression. The differences in the secondary functional outcomes were assessed by Pearson's χ2 test or Fisher's exact test, corrected for IPTW. RESULTS: A total of 194 patients met inclusion criteria. The BCR rate for BT-SCT and CRYO-SCT was 23 (20.4%) and 17 (21%) at 2 years and 30 (26.5%) and 22 (27.2%) at 5 years according to Phoenix criteria. There was no statistical difference in 2 years (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.5-1.7, p = 0.7) or 5-year BCR (HR: 0.86; 95% CI, 0.5-1.5, p = 0.6) between the groups. The functional outcomes like urinary continence (p = 0.4), erectile function (p = 0.1), and recto-urethral fistula (p = 0.3) were not statistically different. CONCLUSION: CRYO-SCT appears to be well tolerated, with comparable oncological and functional outcomes to patients failing primary BT. The findings also demonstrated that SCT can render a significant number of patients biochemically free of disease after initial CRYO with minimal morbidity. SCT is a viable treatment option to salvage local PCa recurrence following either BT or cryoablation failure.
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Braquiterapia , Disfunción Eréctil , Fístula , Neoplasias de la Próstata , Masculino , Humanos , Braquiterapia/efectos adversos , Disfunción Eréctil/etiología , Antígeno Prostático Específico , Estudios Retrospectivos , Puntaje de Propensión , Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/cirugía , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Crioterapia/efectos adversos , Fístula/etiología , Fístula/terapia , Terapia Recuperativa , Resultado del TratamientoRESUMEN
PURPOSE: To report a case of bilateral thalamic infarction (BTI) presenting as progressive thalamic dementia due to a midline tentorial dAVF (TdAVF) and to provide a systematic review of the literature. METHODS: We performed a systematic literature review of previously reported cases of bi-thalamic signal changes due to dAVF considering population characteristics, clinical presentation, imaging findings, treatments, and outcomes. RESULTS: We found 29 papers from 1985 until 2021 describing 35 cases of BTI dAVF-related. We analysed 36 cases comprehensive of our case report. The mean age was 58.7 years (range 38-79), 91.6% were males (n=33). Most cases presented with a subacute syndrome. In 86.1% (n=31) of cases a TdAVF was found; 58.3% (n=21) were type 2 Borden-Shucart fistulas, the remaining were mostly type 3. In 80.5% (n=29), a thrombosed sinus was identified. 33.3% of cases (n=12) had bi-thalamic haemorrhages. Endovascular treatment was performed in 83.3% of cases (n=30). A total of 75% (n=27) of cases had a good recovery. CONCLUSIONS: BTIs due to dAVFs may present with subacute symptoms overlapping with several differential diagnoses. Prompt identification at MRI, before venous drainage failure and bleeding, is crucial for a good prognosis.
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Malformaciones Vasculares del Sistema Nervioso Central , Demencia , Embolización Terapéutica , Fístula , Masculino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Femenino , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Imagen por Resonancia Magnética , Embolización Terapéutica/métodos , Infarto Cerebral/complicaciones , Demencia/diagnóstico por imagen , Demencia/etiología , Demencia/terapia , Fístula/complicaciones , Fístula/terapiaRESUMEN
BACKGROUND: Uterine artery embolization (UAE) is a minimally invasive procedure for treatment of symptomatic uterine leiomyomas, but long-term complications are under-reported. CASE: This is the case of a healthy 51-year-old woman who had previously undergone UAE for symptomatic uterine leiomyomas. The patient presented with gross hematuria and pelvic pain 10 years later. She was found to have both a vesicouterine and a uteroduodenal fistula. The patient was successfully treated with hysterectomy, excision of the vesicouterine fistula, partial cystectomy, excision of the duodenal fistula, and primary duodenal repair. CONCLUSION: Complex gynecologic fistulas may occur as a long-term complication in symptomatic women with a history of UAE.
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Embolización Terapéutica , Fístula , Leiomioma , Embolización de la Arteria Uterina , Neoplasias Uterinas , Femenino , Humanos , Persona de Mediana Edad , Embolización de la Arteria Uterina/efectos adversos , Embolización de la Arteria Uterina/métodos , Neoplasias Uterinas/cirugía , Leiomioma/cirugía , Histerectomía , Fístula/terapia , Resultado del Tratamiento , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodosRESUMEN
BACKGROUND: Transvenous embolization is emerging as a promising treatment for cerebrospinal fluid-venous fistulas (CVF) associated with spontaneous intracranial hypotension (SIH). OBJECTIVE: To perform an independent validation of the efficacy and safety of the procedure and describe the procedural techniques used at our institution. METHODS: A retrospective review was performed including consecutive patients with SIH who had undergone CVF embolization with 3-month clinical and imaging follow-up. Clinical evaluation included the Patient Global Impression of Change (PGIC) Scale and six-item Headache Impact Test (HIT-6). Bern SIH score was used for imaging evaluation on brain MRI. Post-treatment changes in scores were assessed by Wilcoxon signed rank test. Procedural technical details, including use of upper-extremity access and dual-microcatheter pressure cooker technique, were recorded. RESULTS: 18 patients (13 female, median age 60 years) were included. 17 (94%) procedures were performed with upper-extremity access and 12 (67%) using dual-microcatheter pressure cooker technique. After embolization, 16 (89%) patients reported much or very much improved at follow-up PGIC; median (IQR) HIT-6 score improved from 68 (62-72) to 36 (36-38) and Bern SIH score improved from 8 (6-8) to 3 (1.5-3.5), p values <0.001. Side effects were transient embolization site back pain in 15 (83%) and rebound intracranial hypertension requiring medical management in 9 (50%) patients. HIT-6 and Bern SIH score changes were similar between conventional and pressure cooker techniques (p values >0.05). CONCLUSION: Transvenous embolization is independently validated as a highly effective and safe treatment for CVF and is feasible using upper-extremity venous access. Dual-microcatheter and balloon/coil pressure cooker techniques may be used to optimize distribution of embolic material and potentially, treatment efficacy.
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Malformaciones Vasculares del Sistema Nervioso Central , Embolización Terapéutica , Fístula , Humanos , Femenino , Persona de Mediana Edad , Estudios de Factibilidad , Malformaciones Vasculares del Sistema Nervioso Central/terapia , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Extremidades , Fístula/etiología , Fístula/terapiaAsunto(s)
Aneurisma Coronario , Enfermedad de la Arteria Coronaria , Fístula , Cardiopatías Congénitas , Insuficiencia Cardíaca , Fístula Vascular , Humanos , Cardiopatías Congénitas/terapia , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/cirugía , Fístula/terapia , Angiografía Coronaria , Fístula Vascular/diagnóstico , Fístula Vascular/etiología , Fístula Vascular/cirugíaRESUMEN
Perilymphatic fistula (PLF) is a rare condition with a pathological communication between the inner ear and usually the middle ear, causing both cochlear and vestibular symptoms. PLF is typically treated with either a conservative approach or surgically with grafting. But a new treatment has been proposed: intratympanic injection of autologous blood, blood patch. This is a case report of a 21-year-old woman who presented herself with PLF and was successfully treated with blood patch.
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Oído Interno , Fístula , Enfermedades del Laberinto , Enfermedades Vestibulares , Adulto , Oído Interno/cirugía , Femenino , Fístula/diagnóstico , Fístula/etiología , Fístula/terapia , Humanos , Inyección Intratimpánica , Enfermedades del Laberinto/complicaciones , Enfermedades del Laberinto/cirugía , Adulto JovenRESUMEN
Purpose: To report a case of indirect carotid-cavernous fistula (CCF) in a patient who presented as a case of thyroid-associated orbitopathy (TAO). Case presentation: A 60-year-old female, known case of hypothyroidism, presented with left-sided headache associated with pain, protrusion and redness of left eye, the examination revealing vision of 20/ 80, proptosis, chemosis and severe ophthalmoplegia. All routine investigations were normal, including thyroid hormone levels. MRI brain & orbits showed increase in bulk of all extraocular muscles with tendon sparing. In view of suspicion of TAO, she was initially misdiagnosed and treated with parenteral and oral steroids, which resulted in further worsening of vision. Optical coherence tomography macula of the left eye revealed acute central serous chorioretinopathy that compelled the stoppage of steroids. While reviewing the patient again, dilated cork-screw tortuous episcleral vessels were found in the left eye. Thus, advised Digital subtraction angiography, confirmed as a case of low-flow left Indirect CCF, managed with endovascular embolization therapy improved her ocular symptoms completely in three days. Conclusion: CCF may mimic TAO due to overlapping features. In-view of different treatment protocols for both, it is critically important to look for atypical features in thyroid eye disease and keep CCF as one of the differential diagnoses for accurate management. Abbreviations: CCF = carotid-cavernous fistula, ICA = internal carotid artery, ECA = external carotid artery, TAO = thyroid-associated ophthalmopathy, BCVA = best corrected visual acuity, MRI = magnetic resonance imaging, IVMP = intravenous methylprednisolone, OCT = Optical coherence tomography, CSCR = central serous chorioretinopathy, DSA = digital subtraction angiography, IOP = intraocular pressure, CT = computed tomography.
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Fístula del Seno Cavernoso de la Carótida , Coriorretinopatía Serosa Central , Embolización Terapéutica , Exoftalmia , Fístula , Oftalmopatía de Graves , Fístula del Seno Cavernoso de la Carótida/cirugía , Fístula del Seno Cavernoso de la Carótida/terapia , Embolización Terapéutica/métodos , Exoftalmia/diagnóstico , Exoftalmia/etiología , Femenino , Fístula/complicaciones , Fístula/terapia , Oftalmopatía de Graves/complicaciones , Oftalmopatía de Graves/diagnóstico , Oftalmopatía de Graves/terapia , Humanos , Persona de Mediana EdadRESUMEN
Hemoptysis is a common clinical emergency, bronchial arterial embolization is considered to be an effective treatment. The presence of coronary artery-bronchial artery fistula (CBF) may lead to recurrence of hemoptysis after treatment. It is necessary to investigate the imaging characteristics of a CBF and its correlation with the severity of pulmonary disease. With the development of multi-detector computed tomography, our study used the 320-slice CT bronchial artery angiography technology to observe and visualize blood vessels. The image and clinical data of 2015 hemoptysis patients with 320-slice CT bronchial artery angiography were retrospectively reviewed from January 2015 to December 2019. The axial and three-dimensional CT images were analyzed. The incidence, anatomical characteristics of CBF and pulmonary disease severity score were evaluated. A total of 12 CBF vessels were detected in 11 patients. We found that the incidence of CBF in this group was 0.55% (11/2015). Mean CBF diameter was 1.9 mm (1.2-2.5 mm). The course of CBF usually was relatively fixed. The proportions of CBF originated from the left circumflex artery, right coronary artery, and left anterior descending artery were 75%, 16.7% and 8.3%, respectively. Preliminarily analysis of the correlation between the trend of CBF and the pulmonary diseases severity score showed that CBF was more likely to communicate with a bronchial artery on the side with a higher severity score. CBF may occur in patients with chronic pulmonary disease and hemoptysis, and its origin, course and trend are characteristic. Detailed and comprehensive computed tomography angiography image analysis is helpful to improve the clinical treatment of hemoptysis with CBF.
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Embolización Terapéutica , Fístula , Enfermedades Pulmonares , Humanos , Arterias Bronquiales/diagnóstico por imagen , Hemoptisis/diagnóstico , Hemoptisis/etiología , Hemoptisis/terapia , Vasos Coronarios/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada Multidetector , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/terapia , Fístula/complicaciones , Fístula/terapia , Arteria Pulmonar/diagnóstico por imagenRESUMEN
This study aimed to document the experience of integration and the contribution of the Client Tracker (CT) to female genital fistula (FGF) management and data quality in sites supported by the Fistula Care+ Project in the Democratic Republic of Congo (DRC), from 2017 to 2019. It was a parallel mixed methods study using routine quantitative data and qualitative data from in-depth interviews with the project staff. Quantitative findings indicated that CT forms were present in the medical records of 63% of patients; of these, 38% were completely filled out, and 29% were correctly filled out. Qualitative findings suggested that the level of use of CT in the management of FGF was associated with staff familiarity with the CT, staff understanding of concepts in the CT forms, and the CT-related additional workload. The CT has mainly contributed to improving data quality and reporting, quality of care, follow-up of fistula patients, and self-supervision of management activities. A possible simplification of the CT and/or harmonization of its content with existing routine forms, coupled with adequate continuous training of staff on record-keeping, would further contribute to maximizing CT effectiveness and sustainability.
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Fístula , Enfermedades de los Genitales Femeninos , Registros Médicos , República Democrática del Congo , Femenino , Fístula/diagnóstico , Fístula/terapia , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/terapia , Humanos , Registros Médicos/normasRESUMEN
We report the case of a 14-year-old man who arrived at the emergency department affected by a high-flow priapism due to a traumatic left arterial-sinusoidal fistula. After clinical examination, a colour Doppler ultrasound of the penis was performed which showed a left arterial-sinusoidal fistula measuring 7×16×30mm, with high-speed and turbulent flow. The fistula was successfully treated by three highly selective endovascular embolizations and at the 20days follow-up, clinical examination resulted normal.
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Embolización Terapéutica , Fístula , Priapismo , Enfermedades Vasculares , Adolescente , Fístula/terapia , Humanos , Masculino , Pene/irrigación sanguínea , Priapismo/diagnóstico por imagen , Priapismo/etiología , Priapismo/terapia , Ultrasonografía Doppler en Color/métodos , Enfermedades Vasculares/terapiaRESUMEN
This study aimed to compare the treatment efficacy and tolerance between drug-eluting beads transarterial chemoembolization (DEB-TACE) and conventional transarterial chemoembolization (cTACE) in hepatocellular carcinoma (HCC) patients with arterioportal fistula (APF). A total of 44 HCC patients with APF scheduled for DEB-TACE (N = 24, as DEB-TACE group) or cTACE (N = 20, as cTACE group) were recruited. Treatment response, hepatic function, and adverse events were assessed or recorded. Besides, progression-free survival (PFS) and overall survival (OS) were calculated. Total treatment response was better in the DEB-TACE group compared with the cTACE group (P = .012). Meanwhile, the objective response rate (87.5% versus 60.0%) was higher (P = .013), while the disease control rate (95.8% versus 85.0%) was similar in the DEB-TACE group compared to the cTACE group (P = .213). Besides, PFS (mean value: 12.2 (95%CI: 9.9-14.6) months versus 7.8 (95%CI: 5.6-10.0) months) (P = .037), but not OS (mean value: 20.0 (95%CI: 18.1-21.9) months versus. 18.6 (95%CI: 15.4-21.8) months) (P = .341) was prolonged in DEB-TACE group compared with cTACE group. Regarding the safety, Child-Pugh stage, albumin level, and bilirubin level after treatment were all similar between the DEB-TACE group and cTACE group (all P > .05); moreover, no difference was found in the occurrence of adverse events during or after treatment between the two groups (all P > .05). Moreover, subsequent analyses found that embolic materials for APF (microspheres) in the DEB-TACE group did not affect the treatment efficacy (all P > .05). DEB-TACE promotes treatment response and PFS compared with cTACE and shows good safety in HCC patients with APF.
Asunto(s)
Carcinoma Hepatocelular , Quimioembolización Terapéutica , Fístula , Neoplasias Hepáticas , Carcinoma Hepatocelular/patología , Quimioembolización Terapéutica/efectos adversos , Fístula/terapia , Humanos , Neoplasias Hepáticas/patología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Hemoptysis is a frequently encountered symptom of the respiratory system in adult but is rare in children. Bronchial artery-pulmonary artery fistula (BPF) is one of the most important and life-threatening cause in pediatric hemoptysis patients. Although the severity of BPF has been proved in previous studies, details about clinical diagnosis and treatment of BPF in children have been rarely reported. CASE PREPARATION: A 12-year-old boy presented to the hospital with hematemesis after coughing, without any other symptoms. After admission, he had repeated hemoptysis, 20-30 ml each time, and on the 11th night of admission a massive hemoptysis (about 100 ml bright red blood) occurred suddenly. Chest computed tomography demonstrated patchy ground glass opacities in the right lung, suggestive of pulmonary hemorrhage. Bronchial arteriography showed an apparent BPF in the right lobe bronchial artery. Therefore, bronchial artery embolization was performed, following which a thrombus in the bronchial lumen was removed by bronchoscopy. After these interventions, the patient recovered quickly and no recurrence was noted in the following year. CONCLUSION: We believe that this case should raise awareness of cryptogenic massive hemoptysis caused by BPF. In the event of hemoptysis in a child, it is important to clarify the source of the bleeding. If common etiologies have been excluded, the presence of pulmonary and bronchial vascular malformations should be considered. Moreover, multidisciplinary collaboration is crucial in the diagnosis and management of cryptogenic hemoptysis.