RESUMO
Aortocaval fistula (ACF) and false aneurysm are a recognized complication of open abdominal aortic aneurysm (AAA) repair. Untreated they are often fatal. However, open surgical repair of this complication is associated with a high operative mortality and a significant complication rate. Endovascular management using a stent-graft to exclude the false aneurysm and fistula is a technically feasible alternative and confers many advantages over open repair by virtue of its minimally invasive nature. We report the endovascular management of this rare but serious complication of open AAA repair.
Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/cirurgia , Fístula Vascular/etiologia , Veia Cava Inferior/cirurgia , Idoso , Anastomose Cirúrgica , Falso Aneurisma/etiologia , Implante de Prótese Vascular/métodos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Falha de Prótese , Recidiva , StentsRESUMO
OBJECTIVE: To determine the extent to which procedural variations affect pure-tone average-spondee threshold (PTA-SRT) agreement in pseudohypacusis, to propose a theoretical framework to account for threshold differences due to procedural variations, and to devise an effective screening test for identification of pseudohypacusis. DESIGN: The subjects were normally hearing listeners who feigned a hearing loss. One experimental group received an ascending pure-tone (PT) technique combined with an ascending SRT procedure. A second experimental group received an ascending PT technique paired with a descending SRT procedure. A third experimental group received an ascending SRT procedure paired with a descending PT procedure. RESULTS: The group mean difference between the three-frequency PTA and the SRT was 10.6, 2.3, and 41.6 dB for the first, second, and third experimental groups, respectively. Comparison SRTs and PTAs from cooperative patients with hearing loss showed that a two-frequency PTA yielded a more effective test for pseudohypacusis than did a three-frequency PTA. CONCLUSIONS: The procedural differences noted in this study are consistent with a loudness bias. It is recommended that clinicians employ an ascending procedure to measure SRTs and a descending procedure to measure PT thresholds to maximize the effectiveness of a screening test for pseudohypacusis based on PTA-SRT differences.
Assuntos
Transtornos da Audição/diagnóstico , Audição/fisiologia , Percepção da Fala , Teste do Limiar de Recepção da Fala , Adulto , Audiometria de Tons Puros , Limiar Auditivo , Feminino , Humanos , MasculinoRESUMO
A case of colovesical fistula in a 51-year-old male patient is described. The connection, between the base of the bladder and the rectosigmoid junction, was caused by an appendicitis in the tip of a pelvic appendix which had perforated into the bladder and rectosigmoid. There was no appendicovesical fistula connecting with the caecum.