Treatment of a broncho-esophageal fistula complicated by severe ARDS.

INTRODUCTION: Broncho-esophageal fistula formation is a rare complication of tuberculosis, most often seen in immunocompromised patients. METHODS AND RESULTS: In this paper, we report the case of a young non-immunocompromised refugee from Somalia diagnosed with open pulmonary tuberculosis complicated by extensive osseous involvement and a broncho-esophageal fistula with consecutive aspiration of gastric contents. The patient rapidly developed a severe acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (ECMO) therapy for nearly 2 months. The fistula was initially treated by standard antituberculous combination therapy and implantation of an esophageal and a bronchial stent. Long-term antibiotic treatment was instituted for pneumonia and mediastinitis. 7 months later, discontinuity resection of the esophagus was performed and the bronchial fistula covered by an intercostal muscle flap. DISCUSSION: This case illustrates that tuberculosis should always be suspected in patients from high-incidence countries in case of lung involvement and that an interdisciplinary approach including long-term intensive care management can enable successful treatment of tuberculosis with severe, near-fatal complications.

Use of complementary and alternative medicine in breast cancer patients and their experiences: a cross-sectional study.

Complementary and Alternative Medicine (CAM) refers to various treatments not considered as part of conventional care. CAM is used by a high number of breast cancer patients. This is a cross-sectional study employing a validated questionnaire with the aim of studying CAM use and of exploring the needs of information and communication in female breast cancer patients. Experiences associated with discussing CAM within a conventional oncology setting were examined. Answers of patients not using CAM were also elicited. Predictors for CAM use were a higher degree of education and being of a younger age. The study demonstrated that patients were reluctant to initiate communication within standard oncology care. They rather relied on family and friends (49%), on the general practitioner (40%) or media sources (39%) for information. Reasons for not talking about CAM were not having been asked (25%) or not having perceived the inpatient physician to be the adequate person to talk to (11%). Reasons for not using CAM were mainly considering conventional therapy as sufficient (34%) and not having thought about CAM (31%). Particularly within conventional oncological care it is important to train physicians to have knowledge of supportive CAM options as this is what patients look for, but restrain from seeking within the speciality system.