Successful embolisation of pelvic fistulating vessels to the prostate arising after TURP - a rare cause of postoperative bleeding.

Transurethral resection of the prostate (TURP) is considered the gold-standard operation to treat lower urinary tract symptoms due to benign prostatic enlargement in men. Postoperative bleeding is a recognised complication and managing it is a core skill required by attending urologists. We report a rare case of postoperative bleeding caused by fistulating vessels to the prostate which developed after TURP. These fistulas arose from the right internal iliac vessels and communicated with pre-existing pelvic varices affecting the right paraprostaticand seminal vesicle tissues. The fistulating vessels were successfully embolised with liquid embolic agent. Surgeons should be aware that persisting haemorrhage can occur post-TURP from the rare presence of fistulating vessels communicating with pelvic varices. Early computed tomography angiographic assessment is warranted in cases where bleeding is prolonged and refractory to standard management in view of timely referral for percutaneous embolisation.

Actualización en hidradenitis supurativa (II): aspectos terapéuticos / Update on Hidradenitis Suppurative (Part II): Treatment

A pesar de la importancia y de la gravedad de la hidradenitis supurativa, el tratamiento de esta enfermedad no se encuentra bien definido. Hoy en día, la hidradenitis es considerada una enfermedad cutánea que principalmente en las formas moderadas y severas se asocia a un marcado componente inflamatorio sistémico. Por lo tanto, el tratamiento de esta enfermedad irá enfocado hacia un manejo sistémico del control de la inflamación, que ocasionalmente irá acompañado de la intervención quirúrgica para reducir la carga de inflamación localizada en la piel. Los recientes avances en el conocimiento de la enfermedad se han acompañado de novedades terapéuticas, especialmente representadas por el desarrollo de ensayos clínicos de determinadas terapias biológicas, principalmente adalimumab, orientados al tratamiento específico de esta enfermedad. En la presente revisión se pretende analizar las diferentes alternativas terapéuticas existentes en el manejo de la hidradenitis supurativa

Although hidradenitis suppurativa is a common and serious skin condition, its treatment is not well established. It is now accepted that the moderate and severe forms of the disease are associated with marked systemic inflammation. The goal of treatment in hidradenitis suppurative is therefore to achieve systemic control of inflammation. In some cases, surgery may also be necessary to reduce the severity of the manifestations of cutaneous inflammation. Recent advances in our understanding of hidradenitis suppurativa have been accompanied by the emergence of novel approaches to its treatment, including the use of certain biologic drugs. Several clinical trials have been undertaken to test the effects of biologics (mainly adalimumab) in this setting. In this review, we analyze the different treatments available for hidradenitis suppurativa

Identification and early treatment of dehydration in home parenteral nutrition and home intravenous fluid patients prevents hospital admissions.

BACKGROUND: Early identification and treatment of dehydration is prudent in patients requiring home parenteral nutrition (HPN) or home intravenous fluids (HIVF) to prevent hospital admissions for dehydration. Our home nutrition support service (HNS) developed a protocol in 2010 to provide additional bags of HIVF to be kept on hand for immediate use in patients identified at risk of developing dehydration. METHODS: A retrospective review was performed on all HPN and HIVF patients from a clinical database who received additional HIVF during 2010. Standard treatment for dehydration was 1 L HIVF daily for 3 days in addition to prescribed infusions. RESULTS: Of 308 HNS patients in 2010, additional HIVF were ordered in 161 patients with malabsorption, fistula, or obstruction. Of the 161 patients, 63% (n = 102) required additional HIVF and had 201 episodes of dehydration recorded. Increased enterostomy output (P = .021), negative intake and output (I/O data) (P = .014), and age (P = .021) were predictors of multiple dehydration episodes. I/O data were consistent with signs and symptoms of dehydration 80% of the time. One hundred seventy episodes (84.5%) of dehydration were successfully treated at home compared with 9 emergency room (ER) admissions (4.5%) and 22 hospital admissions (11%) for dehydration. CONCLUSION: We demonstrate 84.5% of episodes of dehydration successfully treated in the home in patients initially identified at risk by our protocol. Education of patients at risk of dehydration prior to discharge and providing additional HIVF on hand for immediate use may avoid ER treatment or hospitalization and potentially save healthcare costs.

Enfermedad de zuska. Diagnóstico en atención primaria / Zuska disease. Diagnosis and treatment in primary care

Una fístula es una comunicación anómala patológica que comunica 2 órganos entre sí o con el exterior. Son trayectos fibrosos con revestimiento interno de tejido de granulación, que se extienden desde un orificio interno o primario hasta uno o varios orificios externos o secundarios situados en la piel. La constante recidiva de una mastitis suele ser consecuencia de una fístula entre conductos galactóforos y el límite areola-piel de la mama, llamándose a esto fistulización periareolar recidivante. Para integrar este cuadro en la terminología propuesta, enfermedad de Zuska, es indispensable pensar primero en su existencia para enfocar el tratamiento en su origen. El conocimiento de esta enfermedad y su diagnóstico y tratamiento correctos impedirán las constantes recidivas en forma de mastitis que presentan estas pacientes, evitando así su peregrinaje por distintos especialistas. En este artículo revisamos esta entidad, métodos diagnósticos y tratamiento (AU)

A fistula is an abnormal pathological communication which links two organs together or with the exterior. They are fibrous paths internally coated with granulation tissue, extending from an internal o primary opening to one or more openings located outside or on the skin. The recurrent mastitis that some patients suffer is due to a fistula between a lactiferous duct and the limit of the areola, and this condition is called a recurrent periareolar fistula.To incorporate this clinical condition into the proposed terminology, Zuska disease, is essential to believe in its existence, in order to to treat it from the source. The knowledge of this disease, a proper diagnosis and treatment will prevent the constant recurrence of mastitis as presented by these patients, avoiding their pilgrimage to various specialists. In this article we review this disease, methods of diagnosis and treatment (AU)

Iodized oil pleural effusion in a patient previously treated with transarterial chemoembolization for hepatocellular carcinoma.

Transarterial chemoembolization (TACE) is a nonsurgical therapeutic option for the control of hepatocellular carcinoma (HCC) in patients with cirrhosis. Although less invasive than surgical approaches, this procedure can have severe side effects, with both local and extrahepatic complications, mostly related to treatment-induced ischemic damage. Here, we describe the case of a cirrhotic female patient affected by multinodular HCC, who presented with sudden onset dyspnea and chest pain. After a thorough follow-up, her condition was found to be due to iodinized oil pleural effusion following diaphragm rupture by a fistula. This had developed from a sterile abscess formed on the site of a previously performed TACE. We discuss the differential diagnosis and the management of this case, which, to our knowledge, has never been described as a late side effect of TACE.

Can low frequency sound stimulation during posturography help diagnosing possible perilymphatic fistula in patients with sensorineural hearing loss and/or vertigo?

Perilymphatic fistula (PLF) is often difficult to diagnose because of the similar symptomatology, such as vertigo, tinnitus and hearing loss, which is found in several inner ear diseases. We attempted to correlate a positive result of low frequency sound (LFS) stimulation tests in posturography with the presence or absence of a PLF confirmed by transtympanic endoscopy in 209 patients with various inner ear diseases (Meniere's disease ( n=128), vestibulopathy ( n=41), cochleopathy ( n=28) and sudden deafness ( n=12). LFS provoked unsteadiness in posturography without PLF in 24 patients with Meniere's disease, in 5 patients with vestibulopathy, in 3 patients with cochleopathy and in 2 patients with sudden deafness. In one patient, tympanoscopy revealed fistula in the round window membrane that was covered with a fibrinous layer. In four cases there was abnormal light reflex in the round window but without PLF. In eight cases, Hennebert's sign was present with nystagmus, without PLF. We conclude that pathological responses to the LFS test in posturography can also be encountered in other inner ear diseases without PLF.

Colovenous fistula complicating diverticulitis: CT and radiographic findings.

We report a case of colovenous fistula to the inferior mesenteric vein complicating diverticulitis and mimicking coloureteral fistula. This is the second reported case of venous intravasation of barium complicating diverticulitis that mimicks coloureteral fistula. Radiographic features and characteristics differentiating these two entities are presented.

Thalamic amnesia following venous infarction: evidence from a single case study.

The present paper describes the case of a right-handed Italian-English bilingual male patient suffering from amnesia following a bilateral thalamic lesion due to venous infarction. Within a few months from the onset, the lesion gradually shrank and was finally confined to the left thalamus only, in particular to the antero-medial portion and the pulvinar. The mammillary bodies and the cortical areas of both hemispheres were spared. After the regression of a series of generalized cognitive deficits implying slow psychic activity confusion, and spatial and temporal disorientation, the patient presented a persistent amnesic syndrome with mild language disorders, both in Italian and in English. Major disorders of memory included a dissociation between verbal memory, which was severely impaired, and spatial memory, which was largely preserved.

The role of the radiologist in the management of gastrointestinal bleeding.

The purposes of this article are to clarify the current status of barium studies, radionuclide scans, and arteriography in the diagnosis and management of the bleeding patient; to provide one interventional radiologist's approach to the diagnosis and management of both upper and lower gastrointestinal tract hemorrhage in the adult population, incorporating both radiologic and nonradiologic techniques; and to review the diagnosis and management of several less frequent causes and special categories of bleeding, such as that associated with portal hypertension.

[Zinc deficiency caused by postgastrectomy fistula with high flow in a patient undergoing prolonged parenteral nutrition]. / Déficit de zinc debido a fístula posgastrectomía de alto débito en paciente sometido a nutrición parenteral prolongada.

A case is presented of a 57-year-old male patient who underwent total gastrectomy due to gastric adenocarcinoma. During the postoperative period the patient required long-term parenteral nutrition due to a high-debit GI fistula (over 700 ml/day) and sepsis. Two months after parenteral nutrition was started, the patients presented irritability, mucocutaneous lesions and progressive bolding. Serum alkaline phosphatase and zinc levels were lower than normal, although a supplemental 0.03 mg/k/day of zinc was administered. Faced with this zinc deficiency picture, 10 mg zinc sulfate was administered parenterally on a daily basis. The deficiency picture improved markedly over a week's period, and serum zinc and alkaline phosphatase levels returned to normal. The importance of zinc balance control in patients under long-term parenteral nutrition and high fluid debit through GI fistulas is highlighted.

Ovarian dermoid cyst complicated by an entero-ovarian fistula.

An unusual case of a 21-year-old nonpregnant woman with a left ovarian dermoid cyst complicated by an entero-ovarian fistula is presented. This case illustrates the importance of the contrast media enema for detecting this unusual complication.

Hepatic oil embolization following lymphangiography. A report of 12 cases.

The authors report on 12 personal observations of lymphoportal fistulas, which represented 0.24% of their series of lymphographies. This rare complication of lymphography has no clinical or biological liver manifestations. Review of 71 cases in the literature confirmed that hepatic oil embolization only occurs when there are lymphatic masses, with or without associated thrombosis of the inferior vena cava.

Colovenous fistula complicating diverticulitis. Demonstration by contrast enema.

Colonic diverticulitis is frequently complicated by bowel obstruction, abscess, perforation and fistula formation. We report a unique case of colonic diverticulitis complicated by colovenous fistulization with Gastrografin enema examination demonstrating thrombus in the inferior mesenteric vein.

Priapism as a complication of long-term intravenous nutrition.

A case of priapism following prolonged intravenous nutrition is reported. The small amounts of heparin as received by our patient would tend to minimise a risk of hypercoagulability. However, the administration of intravenous feeding agents and the concomitant metabolic acidosis may have enhanced this risk.