Conservative management of postoperative chylous fistula with octreotide and peripheral total parenteral nutrition.

Postoperative chylous fistula after neck dissection is an uncommon complication associated with significant patient morbidity. Octreotide acetate is a somatostatin analogue established in the treatment of chylothorax; however, its utility in the management of cervical chylous fistulae has not been fully evaluated. The investigators hypothesized that chylous fistula can be managed by a combination of octreotide and peripheral total parenteral nutrition (TPN). A retrospective review of cases compiled at our institution from 2009 to 2015 was conducted. Ten patients, all men, were identified as having a postoperative chylous fistula after a neck dissection. All patients were treated with peripheral TPN and intravenous octreotide. Mean age of the patients was 63.0 years (range 49 to 82). Five (50.0%) had a neck dissection for the management of metastatic nasopharyngeal carcinoma and had previous neck irradiation. In 8 (80%) patients, chylous fistula occurred in the left neck. Seven (70.0%) of the leaks occurred within the first 2 postoperative days. Eight (80%) leaks were controlled using TPN and octreotide, with 2 (20%) patients requiring surgical intervention. No factors were significant in the successful conservative management of chylous fistulae. One patient with a chylous fistula of 1,800 ml/day was managed successfully without surgical intervention. The results of this case series suggest that chylous fistulae may be managed conservatively with octreotide and TPN. However, long-term evaluation is needed to define if and when surgical intervention is required for control.

Prevalence & factors associated with chronic obstetric morbidities in Nashik district, Maharashtra.

BACKGROUND & OBJECTIVES: In India, community based data on chronic obstetric morbidities (COM) are scanty and largely derived from hospital records. The main aim of the study was to assess the community based prevalence and the factors associated with the defined COM--obstetric fistula, genital prolapse, chronic pelvic inflammatory disease (PID) and secondary infertility among women in Nashik district of Maharashtra State, India. METHODS: The study was cross-sectional with self-reports followed by clinical and gynaecological examination. Six primary health centre areas in Nashik district were selected by systematic random sampling. Six months were spent on rapport development with the community following which household interviews were conducted among 1560 women and they were mobilized to attend health facility for clinical examination. RESULTS: Of the 1560 women interviewed at household level, 1167 women volunteered to undergo clinical examination giving a response rate of 75 per cent. The prevalence of defined COM among 1167 women was genital prolapse (7.1%), chronic PID (2.5%), secondary infertility (1.7%) and fistula (0.08%). Advancing age, illiteracy, high parity, conduction of deliveries by traditional birth attendants (TBAs) and obesity were significantly associated with the occurrence of genital prolapse. History of at least one abortion was significantly associated with secondary infertility. Chronic PID had no significant association with any of the socio-demographic or obstetric factors. INTERPRETATION & CONCLUSIONS: The study findings provided an insight in the magnitude of community-based prevalence of COM and the factors associated with it. The results showed that COM were prevalent among women which could be addressed by interventions at personal, social and health services delivery level.

[Nonsurgical and surgical treatment of an urachal fistula in an alpaca cria. A case report]. / Konservative und chirurgische Therapie der Urachusfistel bei einem Alpaka-Cria. Ein Fallbericht.

Urachal fistula is a neonatal condition. There are two reported forms: a congenital and an acquired form. We describe the case of a 6-hour-old female alpaca cria that was presented with a damp umbilicus and a meconium impaction. Conservative treatment of the urachal fistula with local and systemic medication was unsuccessful after 6 days; therefore, a resection of the umbilicus under general anaesthesia was performed. Reconvalescence was uneventful.

Rectal duplication as an unusual cause of chronic perianal fistula in an adult: report of a case.

Duplication of the rectum is a rare embryologic event, but it should be considered as a possibility when perianal fistulas and abscesses remain resistant to conventional standard surgical treatment modalities over the long term. We report the case of a 57-year-old woman who underwent many operations over 30 years for persistent perianal fistulas. After radiological assay by computed tomography, fistulography, and barium enema studies, we performed surgery to remove a cystic mass in the retrorectal region, which was subsequently found to be a rectal duplication. The patient had an uneventful postoperative course and has been asymptomatic for 3 years.

Potato gun ocular injury.

PURPOSE: This study aimed to identify a dangerous new weapon capable of causing damage to the ocular and periocular regions. METHODS: The authors report two patients who had penetrating ocular injury in the past year because of homemade recreational potato guns. RESULTS: In one 14-year-old boy, projectiles from the firing of a potato gun resulted in orbital and cranial injuries that were life threatening with widespread fractures, marked disruption of facial structures, a cerebrospinal fluid fistula requiring bifrontal surgical repair, and loss of one eye. In a separate accident with a different potato gun, a 14-year-old boy who was wearing glasses at the time of injury had a sight-threatening perforating corneal laceration. CONCLUSION: Practitioners must be aware of the existence of these new, homemade unregulated devices. Information about the use and construction of these guns is widespread on the Internet, but no injuries resulting from these guns currently are documented in the medical literature.

Fístulas enterocutáneas; Apoyo nutricional; Modalidad importante en el tratamiento / Enterocutaneous fistulas at the nutritional support important treatment

Se presenta la experiencia en el tratamiento y manejo de 41 fístulas enterocutáneas por la Unidad de Soporte Nutricional del Hospital Universitario de Caracas, durante 1985-1987. Con el enfoque multidisciplinario se obtuvo 80.4% de cierre de las fístulas. La sepsis no controlada sigue siendo la mayor causa de fracasos y muertes con 19.5%. Aún así es una mejoría dramática de lo que era la incidencia de muerte antes de la aparición del Soporte Nutricional

[Uretero-colic fistula. Apropos of 2 cases complicating sigmoid diverticulitis after surgery]. / Fistules urétéro-coliques. A propos de 2 cas compliquant une sigmoïdite diverticulaire opérée.

The authors report on two cases of uretero-colic fistulization in the post-operative period, following surgery for infectious complications involving sigmoidal diverticulitis. In the aftermath of surgery for sigmoidal diverticula, the appearance of very liquid stools at the exact moment when the infectious and semi-occlusive picture seems to resolve, the occurrence of a uro-steraceous fistula should make one suspect a uretero-colic fistula. Air pyelography and the retrograde opacification of the ureter following a radio-opaque enema are diagnostic. The IVU does not help to establish a firm diagnosis but is useful for showing the state of the adjacent kidney and above all the state of the contralateral kidney. In regard to the sepsis which accompanies these complications (there is nearly always a pericolic abscess at the site of the utero-colic fistula) all attempts at repair are futile. Only nephrectomy may be sometimes appropriate. At the same time, nothing except treatment of the infectious focus (colic or pericolic) will safeguard the patient from the risk of further infection which might end in death. The risk of damage to the ureter which sigmoidal diverticular surgery carries, necessitates the following precautions: a pre-operative IVU, a painstaking dissecting-out and well wide of the neighbouring ureter, the systematic injections of dye to colour the urine at the time of operation in order to avoid ureteric injury and of course to ensure the repair of any injury as soon as it happens. It is only possible to save the adjacent kidney and protect the normal urinary outlet if the ureteric lesion is properly identified at operation.