Prevalence of acid gastroesophageal reflux disease in infants with esophageal atresia/tracheoesophageal fistula.

BACKGROUND: Given the high prevalence and complication risks of acid gastroesophageal reflux (GERD) in the first months of life in infants with esophageal atresia, the ESPGHAN/NASPGHAN consensus statement recommends systematic treatment with proton pump inhibitors (PPIs) until the age of 1 year and checking for acid GERD thereafter. However, these recommendations have not been evaluated. METHODS: This prospective study was conducted from 2007 to 2016. We evaluated the prevalence of acid GERD in 100 consecutive infants presenting with esophageal atresia/tracheoesophageal fistula after the age of 18 months when PPI treatment was stopped. The diagnosis of acid GERD was based on positive pH-metry and/or evidence of complications (e.g., peptic esophagitis, need for jejunal nutrition, or antireflux surgery). Those with acid GERD at a median age of 18 months received a control examination every year or adapted to their clinical situation. RESULTS: The prevalence rates of acid GERD were 64.3% at 18 months and 22.8% at the last follow-up (median age 65 months).There is no risk factor for acid GERD identified. CONCLUSIONS: This study shows a high prevalence of acid GERD in late infancy and supports the recommendation of systematic checking for acid GERD when treatment with PPI is stopped. IMPACT: Acid gastroesophageal reflux disease (GERD) is a frequent complication of esophageal atresia in infants. The ESPGHAN/NASPGHAN consensus, which is based on expert opinion, recommends systematic treatment of children with PPI until the age of 1 year. The prevalence rates of acid GERD were 64.3% at 18 months and 22.8% at the last follow-up. This study shows a high prevalence of acid GERD in late infancy and supports the recommendation of systematic checking for acid GERD when treatment with PPI is stopped.

Acquired TEF in Hodgkin Lymphoma in a Child: A Rare Clinical Association.

BACKGROUND: Malignancy is the most common etiology of acquired fistulae between the tracheobronchial tree and esophagus. The majority are due to either primary bronchial or esophageal carcinoma, and are typically observed in adult population. The occurrence of tracheoesophageal fistula (TEF) in patients with Hodgkin lymphoma is a rare phenomenon. OBSERVATION: We report a rare case of Hodgkin lymphoma with TEF in a 10-year-old girl at presentation. She also developed pulmonary tuberculosis later during the follow up. She was fed through a nasogastric tube to avoid aspiration through the fistulous tract. She did well with chemotherapy and anti-tubercular therapy. CONCLUSIONS: Our case suggests TEF in Hodgkin lymphoma at the time of diagnosis is a rare complication in pediatric age group. Lymphoma-related TEF require far less active intervention, as against esophageal or bronchial malignancy related TEF.

[Microbiological monitoring in therapy of patients with iatrogenic esophageotracheal fistula].

The results of the microbiological diagnosis of infective inflammatory complications in patients with iatrogenic esophageotracheal fistula and the tactics of their antibacterial prophylaxis and therapy within a 9-year observation period (2003-2011) were analysed. The main organisms colonizing the tracheobronchial tree in the patients were S. epidermidis, S. aureus, enteric bacteria, P. aeruginosa and Candida. An increase of the S. epidermidis resistance to rifampicin, moxifloxacin and especially ciprofloxacin was observed. The resistance of S. aureus did not significantly change. Within the observation period, high susceptibility of all the Staphylococcus isolates to vancomycin and linezolid remained stable. Among the nonfermenting gramnegative bacteria, the P. aeruginosa isolates were the most frequent and characterized by a lower portion of the isolates with preserved susceptibility to the agents (except polymyxin B) known earlier as antipyocyanic antibiotics, i.e. to imipenem and cefepim. Since the proportion of P. aeruginosa in the etiology of pyoinflammatory processes in the region of esophageotracheal fistula ranged within 9.3 to 17.5%, the fact should be considered in the antibiotic therapy. There was observed an increase in the frequency of infectious complications due to other nonfermenting gramnegative bacteria (acinetobacters) and first of all A.baumannii. Various Candida isolates were characterized by dependence of the susceptibility on the selective pressure of irrational therapy, as well as their species (the presence of such species as C. Krusei and C. glabrata with natural resistance), that required not only the species identification but also determination of the Candida isolates resistance in every particular case.

[Aspergillus niger responsible for a tracheo-oesophageal fistula in an immunocompetent patient]. / Aspergillus niger responsable d'une fistule trachéo-oesophagienne chez un sujet immunocompétent.

Tracheal or bronchial aspergillar locations are rare. They are mainly found in patients with general or localised immune deficiency. The authors report the case of a 53-year-old Vietnamese immunocompetent patient without any factors of risk who suddenly came down with a perforation syndrome indicating a tracheo-oesophageal fistula. The bronchial samples helped identify Aspergillus niger as the agent incriminated. Surgical treatment associated with an antifungal treatment provided a cure without any recurrence for 3 years.

Fístula tráqueo-innominada. Diagnóstico y tratamiento / Endovascular treatment of tracheo-innominate fistula

Introducción:la fístula tráqueo-innominada (TIF) es una complicación poco frecuente (0,1-1 %) de las traqueotomías e intubaciones endotraqueales. Tiene una alta morbilidad y mortalidad asociadas (90 %), por lo que es de vital importancia un diagnóstico y tratamiento precoz.Caso clínico:presentamos el caso de un varón de 53 años intervenido mediante laringectomía total con linfadenectomía cervical bilateral que en el segundo día posoperatorio debuta con sangrado activo por cánula de traqueostomía. El paciente fue sometido a un angio-TAC urgente que reveló una fístula entre el tronco braquiocefálico (BCT) y tráquea en aparente relación con decúbito de cánula de traqueostomía. Se implanta stent recubierto balón explandible (BeGraft®, Bentley InnoMed, Hechingen, Alemania) desde el origen del BCT hasta su bifurcación mediante acceso humeral derecho. El paciente es dado de alta un mes después de haberse realizado la cirugía endovascular presentando un postoperatorio satisfactorio con ausencia de complicaciones.Discusión:la TIF es una complicación poco común y muy letal que requiere manejo quirúrgico emergente. Clásicamente, las TIF se tratan mediante cirugía abierta con una tasa de supervivencia del 25-50 %.El uso de técnicas endovasculares parece ser una opción segura y eficaz con una menor morbilidad y mortalidad asociadas para el tratamiento de la TIF en casos seleccionados.(AU)

Introduction:tracheo-innominate fistula (TIF) is a rare complication (0.1-1 %) of tracheotomies and endotracheal intubations. It has a high associated morbidity and mortality (90 %), and thus needs early diagnosis and treatment.Case report:we present the case of a 53-year-old man who underwent total laryngectomy with bilateral cervical lymphadenectomy, and who on the second postoperative day presented active bleeding from the tracheostomy tube. The patient underwent an urgent CT angiography that revealed a fistula between the brachiocephalic trunk (BCT) and the trachea in a position with the tracheostomy tube over the BCT. Expandable balloon covered stent (BeGraft®, Bentley InnoMed, Hechingen, Germany) is deployed from the origin of the BCT to its bifurcation through right humeral approach. The patient is discharged one month after endovascular surgery, presenting a satisfactory postoperative period with the absence of complications.Discussion:TIF is a rare and highly lethal complication that requires emergency management. Typically, TIF were first repaired by open surgery with a survival rate of 25-50 %.Treating TIF in selected cases with the use of endovascular techniques appears to be a safe and effective choice with lower associated morbidity and mortality.(AU)

Closure of tracheoesophageal fistulas with chemotherapy and radiotherapy.

In patients who have esophageal cancer with a tracheoesophageal fistula, chemotherapy and radiotherapy are usually contraindicated because it is thought to enlarge the fistula. The records of 50 patients who had esophageal cancer and received simultaneous chemotherapy and radiotherapy from January 1992 to January 1997 were evaluated in the Medical Oncology Section of the Veterans Administration Medical Center, Washington, D.C. All patients were staged radiographically and endoscopically. Four patients developed a tracheoesophageal fistula while receiving treatment. One patient developed a fistula before treatment and another patient developed a fistula after treatment. Closure of the tracheoesophageal fistulas was achieved in 4 of 5 patients who responded to therapy and in those who developed fistulas before or during therapy. One of the patients whose fistula did not close died during therapy, whereas the other who developed a fistula after therapy underwent stenting. This finding indicates that development of a tracheoesophageal fistula is not a contraindication to chemotherapy and radiotherapy, and patients who are responsive to therapy may have closure of their fistulas.

Use of cimetidine in esophageal atresia with lower tracheoesophageal fistula.

Pneumonia, in infants suffering from esophageal atresia with lower esophageal fistula, is usually caused by gastric reflux through the fistula, In order to abolish the acidity of the gastric content, Cimetidine i.v. infusion was used during the first 12--48 hr after diagnosis, while treating the pneumonia. The amount of Cimetidine required to induce achlorhydria was established by serial aspiration of gastric content, in infants and children with gastrostomies performed for various causes.

[Preliminary results in the use of polydimethylsiloxane textured elastomers (Bioplastique) in the treatment of leakage around tracheoesophageal voice prosthesis]. / Utilizzo degli elastomeri testurizzati di polidimetilsilossano (Bioplastique) per il trattamento dell'incontinenza perivalvolare nei pazienti portatori di protesi fonatoria tracheo-esofagea.

Leakage around the prosthesis is one of the worst problems afflicting patients fitted with tracheoesophageal (TE) voice prosthesis. Removing the prosthesis for a few days can reduce the size of the fistula, or the leakage may be eliminated simply by replacing the prosthesis. In cases that are refractory to such treatment, the perifistular injection of different types of autologous, heterologous or alloplastic substances has been proposed. A new kind of silicone, previously available abroad, has recently appeared on the Italian market as well; constituted by polydimethylsiloxane textured elastomers (Bioplastique) for soft tissue implants, it appears to guarantee excellent standards of long-term safety and stability. Three patients fitted with Provox2 tracheoesophageal voice protheses who had been experiencing leakage for about 4 months underwent Bioplastique implant procedures. The correction of the fistula size was easy to accomplish and well tolerated by the patients. There was no sign of inflammation, formation of granulomas or other pathological modifications, and the size of the fistula, together with its fluid-tightness, remained stable in time. From our point of view, the Bioplastique implant appears to provide valid and effective treatment of gaping TE fistulas.

The medical treatment of a tuberculous tracheo-oesophageal fistula.

Tracheo-oesophageal (TE) fistulas caused by Mycobacterium tuberculosis are rare and usually require both surgical treatment and medical treatment with antituberculosis drugs. A patient with a tuberculous TE fistula and mediastinal lymphadenitis was successfully treated by medical management alone.

Complete remission with long-term survival in a patient with esophageal carcinoma and a tracheoesophageal fistula after treatment with the AIO regimen and bi-weekly cisplatin.

INTRODUCTION: To date, only few reports are available on patients with esophageal carcinoma containing a tracheoesophageal fistula under chemotherapy. CASE REPORT: A 56-year-old patient presented to the hospital with a stenosing squamous cell carcinoma of the esophagus containing a tracheoesophageal fistula 3 cm above the carina. After placement of a Port-a-Cath and adequate hydration he received weekly 500 mg/m (2) i. v. folinic acid (FA) as a 1 - 2-hour infusion and 2000 mg/m (2) 5-fluorouracil (5-FU) as a 24-hour infusion (24-h inf.) (AIO regimen) with prior application of bi-weekly 50 mg/m (2) i. v. cisplatin. A tracheal Y-Dumont metallic stent was inserted prior to initiating systemic treatment. The patient's alimentation was completely parenteral. After three cycles of chemotherapy (six months) the patient revealed complete remission (CR) with closure of the tracheoesophageal fistula. The tracheal Y-Dumont stent could be removed and the patient had oral alimentation restored. 29 months after initiating treatment he is without evidence of disease. CONCLUSION: Patients with esophageal carcinoma containing a tracheoesophageal fistula might benefit from chemotherapy and should not be generally excluded from systemic treatment.

[Mediastinal actinomycosis with formation of an esophagotracheal fistula. A case report]. / Mediastinale Aktinomykose mit ösophagotrachealer Fistelbildung. Ein Fallbericht.

Before antibiotics were available, actinomycosis was the most commonly diagnosed "fungal disease" of the lung because of its morphological similarity to true fungi. At that time actinomycosis presented a fairly typical clinical picture of empyema thoracis and sinus tracts in the chest wall. Nowadays it has become a rare infectious disease that is usually caused by the bacterium Actinomyces israelii and is amenable to treatment by most antibiotics available today. The following report describes the case of a 59-year-old man with an uncommon mediastinal actinomycosis that caused an oesophagotracheal fistula. This complication may develop due to the necrotizing inflammatory process that is typical for actinomycosis. With regard to the literature, the clinical manifestations of the disease and diagnostic and therapeutic considerations are discussed.

Tratamiento anestésico del neonato con atresia de esófago asociada a fístula traqueoesofágica y ano imperforado / Anesthetic management of a neonate with esophageal atresia, tracheoesophageal fistula and imperforate anus

La atresia de esófago es una malformación infrecuente (1:2.500-4.500 recién nacidos vivos), incompatible con la vida y una urgencia quirúrgica neonatal. El 30% de los pacientes son prematuros o presentan bajo peso al nacer y el 50% presentan anomalías asociadas, principalmente cardíacas. Las cardiopatías congénitas de orden mayor o el bajo peso al nacer son predictores independientes de mortalidad y eventos críticos perioperatorios. Presentamos el caso de un paciente intervenido de urgencia de atresia de esófago, fístula traqueoesofágica tipo iii b/C e imperforación anal. El objetivo de este artículo es la exposición de las consideraciones anestésicas en pacientes con esta afección, cuyo complejo manejo perioperatorio supone un importante reto y debe realizarse por equipos multidisciplinares con experiencia en neonatología. Establecer una vía aérea segura y obtener una ventilación pulmonar efectiva que minimice la fuga de aire al tracto digestivo debe ser uno de los objetivos prioritarios del manejo anestésico (AU)

Esophageal atresia is a rare condition (1:2,500-4,500), incompatible with life, and a surgical emergency in the neonatal period. It is associated with prematurity in 30% of cases, and to congenital abnormalities in 50% of cases, especially cardiac anomalies. Major congenital heart diseases and low weight are independent predictors of mortality and critical perioperative events. The aim of this article is to describe the most significant anaesthetic challenges presented in a case of a term neonate undergoing emergency surgery after being diagnosed with esophageal atresia, tracheoesophageal fistula type iiib/C, and imperforate anus. The major priorities during the anaesthetic management consist of establishing a safe airway and effective pulmonary ventilation that minimises air leakage to the upper digestive tract (AU)

Reparación de fístula traqueoesofágica intratorácica post quimioterapia en pacientes con cáncer de esófago / Reparation of intrathoracic tracheoesophageal fistule post-chemotherapy in patients with esophageal neoplasms

Una de las complicaciones más graves que ocurren en las quimioterapias y radioterapias que se realizan como tratamiento del Ca de esófago es la fístula traqueoesofágica (FTE). Se presenta caso clínico de paciente de 33 años con Ca de esófago que mientras era tratado con una quimioterapia, presenta una FTE ubicada a la altura de la carina, el tumor presentó una remisión completa, no así la fístula que persistió. Se realizó reparación quirúrgica en dos etapas: en la primera, por esofagectomía vía torácica con cierre de la fístula traqueal, esofagostomía cervical, cierre de muñón gástrico y yeyunostomía; en un segundo tiempo, ascenso gástrico al cuello. controlado hasta un año y nueve meses el paciente se mantiene bien sin signos de recidiva. En las cirugías más recomendadas actualmente como tratamiento (paliativo) de la FTE por Ca, no se practica el cierre de la fístula, dejando unida ésta a un segmento cerrado de esófago, lo que es causa que el 50 por ciento de estos pacientes fallezcan posteriormente por infecciones respiratorias, complicación que se evita con la reparación aquí presentada