RESUMEN
AIM: Aim of the study to summarize the current information on diagnostic and treatment options for uterovesical fistula as a consequence of iatrogenic complication. Methods: Literature review of available information on surgical treatment options for uterovesical fistula resulting from previous caesarean section and comparison with our own experience in the developing world. Conclusion: Uterovesical fistula is an abnormal communication between the bladder and uterus. The cause of this pathology in most cases is an iatrogenic complication, most commonly arising after a caesarean section. The incidence of this pathology varies significantly geographically. In developed countries, these fistulas are rather rare. On the other hand, in developing countries, uterovesical fistulas are more common with a significant impact on the subsequent life of the patient due to generally inaccessible health care.
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Fístula , Fístula de la Vejiga Urinaria , Enfermedades Uterinas , Embarazo , Humanos , Femenino , Cesárea/efectos adversos , Fístula de la Vejiga Urinaria/diagnóstico , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Fístula/diagnóstico , Fístula/etiología , Fístula/cirugía , Enfermedades Uterinas/diagnóstico , Enfermedades Uterinas/cirugía , África del Sur del Sahara/epidemiología , Enfermedad IatrogénicaRESUMEN
Pleuroperitoneal communication occurs when ascites moves from the abdominal cavity to the pleural cavity via a diaphragmatic fistula. Managing large pleural fluid volumes is challenging, often requiring an operation. Identifying small diaphragmatic fistulas during the operation can be problematic, but ensuring their detection improves outcomes. This video tutorial presents a recent empirical case in which we successfully identified and closed a pleuroperitoneal contact using a thoracoscopic surgical procedure aided by indocyanine green fluorescence imaging. The patient, a 66-year-old woman, was hospitalized due to acute dyspnoea from a right thoracic pleural effusion during hepatic ascites treatment for cirrhosis. Because ascites decreased with pleural fluid drainage, surgical intervention was considered due to suspicion of a pleuroperitoneal connection. During the operation, indocyanine green was injected intraperitoneally, and near-infrared fluorescence-guided thoracoscopy pinpointed the location of the diaphragmatic fistula. The fistula was sutured and reinforced with a polyglycolic acid sheet and fibrin glue. Detecting the fistula intraoperatively is crucial to prevent recurrence, and the indocyanine green fluorescence method is a safe and effective technique for detecting small fistulas.
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Verde de Indocianina , Humanos , Verde de Indocianina/administración & dosificación , Femenino , Anciano , Ascitis/diagnóstico , Ascitis/etiología , Ascitis/cirugía , Enfermedades Peritoneales/diagnóstico , Enfermedades Peritoneales/cirugía , Enfermedades Pleurales/diagnóstico , Enfermedades Pleurales/cirugía , Fístula/diagnóstico , Fístula/cirugía , Colorantes/administración & dosificación , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Derrame Pleural/cirugía , Toracoscopía/métodos , Diafragma/cirugíaRESUMEN
A 72-year-old male with a history of a triple-vessel coronary artery bypass graft years ago presented with a DeBakey type 2 aortic dissection and an aorto-left atrial fistula with patent bypass grafts (left internal mammary artery and saphenous vein grafts). He developed pulmonary oedema and required intubation. The right axillary artery was cannulated. After the ascending aorta and left internal mammary artery were clamped, the aorta was transected, leaving aortic tissue around two saphenous vein grafts as two separate patches. An entry tear was found adjacent to the proximal anastomosis of the saphenous vein graft to the posterior descending artery. A fistula, which was located between a false lumen in the non-coronary sinus and the dome of the left atrium, was primarily closed. Because the adventitia was thinned out in the non-coronary sinus due to aortic dissection, partial aortic root remodelling was performed with resuspension of the commissures. Hemiarch repair was performed under moderate hypothermia and unilateral antegrade cerebral perfusion. After systemic perfusion was resumed, the locations of the saphenous vein graft buttons were determined. The ascending graft was cross-clamped again; the saphenous vein graft to the obtuse marginal branch graft was reimplanted using the Carrel patch technique while a saphenous vein graft to the posterior descending artery required interposition of a 10-mm Dacron graft to accommodate the length.
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Disección Aórtica , Puente de Arteria Coronaria , Atrios Cardíacos , Humanos , Masculino , Anciano , Atrios Cardíacos/cirugía , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/efectos adversos , Fístula Vascular/cirugía , Fístula Vascular/etiología , Fístula Vascular/diagnóstico , Fístula/cirugía , Fístula/etiología , Fístula/diagnóstico , Reoperación/métodos , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Vena Safena/trasplanteRESUMEN
A fístula liquórica para o osso temporal constitui um evento raro que decorre da comunicação anormal entre o espaço subaracnóideo e as células da mastoide, permitindo que o líquido cefalorraquidiano flua para as porções pneumatizadas do osso temporal. Tem como consequência a hipotensão intracraniana espontânea, caracterizada por perda de líquor e pela manifestação clínica de cefaleia ortostática. Acredita-se que a hipotensão intracraniana espontânea crie condições hemodinâmicas favoráveis à ocorrência de trombose venosa cerebral, uma desordem potencialmente fatal e de difícil diagnóstico, visto a inespecificidade de sinais clínicos e sintomas. Dessa forma, é pertinente atentar para a possibilidade de trombose venosa cerebral em pacientes com fístulas liquóricas, especialmente quando houver mudança do padrão da cefaleia, que passa de ortostática a intensa e contínua.
Temporal bone cerebrospinal fluid fistula is a rare event that results from abnormal communication between the subarachnoid space and the mastoid cells, allowing the cerebrospinal fluid to flow into the pneumatized portions of the temporal bone. It leads to spontaneous intracranial hypotension, characterized by loss of cerebrospinal fluid and orthostatic headache as a clinical manifestation. Spontaneous intracranial hypotension is believed to create favorable hemodynamic conditions to the occurrence of cerebral venous thrombosis, a potentially fatal disorder of difficult diagnosis given the nonspecific clinical signs and symptoms. Therefore, it is pertinent to consider the possibility of cerebral venous thrombosis in patients with cerebrospinal fluid fistulas, especially when there is a modification in the headache pattern from orthostatic to intense and continuous pain.
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Humanos , Femenino , Adulto , Venas Cerebrales/fisiopatología , Trombosis de la Vena/fisiopatología , Hipotensión Intracraneal/diagnóstico , Fístula/diagnóstico , Cefalea/complicacionesRESUMEN
La tiroiditis aguda supurada es una entidad poco frecuente en pediatría; de origen infeccioso, cuya etiología más frecuente es bacteriana. Su presentación típica en niños es la aparición de una tumoración en la cara anterior del cuello, con signos de flogosis, dolorosa, caliente y eritematosa, que excursiona con la deglución, y puede o no estar acompañada de fiebre, disfagia o disfonía. En niños, las anomalías congénitas, principalmente la fístula del seno piriforme, predisponen a la infección de la glándula, por lo que es importante la resolución quirúrgica del defecto anatómico para prevenir las recurrencias. El diagnóstico rápido, basado en la clínica y los estudios por imágenes, es importante para comenzar en forma temprana con un tratamiento antibiótico adecuado.Se presenta una paciente de 3 años, previamente sana, con tumoración cervical izquierda dolorosa y asociada a fiebre. Durante la internación, se arribó al diagnóstico de tiroiditis aguda supurada secundaria a fístula de seno piriforme.
Acute suppurative thyroiditis is an infectious disease, uncommon in children, caused by various microorganisms, being bacteria the most frequently involved. The typical presentation includes the appearance of a tumor in combination with signs of swelling in the anterior aspect of the neck, which is painful on palpation and is associated with warmth and erythema. It usually moves with swallowing and the patient can suffer fever, dysphagia or dhysfonia. In children, congenital anomalies can lead to the gland's infection, and the surgical excision of them is important to prevent recurrency. A quick diagnosis, based on clinical manifestations and imaging studies, is necessary to install an adequate antibiotic treatment. We present the case of a 3-year-old patient, who was previously healthy, with a painful left cervical tumor associated with fever. During the hospitalization, we reached the diagnosis of acute suppurative thyroiditis caused by an underlying pyriform sinus fistula
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Humanos , Femenino , Preescolar , Tiroiditis Supurativa/complicaciones , Tiroiditis Supurativa/diagnóstico , Enfermedades Faríngeas , Seno Piriforme , Fístula/diagnóstico , Enfermedad Aguda , CuelloRESUMEN
Abstract Background: Coronary artery fistula (CAF) is an abnormal connection that links a coronary artery to a cardiac chamber or another major blood vessel. Several studies have shown the association between mean platelet volume (MPV) and cardiovascular diseases. In the literature, there is no previous study about the association between hematologic parameters and congenital CAF. For this reason, we aimed to investigate the association of MPV with CAF. Methods: 70 patients with normal coronary arteries and 50 with coronary artery fistulas were included. Routine blood and biochemical parameters were measured before the arteriography. Differences between groups for continuous variables were analyzed with t- test or Mann-Whitney test. P values < 0.05 were considered significant. Regression analysis was used to find independent predictors of CAF. Results: Baseline patient demographics, including age and clinical risk factors, were similar between the groups. Compared to the control group, median (IQR) High-density lipoprotein cholesterol (HDL) levels were significantly higher (p=0.04) and MPV levels were significantly lower in the CAF group (8.84 ± 1.71fL vs. 10.43 ± 1.34, p < 0.001). In the multivariate analysis, only MPV was a significant predictor of CAF (p < 0.001, 95% CI for OR: 0.438 (0.306-0.629). A negative correlation was found between MPV and fistulae in Pearson's correlation test (r: -0.454, p < 0.001). An MPV level of < 9,6 fL showed sensitivity, specificity, positive predictive value and negative predictive value of 80%, 68%, 71% and 78% respectively (AUC = 0.766, 95% CI, 0.678-0.854) for the prediction of CAF. Conclusion: The present study suggests that MPV may decrease in patients with CAF.
Resumo Fundamento: A fístula da artéria coronária (FAC) é uma conexão anormal que liga a artéria coronária a uma câmara cardíaca ou outro importante vaso sanguíneo. Vários estudos mostraram a associação entre o volume plaquetário médio (VPM) e as doenças cardiovasculares. Na literatura, não há estudo prévio sobre a associação entre os parâmetros hematológicos e a FAC congênita. Por essa razão, nosso objetivo foi investigar a relação do VPM com a FAC. Métodos: Foram incluídos 70 pacientes com artérias coronárias normais e 50 com fístulas de artérias coronárias. Os parâmetros sanguíneos e bioquímicos de rotina foram medidos antes da arteriografia. As diferenças entre os grupos para as variáveis contínuas foram analisadas com o teste t ou teste de Mann-Whitney. Valores de p < 0,05 foram considerados significativos. A análise de regressão foi utilizada para encontrar preditores independentes de FAC. Resultados: Os dados demográficos basais dos pacientes, incluindo idade e fatores de risco clínicos, foram semelhantes entre os grupos. Comparados à mediana do grupo controle (IIQ), os níveis de HDL-colesterol foram significativamente mais altos (p = 0,04) e os níveis de VPM foram significativamente mais baixos no grupo FAC (8,84 ± 1,71fL vs. 10,43 ± 1,34, p < 0,001). Na análise multivariada, apenas o VPM foi um preditor significativo de FAC (p<0,001, IC 95% para OR: 0,438 (0,306-0,629)). Foi encontrada uma correlação negativa entre o VPM e fístulas no teste de correlação de Pearson (r: -0,454, p < 0,001). Um nível de VPM < 9,6 fL apresentou sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 80%, 68%, 71% e 78%, respectivamente (AUC = 0,766, IC 95%, 0,678-0,854) para a previsão de FAC. Conclusão: O presente estudo sugere que o VPM pode diminuir no paciente com FAC.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad de la Arteria Coronaria/sangre , Anomalías de los Vasos Coronarios/sangre , Volúmen Plaquetario Medio , Fístula/sangre , Enfermedad de la Arteria Coronaria/diagnóstico , Estudios de Casos y Controles , Valor Predictivo de las Pruebas , Factores de Riesgo , Sensibilidad y Especificidad , Anomalías de los Vasos Coronarios/diagnóstico , Fístula/diagnósticoRESUMEN
Resumen Introducción: Las fístulas del seno piriforme, originadas desde el tercer o cuarto arco branquial, son entidades poco frecuentes. Se pueden presentar como aumento de volumen cervical, fístula cervical, absceso cervical, tiroiditis abscedada y/o disfonía. Objetivo: Reportar 4 casos tratados en nuestro hospital y revisión de la literatura. Discusión: Frente a un cuadro clínico compatible, se debe realizar estudio endos- cópico y de imágenes. El manejo quirúrgico sigue siendo el de mejores resultados, pero se han desarrollado terapias endoscópicas y combinaciones de estas con buenos resultados. Conclusión: El diagnóstico requiere un alto índice de sospecha clínica. La cirugía abierta se mantiene como el gold standard, sin embargo, en población pediátrica estaría indicada la resolución endoscópica debido a la alta morbilidad de la cirugía tradicional.
Introduction: Pyriform sinus fistula is a rare cervical branchial anomaly derived from the third and fourth branchial arch. Pyriform sinus fistula should be considered in children presenting enlarged neck mass, fistula, abscess, thyroid infection and/or dysphonia. Objective: We here report 4 cases treated in Hospital Clínico Universidad de Chile and review of the current literature on pyriform sinus fistula. Discussion: When clinical presentation is compatible with pyriform sinus fistula, endoscopic and imaging techniques are required. Surgical outcomes are better, although endoscopic therapies and combination of both surgery and endoscopy have also reported good outcomes. Conclusion: Diagnosis is made based on signs and symptoms and a high index of clinical suspicion. Open surgery is gold standard, however in pediatric population endoscopic resolution should be considered to reduce the high morbidity of traditional surgery.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Enfermedades Faríngeas/cirugía , Seno Piriforme , Fístula/cirugía , Enfermedades Faríngeas/congénito , Enfermedades Faríngeas/diagnóstico , Endoscopía , Fístula/congénito , Fístula/diagnósticoRESUMEN
RESUMEN Introducción: la fístula faringocutánea es la complicación postoperatoria más frecuente de la laringectomía total. Incrementa la morbimortalidad, demora la administración del tratamiento oncológico y repercute en la esfera psicológica del paciente. Objetivo: conocer el comportamiento de la fístula faringocutánea en pacientes con laringectomía total. Materiales y métodos: se realizó un estudio observacional, descriptivo, retrosprospectivo en el Hospital Universitario "Comandante Faustino Pérez", en el período comprendido entre enero 2010 a diciembre 2015. El universo lo constituyó 143 pacientes laringectomizados. Se estudiaron las variables: edad, sexo, estado nutricional previo a la cirugía, estadio del tumor, radiaciones, traqueostomía; manejo del cuello, previo a la cirugía, y evolución de la fístula. Resultados: presentó fístula postoperatoria el 28 %, predominando el sexo masculino, en un 92.3 %; y los normopesos en un 56,6 %. Se encontraban en estadio IV, el 70 %. Fueron irradiados 72,5 % y se les practicó traqueostomía, previa a la cirugía, al 95 % de los pacientes. Vaciamiento cervical se realizó al 37,5 %. En el 70 % de los pacientes, la fístula apareció entre los 8 y 14 días. Conclusiones: la incidencia de la fístula faringocutánea es mayor en el sexo masculino entre los 60-69 años. La mayor incidencia ocurrió en el año 2015. El estadio avanzado del tumor, la presencia de traqueostomía, el estado nutricional e irradiación previa, fueron los factores que más incidieron en la aparición de fístula faringocutánea. En la mayoría de los pacientes el cierre fue espontáneo con buena su evolución (AU).
ABSTRACT Introduction: pharyngocutaneous fistula is the most frequent post-surgery complication of the total laryngectomy. It increases morbimortality, delays the administration of the oncological treatment and rebounds in the patient's psychological sphere. Objective: to know the behavior of the pharyngocutaneous fistula in patients with total laryngectomy. Materials and methods: a retrospective, descriptive, observational study was carried out in the University Hospital "Comandante Faustino Pérez", in the period from January 2010 until December 2015. The universe were 143 patients who undergone a laryngectomy. The studied variables were age, sex, nutritional status before the surgery, tumor stage, radiations, tracheotomy, neck management before surgery, and fistula evolution. Results: 28 % of the patients presented post-surgery fistula, predominantly among males (92.3 %). Normal weight patients were 56.6 %; 70 % were in the IV stage. 72.5 % of the patients were irradiated and 95 % undergone tracheotomy before the surgery. 37.5 % of them undergone cervical resection. In 70 % of the patients, the fistula appeared after 8-14 days. Conclusions: the incidence of the pharyngocutaneous fistula is higher in the male sex and the 60-69 years age-group. The highest incidence occurred in 2015. The advanced stage of the tumor, the presence of tracheotomy, the nutritional status and previous irradiation were the factors that had more incidences on pharyngocutaneous fistulae. The closure of the fistula was spontaneous in most of the patients, with a good evolution (AU).
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Humanos , Masculino , Femenino , Factores de Riesgo , Fístula/complicaciones , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/complicaciones , Fístula Cutánea/cirugía , Fístula Cutánea/complicaciones , Fístula/cirugía , Fístula/diagnóstico , LaringectomíaRESUMEN
Abstract Objective To describe a case of vesicouterine fistula and to review the literature related to this condition. Methods For the review, we accessed the MEDLINE, BIREME and LILACS databases; the references of the searched articles were also reviewed. Results A 38-year-old woman, in the 1st day after her 3rd cesarean, presented heavy hematuria, which was considered secondary to a difficult dissection of the bladder. A total of 6 months after delivery, she failed to resume her regular menstrual cycles and presented cyclic menouria and amenorrhea. At this time, she had two episodes of urethral obstruction by blood clots. She remained without a correct diagnosis until about two years postdelivery, when a vesicouterine fistula was confirmed through cystoscopy. A surgical correction through open abdominal route, coupled with hysterectomy, was performed. After the surgery, the symptoms disappeared. The review showed a tendency of change in the relative frequency of the different types of genitourinary fistulae. Vesicovaginal fistulae, usually caused by inadequate care during labor, are becoming less frequent than those secondary tomedical procedures, such as vesicouterine fistulae. The most common cause of this latter kind of fistula is cesarean section, especially repeated cesarean sections. The diagnosis is confirmed through one or more imaging exams, or through cystoscopy. The most common treatment is surgical, and the routes are: open abdominal, laparoscopic, vaginal or robotic. There are some reports of success with the conservative treatment. Conclusion Vesicouterine fistulae are becoming more common because of the increase in the performance of cesarean sections, and the condition must be considered a possible complication thereof.
Resumo Objetivo Apresentar um caso de fístula vesico-uterina e realizar revisão da literatura sobre esta condição. Métodos Revisão realizada consultando-se as bases MEDLINE, BIREME e LILACS, além das referências dos artigos consultados. Resultados Uma mulher de 38 anos, após sua terceira cesárea, no puerpério imediato, apresentou hematúria importante, que foi atribuída a uma dificuldade na dissecção da bexiga durante o procedimento. Seis meses pós-parto, emvez de retomar os ciclos menstruais regulares, apresentou menúria cíclica e amenorreia (síndrome de Youssef). A paciente chegou a apresentar obstrução uretral por coágulos, e permaneceu sem diagnóstico correto até cerca de anos pós-parto, quando este foi feito por cistoscopia. Ela foi então submetida a correção cirúrgica por via abdominal, associada a uma histerectomia, com desaparecimento dos sintomas. A revisão mostrou que tem havido mudança na frequência dos vários tipos de fístulas urogenitais. As fístulas vesicovaginais, normalmente secundárias à má assistência durante o parto, têm sido mais raras, enquanto aquelas secundárias a procedimentos médicos, como as vesicouterinas, têm sido mais frequentes. A causa mais comum deste tipo de fístula é a cesárea, especialmente a de repetição. A apresentação pode ser de amenorreia e menúria e/ou perda urinária. O diagnóstico é feito por um ou maismétodos de imagem ou cistoscopia. O tratamento mais comum é cirúrgico, por via abdominal aberta, laparoscópica, transvaginal ou robótica. Existem relatos de cura com tratamento conservador. Conclusão As fístulas vesicouterinas têm sido mais comuns devido ao aumento da proporção de cesáreas. Deve-se ter em mente a possibilidade deste diagnóstico e considerá-las uma das possíveis complicações da cesárea.
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Humanos , Femenino , Adulto , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/diagnóstico , Enfermedades Uterinas/cirugía , Enfermedades Uterinas/diagnóstico , Fístula de la Vejiga Urinaria/cirugía , Fístula de la Vejiga Urinaria/diagnóstico , Fístula/cirugía , Fístula/diagnóstico , Síndrome , CesáreaRESUMEN
El origen anómalo de la arteria coronaria derecha de la arteria pulmonar es una entidad rara con una incidencia del 0,002 % y potencialmente grave, que puede causar muerte súbita. El diagnóstico frecuentemente es incidental, secundario a evaluaciones por soplos cardíacos a diferencia del origen anómalo de la arteria coronaria izquierda de la arteria pulmonar, reconocido por presentar isquemia miocárdica e insuficiencia cardíaca. Se reporta el caso de una niña de 6 meses evaluada por un soplo y derivada por sospecha de fístula coronaria. La evaluación mediante ecocardiograma doppler color, cateterismo cardíaco y angiotomografía mostró la presencia de una comunicación interauricular ostium secundum pequeña y origen anómalo de la arteria coronaria derecha de la arteria pulmonar. A los 11 meses, se realizó una cirugía de reimplante de la arteria coronaria derecha en la arteria aorta y el cierre de la comunicación interauricular.
The anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare entity that has an incidence of 0.002 % and can potentially cause sudden death. Unlike to the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), usually presented with myocardial ischemia and heart failure; the diagnosis of ARCAPA is often incidental during evaluation of a heart murmur. We report a case of a 6 months old female patient referred to us with a cardiac murmur and a suspicion of coronary fistula. For a proper diagnostic assessment an echocardiogram, a computed tomography angiography and a cardiac catheterization were requested. A small ostium secundum-type atrial septal defect (ASD) and an ARCAPA were revealed. At 11 months old, the patient was scheduled for corrective cardiovascular surgery. The aim of this report is to describe a low incidence and potentially fatal disease.
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Humanos , Femenino , Lactante , Soplos Cardíacos/etiología , Síndrome de Bland White Garland/diagnóstico , Defectos del Tabique Interatrial/diagnóstico , Ecocardiografía/métodos , Cateterismo Cardíaco/métodos , Vasos Coronarios/patología , Vasos Coronarios/diagnóstico por imagen , Síndrome de Bland White Garland/cirugía , Síndrome de Bland White Garland/fisiopatología , Fístula/diagnóstico , Angiografía por Tomografía Computarizada/métodos , Defectos del Tabique Interatrial/cirugíaRESUMEN
Introducción. El diagnóstico precoz de las fístulas de líquido cefalorraquídeo (LCR) minimiza el riesgo de que los pacientes desarrollen graves complicaciones. Una herramienta diagnóstica es demostrar la presencia de LCR en las secreciones nasales, óticas y heridas quirúrgicas mediante el uso de marcadores bioquímicos específicos. El objetivo del trabajo es evaluar la utilidad de la β2-transferrina (β2-Tr) y la proteína β-traza (p-βT) en el diagnóstico de la fístula de LCR. Material y métodos. Se realizó la detección de β2-Tr y la medición de p-βT en 68 muestras de secreciones nasales, óticas y heridas quirúrgicas, procedentes de 54 pacientes con sospecha de presentar una fístula de LCR. El diagnóstico fue confirmado por criterios clínicos y otras pruebas diagnósticas. Se calcularon la sensibilidad y la especificidad diagnóstica, el valor predictivo positivo (VPP) y negativo (VPN). Para la p-βT se obtuvo el punto de corte óptimo mediante un análisis de curva ROC. Resultados. Para la β2-Tr se obtuvo una sensibilidad del 83%, especificidad del 96%, VPP del 95% y VPN del 86%. Para la p-βT, se obtuvo un área bajo la curva de 0,981. Para un punto de corte óptimo de 1,14mg/L, se obtuvo una sensibilidad del 92%, especificidad del 95%, VPP del 96% y VPN del 91%. El punto de corte con un VPN del 100% fue de 0,64mg/L. Conclusiones. La β2-Tr y la p-βT pueden utilizarse como marcadores de la existencia de fístula de LCR por su elevada sensibilidad y especificidad diagnóstica. Se concluye que un valor de p-βT ≥ 1,14mg/L indica fístula de LCR y un valor ≤ 0,64mg/L la descarta. Valores entre 0,64 y 1,14mg/L no son concluyentes y sería necesario realizar la detección de β2-Tr (AU)
Introduction. Early diagnosis of cerebrospinal fluid (CSF) fistula minimizes the risk of severe complications for patients. A diagnostic approach consists in revealing the presence of CSF in nasal, ear, and surgical wound secretions. The aim of this work is to evaluate the usefulness of β2-transferrin (β2-Tr) and β-trace protein (p-βT) as markers for the diagnosis of a CSF fistula. Material and methods. A total of 68 samples of nasal, ear, and surgical wound secretions were taken and analysed from 54 patients with clinical suspicion of a CSF fistula. β2-Tr and p-βT were determined in all fluids. The CSF fistula was diagnosed by clinical criteria and other diagnostic procedures. Sensitivity and specificity, as well as positive (PPV) and negative (NPV) predictive values, were calculated. The optimal cut-off point for p-βT was obtained using a ROC curve analysis. Results. For β2-Tr, a sensitivity of 83%, a specificity of 96%, a PPV of 95% and a NPV of 86% were obtained. For the p-βT ROC curve analysis, the area under the curve was 0.981, with an optimal cut-off value of 1.14mg/L. For this cut-off point, a sensitivity of 92%, a specificity of 95%, a PPV of 96%, and a NPV of 91% were calculated. The p-βT cut-off point obtained for 100% NPV was 0.64mg/L. Conclusions. β2-Tr and p-βT can be used as CSF fistula markers, since both proteins have high sensitivity and specificity diagnostic values. It is concluded that, ≥ 1.14mg/L p-βT values are indicative of CSF fistula, and values ≤ 0.64mg/L rules it out. Values>0.64 and<1.14mg/L are not conclusive, and in these cases it would be necessary to determine β2-Tr (AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Fístula/líquido cefalorraquídeo , Fístula/diagnóstico , Proteína B de Unión a Transferrina/análisis , Diagnóstico Precoz , Sensibilidad y Especificidad , Biomarcadores/análisis , Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/normas , Secreciones CorporalesRESUMEN
A fenda palatina é uma comunicação congênita ou adquirida entre as cavidades oral e nasal, permitindo a passagem de alimentos e líquidos entre elas. O diagnóstico é feito por meio do exame físico da cavidade oral, sendo o tratamento baseado em técnicas cirúrgicas. Relata-se um caso bem-sucedido de oclusão de fístula oronasal utilizando somente resina acrílica autopolimerizável em um felino com histórico de espirros frequentes, secreção nasal purulenta crônica, halitose severa, emagrecimento e trauma sofrido há dois anos, que culminara em fratura da sínfise mandibular corrigida no mesmo período por cerclagem com fios de aço. No exame clínico verificou-se secreção nasal muco-purulenta fétida e a presença de uma grande fístula palatina na extensão do palato duro. Encaminhou-se o paciente para realização dos exames pré-cirúrgicos para posterior correção da fistula oronasal com o uso de resina acrílica autopolimerizavel. O procedimento foi bem sucedido visto que o animal deixou de apresentar os sinais clínicos e voltou a alimentar-se normalmente. A técnica mostrou-se eficaz e de fácil execução para correção de fenda palatina traumática de grande extensão em gato, na qual não se utilizou suturas ou flaps, pois os mesmos não eram praticáveis, podendo ser utilizada em substituição a outros métodos convencionais.
Cleft palate is a congenital or acquired communication between the oral and nasal cavities which can often contaminate the nasal cavity with saliva or food. The diagnosis is made by physical examination of the oral cavity and it is usually treated with surgery. We report a successful case of oronasal fistula occlusion using only acrylic resin in a feline. The patient presented with a history of frequent sneezing, chronic purulent nasal discharge, severe halitosis, weight loss and facial trauma suffered two years ago. The animal had mandibular symphysis fracture that was corrected by cerclage with steel wires. On clinical examinationit was observedthe presence of smelling nasal mucus, purulent secretions and the presence of a large cleft fistula in the extension of the hard palate. The patient was submitted to surgery in order to repair the oronasal fistula using acrylic resin. The surgery was curative eliminating clinical signs. The technique was effective and easy to be performed in this case of a traumatic cleft palate with large deffect in a cat. This technique can be used to replace other conventional methods, mainly in cases that the use of sutures or flaps are not feasible.
El paladar hendido es una comunicación congénita o adquirida entre las cavidades oral y nasal, lo que permite el paso de alimentos y líquidos entre ellos. El diagnóstico se realiza mediante un examen físico de la cavidad oral, siendo el tratamiento basado en técnicas quirúrgicas. Presentamos un caso de éxito de oclusión de la fístula oronasal usando sólo la resina acrílica autopolimerizável en un felino con histórico de frecuentes estornudos, secreción nasal purulenta crónica, halitosis severa, pérdida de peso y trauma sufrido hace dos años, culminando en fractura de la sínfisis mandibular, corregida en el mismo período por cerclaje con hilos de acero. En el examen clínico se verificó moco nasal maloliente, secreciones purulentas y la presencia de una gran fístula palatina en la extensión del paladar duro. Se hicieron exámenes pre-quirúrgicos para la posterior corrección de la fístula oronasal, mediante resina acrílica autopolimerizavel. El procedimiento fue exitoso porque el animal dejó de presentar signos clínicos y volvió a alimentarse normalmente. La técnica fue eficaz y de fácil ejecución para corrección de paladar hendido traumático de gran longitud en gato, en la cual no se utilizó suturas o aletas, ya que no eran viables y puede ser utilizado para sustituir a otros métodos convencionales.
Asunto(s)
Animales , Gatos , Fisura del Paladar/veterinaria , Fístula/diagnóstico , Resinas Acrílicas/análisisRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Fístula/diagnóstico , Venas Cavas/lesiones , Aorta/lesiones , Aneurisma de la Aorta/complicaciones , Diagnóstico Diferencial , Procedimientos EndovascularesRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Implantes Cocleares , Implantes Cocleares/efectos adversos , Cóclea/patología , Cóclea/cirugía , Fístula/diagnóstico , Perilinfa , Trompa Auditiva/patología , Neuroma Acústico/radioterapia , Drenaje/métodos , Drenaje , Complicaciones PosoperatoriasRESUMEN
La fístula preauricular consiste en una malformación congénita benigna de los tejidos blandos preauriculares. Puede presentase de forma aislada o asociada a otras anomalías congénitas. Generalmente cursa de forma asintomática, constituyendo un hallazgo casual. Sin embargo, puede derivar en infecciones locales. Su abordaje incluye antiobioterapia sistémica, considerando la intervención quirúrgica en base a las complicaciones (AU)
The preauricular fistula is a benign congenital malformation of the preauricular soft tissues. It can present itself in in isolation or associate with other congenital anomalies. Usually it is asymptomatic, being a chance finding. However, it can lead to local infections. Its approach includes systemic antibiotics, considering surgery based on complications (AU)
Asunto(s)
Humanos , Femenino , Preescolar , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/tratamiento farmacológico , Antibacterianos/uso terapéutico , Eritema/complicaciones , Eritema/tratamiento farmacológico , Fístula/complicaciones , Fístula/diagnóstico , Pabellón Auricular , Pabellón Auricular/patología , Anomalías Congénitas/diagnósticoAsunto(s)
Humanos , Masculino , Adolescente , Fístula/diagnóstico , Fístula/cirugía , Cartílago Auricular/cirugía , Pabellón AuricularRESUMEN
Las adenopatías son la tumoración cervical benigna más frecuente en los niños, pero se deben sospechar otras patologías en caso de localización atípica, crecimiento rápido, consistencia pétrea, signos inflamatorios o supuración espontánea. La fístula del seno piriforme es una malformación congénita infrecuente de los arcos branquiales. Tras una infección, da lugar a una pseudotumoración que normalmente cursa con signos inflamatorios locales, fiebre y odinofagia, por lo que el tratamiento del proceso agudo es la antibioterapia sistémica de amplio espectro asociada en ocasiones a drenaje. El estudio de toda masa cervical debe iniciarse con una ecografía, a completar con una tomografía computarizada con contraste en caso de hallazgos sugestivos de absceso adyacente al tiroides o inflamación del mismo, que pueden orientar hacia fístula del seno piriforme. El método diagnóstico de confirmación es el examen endoscópico en el quirófano bajo anestesia general, que permite además realizar el tratamiento quirúrgico definitivo. Presentamos el caso clínico de una paciente que acude remitida desde Atención Primaria tras detectársele una tumoración indurada a nivel paramedial izquierda como única manifestación, consecuencia de una fístula de seno piriforme
Lymphadenopathy is the most common benign cervical tumor in children, but other pathologies should be suspected in case of atypical location, rapid growth, tougher consistency, inflammatory signs or spontaneous suppuration. Pyriform sinus fistula is an unusual congenital malformation of the branchial arches. After an infection, it results in a pseudotumoration that usually occurs with local inflammatory signs, fever and odynophagia, so that the treatment of the acute process is broad-spectrum systemic antibiotic therapy sometimes associated with drainage. The study of any cervical mass should begin with an ultrasound, to be completed with a CT scan with contrast in case of suggestive findings of abscess adjacent to the thyroid or inflammation of the thyroid, that can point towards a pyriform sinus fistula. The diagnostic method of choice is the endoscopic examination in the operating room under general anesthesia, that also allows the definitive surgical treatment. We present the clinical case of a patient who comes from Primary Care after detecting an indurated tumor at the left paramedial level as the only manifestation, consequence of a pyriform sinus fistula
Asunto(s)
Humanos , Femenino , Preescolar , Fístula/diagnóstico , Seno Piriforme/anomalías , Neoplasias Hipofaríngeas/diagnóstico , Seno Piriforme/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico , Diagnóstico Diferencial , Linfadenopatía/diagnósticoRESUMEN
No disponible