[Spontaneous esophago-pleural fistula secondary to candidiasis in a patient with human immunodeficiency virus infection. An infrequent complication of esophageal moniliasis]. / Fistula esófago-pleural espontanea secundaria a candidiasis en paciente con infección por el virus de la inmunodeficiencia humana. Una rara complicación de la moniliasis esofágica.

Several nosologic conditions may affect the esophagus and cause fistulas communicating this organ with the respiratory system. Rarely, infections cause perforation and further fistula to the bronchial tree, lungs or pleural space. We present the rare case of an HIV-infected patient with related spontaneous esophago-pleural fistula related to Candida infection.

Proposed protocol for reading images of humeral head fractures.

UNLABELLED: Fractures of the proximal humerus can be treated effectively but require proper characterization. None of the existing classifications intended to facilitate characterization have been satisfactory. We studied proximal humerus fractures using radiographs alone and radiographs plus computed tomography scans to ascertain which imaging studies were most useful to characterize these fractures. We designed an assessment protocol consisting of 17 parameters divided in four groups: cephalodiaphyseal relationship (six parameters), cephalotuberosity relationship (six parameters), humeral head (two parameters), and fracture fragment description (three parameters). The computed tomography scans were assessed using 11 parameters (the same parameters used for assessing radiographs except for the six cephalodiaphyseal parameters). Four observers analyzed the parameters in 30 selected fractures with biplanar radiographic projections (30 patients) and computed tomography scans (22 patients) on two occasions. We found good interobserver reliability and intraobserver reliability with radiographs alone for the cephalodiaphyseal parameters. The best interobserver reliabilities with radiographs plus computed tomography scans were with the number of fragments, displacement of the lesser tuberosity, and extraarticular or articular fractures. Computed tomography allows better assessment of some parameters in characterizing proximal humeral fractures. The use of a structured protocol in reading images seems useful and allows better reliability than reported for other approaches. LEVEL OF EVIDENCE: Diagnostic study, Level III (study of nonconsecutive patients without consistently applied reference "gold" standard). See the Guidelines for Authors for a complete description of levels of evidence.