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1.
J Laryngol Otol ; 134(6): 501-508, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32614760

RESUMO

OBJECTIVE: The diagnostic value of exploratory tympanotomy in sudden sensorineural hearing loss remains controversial. This study and review were performed to identify the incidence of perilymphatic fistula in patients with sudden sensorineural hearing loss. The effectiveness of tympanotomy for sealing of the cochlear windows in cases with perilymphatic fistula was evaluated. METHODS: A search in common databases was performed. Overall, 5034 studies were retrieved. Further, a retrospective analysis on 90 patients was performed. RESULTS: Eight publications dealing with tympanotomy in patients with sudden sensorineural hearing loss were identified. In 90 patients diagnosed with sudden sensorineural hearing loss and undergoing exploratory tympanotomy, 10 patients (11 per cent) were identified with a perilymphatic fistula, and this corresponds to the results obtained from our review (13.6 per cent). CONCLUSION: There was no significant improvement after exploratory tympanotomy and sealing of the membranes for patients with a definite perilymphatic fistula.


Assuntos
Fístula/cirurgia , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Súbita/complicações , Ventilação da Orelha Média/métodos , Feminino , Fístula/diagnóstico por imagem , Alemanha/epidemiologia , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Súbita/epidemiologia , Perda Auditiva Súbita/terapia , Humanos , Incidência , Doenças do Labirinto/patologia , Masculino , Pessoa de Meia-Idade , Ventilação da Orelha Média/efeitos adversos , Perilinfa , Estudos Retrospectivos , Janela da Cóclea/diagnóstico por imagem , Janela da Cóclea/patologia , Janela da Cóclea/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Doenças Vestibulares/complicações
2.
Medicine (Baltimore) ; 99(29): e21201, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702884

RESUMO

RATIONALE: We hypothesize that with the determination of lymph fistula location 3-dimensionally, application of appropriate pressure would promote fistula healing, and a secondary surgery may be avoided. Ga-labeled 1,4,7-triazacyclononane-N, N', N"-triacetic acid (NOTA) conjugated with truncated Evan blue (NEB) forms a complex with serum albumin in the interstitial fluid after it is locally injected and allows rapid visualization of the lymphatic system. PATIENT CONCERNS: A 44-year-old woman had a chief complaint of left nipple discharge. A 38-year-old woman came to the hospital after sensing a right breast mass. DIAGNOSES: The 2 patients were diagnosed with chylous fistula after breast cancer surgery based on the findings of a novel method, Ga-NOTA-Evans Blue (NEB) positron emission tomography/computed tomography. INTERVENTIONS: We successfully obtained clear images to locate the fistula using Ga-NEB positron emission tomography/computed tomography (PET/CT) for both patients. The lymphatic vessels and lymph nodes could be clearly visualized owing to the Ga-NEB activity during PET/CT. OUTCOMES: Three-dimensional positioning to locate the fistula could direct the application of the pressure dressing and reduce drainage markedly. LESSONS: Ga-NEB PET/CT may be a new method for diagnosing chylous fistula and providing guidance for treatment.


Assuntos
Axila/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Fístula/etiologia , Mastectomia/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Adulto , Axila/anormalidades , Axila/cirurgia , Neoplasias da Mama/complicações , Feminino , Fístula/cirurgia , Humanos , Mastectomia/métodos , Derrame Papilar , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia
5.
Ann Otol Rhinol Laryngol ; 129(7): 649-652, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32005077

RESUMO

INTRODUCTION: Double aortic arch is a rare congenital malformation of the aortic arch that most frequently presents in childhood. Early surgical intervention typically yields excellent outcomes. OBJECTIVES: To describe aortotracheal fistula as a rare, yet serious complication of vascular ring and subsequent aortic aneurysm in an adult patient. METHODS: Clinical history, as well as radiographic and endoscopic imaging were obtained to describe the development, diagnosis, and clinical course of this patient's aortotracheal fistula. Additionally, follow up data was obtained to document the healing of this fistula after surgical repair. RESULTS: We describe a case of a 46-year-old male with DiGeorge Syndrome and a double aortic arch, repaired in childhood, which developed into an aortotracheal fistula after tracheostomy placement as an adult. CONCLUSIONS: This case demonstrates that dangerous complications of a double aortic arch can persist into adulthood, even after surgical repair in infancy. Each patient's unique anatomy must be considered when thinking about airway management and prevention of complications of this rare congenital anomaly.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Fístula/cirurgia , Complicações Pós-Operatórias/cirurgia , Doenças da Traqueia/cirurgia , Traqueomalácia/cirurgia , Anel Vascular/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Síndrome de DiGeorge/complicações , Fístula/complicações , Fístula/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Torácicos , Tomografia Computadorizada por Raios X , Doenças da Traqueia/complicações , Doenças da Traqueia/diagnóstico por imagem , Traqueomalácia/complicações , Traqueostomia , Enxerto Vascular , Anel Vascular/complicações
7.
Int J Gynaecol Obstet ; 148 Suppl 1: 37-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943184

RESUMO

OBJECTIVE: To identify criteria to guide surgeons regarding indications for use of the Singapore and gracilis muscle flaps in obstetric fistula repair. METHODS: This is a retrospective case series. Obstetric fistula surgeons in Lilongwe, Malawi, have been incorporating plastic surgery techniques with the Singapore and gracilis muscle flaps since collaborating with plastic surgeons in 2016. We describe the surgical outcomes of procedures utilizing each flap individually and those using both. RESULTS: Between February 2016 and June 2019, 69 patients received a flap at the time of obstetric fistula repair at the Fistula Care Center in Lilongwe, Malawi. A total of 32 (46.4%) received a Singapore flap, 20 (29.0%) received a gracilis flap, and 17 (24.6%) received both types of flap. CONCLUSION: Based on our outcomes, we note the possible advantage of incorporating the gracilis flap even when it is thought that the Singapore flap is sufficient. However, more data are needed.


Assuntos
Músculo Grácil/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Fístula Vesicovaginal/cirurgia , Adulto , Feminino , Fístula/cirurgia , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fístula Vesicovaginal/patologia
8.
J Am Vet Med Assoc ; 256(4): 463-468, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31999513

RESUMO

CASE DESCRIPTION: A 9-year-old pony gelding was evaluated because it was suspected that a persistent oronasal fistula had developed after a fractured right maxillary second premolar tooth had been extracted via repulsion 6 months earlier. CLINICAL FINDINGS: Unilateral mucopurulent nasal discharge and malodorous breath were noted on clinical examination. Examination of the oral cavity revealed a 1 × 0.5-cm defect at the oral aspect of the right maxillary second premolar alveolus, from which feed material was extracted. Endoscopic examination revealed feed material in the rostral aspect of the right nasal cavity, confirming the diagnosis of oronasal fistula. TREATMENT AND OUTCOME: The pony initially underwent a reconstructive surgical procedure that combined an alveolar bone flap with a sliding mucoperiosteal hard palate flap to repair the oronasal fistula. The fistula reoccurred 5 months later and was ultimately repaired by means of a novel 2-layer flap closure method involving an autogenous fascia lata graft and oral mucosa flap. CLINICAL RELEVANCE: Fascia lata was effective as a scaffolding graft for repair of the oronasal fistula in this pony and may be useful for repair of oronasal fistulas in other equids as well.


Assuntos
Fístula/veterinária , Doenças dos Cavalos/cirurgia , Doenças Nasais/veterinária , Procedimentos Cirúrgicos Reconstrutivos/veterinária , Animais , Fascia Lata , Fístula/cirurgia , Cavalos , Masculino , Doenças Nasais/cirurgia , Fístula Bucal/cirurgia , Fístula Bucal/veterinária , Retalhos Cirúrgicos/veterinária
9.
Updates Surg ; 72(1): 205-211, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31927754

RESUMO

Recto-vaginal (RVF) and recto-urethral (RUF) fistulas are infrequent but disabling conditions that severely affect patients' quality of life. Considering the high recurrence rate after conservative approaches, the best surgical treatment is still challenging. The aim of this study was to evaluate the outcome of graciloplasty to treat patients with complex RVF or RUF, and to investigate its effect on the quality of life. Fourteen patients with RVF and RUF who underwent graciloplasty between 2003 and 2017 were retrospectively enrolled. The main outcome was the healing rate of fistulas. Postoperative patients satisfaction was evaluated administering the Clinical Patient Grading Assessment Scale (CPGAS), SF-36 questionnaires and Changes in Sexual Functioning (CSF) questionnaires. The Wexner score was calculated in case of preoperative faecal incontinence. RVF and RUF were iatrogenic in 11 patients and due to Crohn's disease in 3 cases. After 1 year of follow-up (IQR 10-14 months), the success rate of the procedure was 78%. Out of three patients with RVF due to Crohn's disease, two healed after the procedure. Six months after surgery, all eight SF-36 domains significantly improved except for "body pain"; CSF score significantly increased from 35.5 (IQR 31-38.7) to 44 (IQR 37.7-48.5); CPGAS score improved from a median value of 0 (IQR 0-0) to 4 (IQR 3.2-4). The Wexner score was calculated only in 5 patients with preoperative faecal incontinence and it significantly decreased from a median value of 12 (IQR 11-14) to 5 (IQR 4-5). Graciloplasty could be considered as a first option treatment for complex or recurrent RVF and RUF. It shows a good healing rate even in case of unfavourable factors like Crohn's disease.


Assuntos
Fístula/fisiopatologia , Fístula/cirurgia , Qualidade de Vida , Recuperação de Função Fisiológica , Doenças Retais/fisiopatologia , Doenças Retais/cirurgia , Doenças Uretrais/fisiopatologia , Doenças Uretrais/cirurgia , Fístula Urinária/fisiopatologia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urogenitais/métodos , Doenças Vaginais/fisiopatologia , Doenças Vaginais/cirurgia , Feminino , Humanos , Masculino , Satisfação do Paciente , Inquéritos e Questionários , Resultado do Tratamento
10.
Ann Thorac Surg ; 110(2): e127-e128, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31987820

RESUMO

Infection of an endoventricular patch used for left ventricular aneurysm repair with formation of cardiocutaneous fistula is a rare but potentially serious complication. We report an adult patient who developed a cardiocutaneous fistula 1 year after repair of a third left ventricular aneurysm. The patient was successfully treated with a redo operation using a bovine pericardial patch with omental flap coverage. He is alive and well 10 years later.


Assuntos
Fístula Cutânea/cirurgia , Fístula/cirurgia , Cardiopatias/cirurgia , Complicações Pós-Operatórias/cirurgia , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Cardíacos/métodos , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Omento/transplante
11.
Ann Thorac Surg ; 110(2): e111-e113, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31987830

RESUMO

Atrioesophageal fistula is a rare but highly morbid complication after endovascular ablation for atrial fibrillation. We report the case of a 63-year-old man with an atrioesophageal fistula after ablation who presented with neurologic symptoms and underwent emergent repair. He subsequently sustained a leak from the esophageal repair requiring emergent esophagectomy with end-esophagostomy. After several months, the patient underwent re-establishment of gastrointestinal continuity via retrosternal gastric conduit reconstruction.


Assuntos
Fibrilação Atrial/cirurgia , Fístula Esofágica/cirurgia , Esofagectomia , Fístula/cirurgia , Átrios do Coração , Cardiopatias/cirurgia , Complicações Pós-Operatórias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Terapia de Salvação
13.
J Craniofac Surg ; 31(1): 62-63, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31469729

RESUMO

BACKGROUND: An anterior palatal fistula in a bilateral cleft lip and palate is a challenging clinical dilemma. The authors evaluate the feasibility and outcomes of the reconstruction of large anterior palatal fistulae using anteriorly based dorsal tongue flaps. METHODS: Eight patients with anterior palatal fistulae after repair of a bilateral cleft lip and palate using anteriorly based dorsal tongue flaps. The defect size varied from 1.0 × 1.0 cm to 1.5 × 2.0 cm, and the tongue flap size varied from 1.5 × 3.5 cm to 2.0 × 3.5 cm. RESULTS: All patients underwent successful reconstruction of palatal defects using anteriorly based tongue flaps, and no case of spontaneous detachment of the tongue flap occurred. The patients with palatal fistulae were followed up for 10 to 30 months, and no recurrence was encountered. CONCLUSION: An anteriorly based dorsal tongue flap is a safe and feasible surgical technique for the closure of anterior palatal fistulae.


Assuntos
Fístula/cirurgia , Retalhos Cirúrgicos/cirurgia , Língua/cirurgia , Adolescente , Fenda Labial/cirurgia , Feminino , Humanos , Masculino , Recidiva , Adulto Jovem
14.
Br J Radiol ; 93(1108): 20190523, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31638419

RESUMO

Coronary artery fistulas (CAFs) are abnormal connections of the coronary arteries that bypass the myocardial capillary bed and terminate into chambers of the heart or major blood vessels. CAFs are rare, and most of them are congenital. Because CAFs can be asymptomatic and detected incidentally, the true incidence is difficult to evaluate. CAFs usually have various and complicated image features, and the clinical symptoms mainly depend on the size, origin and drainage site of the fistulas. Thus, accurate imaging assessment of these characteristics is crucial for therapeutic planning and post-operative evaluation. Due to the high temporal and spatial resolution, coronary CT angiography has recently become more widely used in cardiovascular disease diagnosis, and more asymptomatic CAFs are accidentally found. Furthermore, with multiplanar reconstruction images, some complicated and subtle structures can be displayed more accurately. In this article, we reviewed the imaging features of CAFs on coronary CT angiography, mainly focusing on the pre- and post-operative anatomy displaying of these abnormalities.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Fístula/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/cirurgia , Feminino , Fístula/epidemiologia , Fístula/etiologia , Fístula/cirurgia , Humanos , Incidência , Achados Incidentais , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
Ann Thorac Surg ; 110(1): e13-e14, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31877286

RESUMO

Atrioesophageal fistula (AEF) is a rare but disastrous complication encountered after radiofrequency catheter ablation for atrial fibrillation or flutter. Furthermore cerebral air embolism due to AEF is considered a strong predictor of mortality. In our case a patient presented with AEF and cerebral air embolism. As a rescue effort ventricular fibrillation was induced and sustained under venoarterial extracorporeal membrane oxygenation support until emergency AEF repair was feasible. Herein we report the successful use of the above measures to prevent further air embolism in a patient with radiofrequency catheter ablation-related AEF.


Assuntos
Ablação por Cateter/efeitos adversos , Embolia Aérea/prevenção & controle , Fístula Esofágica/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Cardiopatias/cirurgia , Complicações Pós-Operatórias , Ecocardiografia , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Fístula Esofágica/complicações , Fístula Esofágica/diagnóstico , Feminino , Fístula/complicações , Fístula/diagnóstico , Fístula/cirurgia , Átrios do Coração , Cardiopatias/complicações , Cardiopatias/diagnóstico , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
16.
BMJ Case Rep ; 12(12)2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31811107

RESUMO

Uterocutaneous fistula is an extremely rare clinical condition that may be caused by postoperative or postpartum complications, such as infection or inflammation. Although fibroids and myomectomy are common clinical entities among women of reproductive age, there are very few postmyomectomy uterocutaneous fistula cases in the literature. This article presents the first reported case of a succesful pregnancy and live birth following treatment of a postmyomectomy uterocutaneous fistula. After laparoscopic adhesiolysis, a minilaparotomy was performed to excise the fistula tract completely from both the abdominal wall and the uterus. The uterine wall defect was repaired in multiple layers. The patient had a good recovery after surgery, and the uterocutaneous fistula resolved completely. Due to obliteration of both tubal ostia, the patient was referred for in vitro fertilisation treatment. She conceived after the third frozen embryo transfer procedure and gave birth to a 4.4 kg baby at full term by caesarean section.


Assuntos
Fístula Cutânea/diagnóstico , Fístula/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Doenças Uterinas/diagnóstico , Miomectomia Uterina , Adulto , Fístula Cutânea/cirurgia , Diagnóstico Diferencial , Feminino , Fístula/cirurgia , Humanos , Complicações Pós-Operatórias/cirurgia , Gravidez , Resultado da Gravidez , Doenças Uterinas/cirurgia
18.
BMC Surg ; 19(1): 166, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703594

RESUMO

BACKGROUND: Coronary artery aneurysms in most cases require surgical treatment once diagnosed. Lifelong anticoagulation is often needed after surgery. We herein describe a 55-year-old man who was asymptomatic and diagnosed with right giant coronary artery aneurysm combined with right atrial fistula. CASE PRESENTATION: This is a case of asymptomatic giant right coronary artery aneurysm concurrent with coronary artery fistula. Because the aneurysm was in the distal right posterior descending coronary artery, right coronary artery ligation and fistula occlusion through the right atrium were performed in the absence of cardiopulmonary bypass. The aneurysm was excluded without impacting the myocardial blood supply, and the patient was exempted from lifelong anticoagulation regimen. The follow-up revealed favorable outcomes and the patient's life expectancy was improved. CONCLUSION: Decompression and exclusion without cardiopulmonary bypass can be adopted for distal coronary artery aneurysms that do not involve or only have a limited impact on distal blood supply. This procedure can exempt the patient from the lifelong anticoagulation regimen. In addition, the risk for myocardial ischemia caused by the thrombus in the aneurysm can also be avoided. The whole procedure is comparatively easy to perform.


Assuntos
Aneurisma Coronário/cirurgia , Fístula/cirurgia , Átrios do Coração/patologia , Vasos Coronários/cirurgia , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade
19.
Rev. neurol. (Ed. impr.) ; 69(10): 417-422, 16 nov., 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-187107

RESUMO

Introducción: Mycobacterium bovis es una causa infrecuente de tuberculosis del sistema nervioso central en España, del cual existen pocos casos descritos en la bibliografía. Desde la pasteurización obligatoria de la leche y la implementación de programas de erradicación del ganado infectado, la enfermedad esporádica humana con este organismo ha disminuido drásticamente en los países desarrollados. Caso clínico: Varón inmunoafectado de 71 años, que presentaba una lesión lítica esporádica en la calota. Se realizó una craneotomía de la lesión y los resultados de microbiología fueron positivos para M. bovis, por lo que se inició tratamiento con terapia antituberculosa. A pesar del tratamiento correcto, el paciente desarrolló un absceso tuberculoso, que requirió un tratamiento quirúrgico agresivo, seguido de una complicación con una fístula supurativa. Sobre la base del tratamiento descrito para la linfadenitis tuberculosa, se decidió realizar un tratamiento conservador de la fístula supurativa, sin realizar nuevas limpiezas del lecho quirúrgico, y mantener de manera prolongada la terapia antituberculosa (isoniacida + rifampicina + etambutol + moxifloxacino + esteroides durante 12 meses), con lo que presentó una buena evolución clínica. Conclusiones: Hasta la fecha, éste es el primer caso descrito de una fístula supurativa después de la resección de un absceso cerebral causado por M. bovis, por lo que no existe en la bibliografía artículo alguno que describa el tratamiento adecuado de esta complicación


Introduction: Mycobacterium bovis is an infrequent cause of central nervous system tuberculosis in Spain, with few cases described in the literature. Since compulsory pasteurization of milk and implementation of eradication programs on infected cattle, human sporadic illness with this organism has dramatically declined in developed countries. Case Report: A 71-year-old immunocompromised male, who presented a calvarial lytic lesion. A craniotomy for the total resection of the lesion was performed and the microbiology results were positive for M. bovis, therefore antituberculous therapy was initiated. Despite of the correct treatment, the patient developed a tuberculous abscess that required an aggressive surgical management followed by a suppurative fistula. Based on the treatment of tuberculous lymphadenitis, we decided to perform a conservative management with antituberculous therapy (isoniazid + rifampicin + ethambutol + moxifloxacin + steroids during 12 months) and avoided new surgical cleanings of the surgical bed obtaining a good response and a good clinical evolution. Conclusions: As far as we know, this is the first case reported of a suppurative fistula after the resection of a cerebral abscess caused by M. bovis, therefore, there is no report in the literature about the treatment of this complication


Assuntos
Humanos , Masculino , Idoso , Abscesso Encefálico/etiologia , Mycobacterium bovis/isolamento & purificação , Fístula/complicações , Tuberculoma/diagnóstico por imagem , Abscesso Encefálico/microbiologia , Fístula/cirurgia , Craniotomia , Crânio/lesões , Crânio/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Reação em Cadeia da Polimerase
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