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Fistula Formation (fistula + formation)
Selected AbstractsTime Course of Esophageal Lesions After Catheter Ablation with Cryothermal and Radiofrequency Ablation: Implication for Atrio-Esophageal Fistula Formation After Catheter Ablation for Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2007KENNETH LAUREN RIPLEY M.S.E.E. Background: Atrio-esophageal fistulas have been described as a consequence of radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF). However, whether cryoablation can avoid this potential fatal complication remains unclear. Methods and Results: We studied the effects of direct application of RF and cryoablation on the cervical esophagus in 16 calves. Cryoablation was performed with a 6.5-mm catheter probe using a single 5-minute freeze at <,80°C, and RF ablation was delivered with an 8-mm catheter electrode at 50 W and 50°C for 45,60 seconds. Histopathologic assessments were performed at 1, 4, 7, and 14 day(s) after completion of the ablation protocol: four animals were examined each day. A total of 85 direct esophageal ablations were performed: 41 with RF and 44 with cryoablation. There were no significant differences in lesion width, depth, or volume between cryoablation and RF ablation at Day 1, 4, and 14 after the procedure (P > 0.05). However, lesion width and volume were significantly larger with RF than with cryoablation at Day 7. Although acute (Day 1) and chronic (Day 14) RF and cryoablation lesions were of comparable size, histologic evidence of partial- to full-wall esophageal lesion ulceration was observed in 0 of 44 (0%) lesions with cryoablation, compared with 9 of 41 (22%) lesions with RF ablation (P = 0.0025). Conclusions: Direct application of cryoablation and RF ablation created similar acute and chronic lesion dimensions on the esophagus. However, cryoablation was associated with a significantly lower risk of esophageal ulceration, compared with RF ablation. [source] Xanthogranulomatous pyelonephritis with a renocolic fistula caused by a parapelvic cystINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2006YOH MATSUOKA Abstract, Fistula formation between the upper urinary tract and bowel is an uncommon complication in urogenital diseases. We present a rare case of focal xanthogranulomatous pyelonephritis with a renocolic fistula. This is the first case where a parapelvic cyst obstructs the caliceal outflow and leads to the formation of a renocolic fistula in renal inflammatory disease. It is difficult to make a preoperative diagnosis of focal xanthogranulomatous pyelonephritis with widespread involvement that is caused by non-calculous urinary tract obstruction. [source] Salvage surgery after radical accelerated radiotherapy with concomitant boost technique for head and neck carcinomasHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2005Daniel Taussky MD Abstract Background. Definitive radiotherapy (RT) for head and neck cancer is increasingly used to preserve organ function, whereas surgery is reserved for treatment failure. However, data are sparse regarding the feasibility of salvage surgery, particularly for unselected patients after accelerated RT. Methods. From 1991 to 2001, 297 patients, most with stage III to IV cancer (Union Internationale Contre le Cancer) were treated with concomitant boost RT (median dose, 69.9 Gy in 41 fractions) with or without chemotherapy (in 33%, usually cisplatin with or without 5-fluorouracil). The 75 patients seen with local and/or regional failure were studied. We analyzed the factors influencing the decision to attempt surgical salvage, the oncologic outcome, and the associated complications. Results. Seventeen (23%) of the 75 patients had a salvage operation. This included all five patients with laryngeal cancers but only 16% to 20% of patients with tumors in other locations. Most patients could not be operated on because of disease extension (40%) and poor general condition/advanced age (30%). Patients with low initial primary T and N classification were more likely to undergo surgery (p = .002 and .014, respectively). Median post-recurrence survival was significantly better for patients who had salvage operations than for those without surgical salvage treatment (44 vs 11 months, p = .0001). Thirteen patients were initially seen with postoperative complications (mostly delayed wound healing and fistula formation). Conclusions. After definitive accelerated RT with the concomitant boost technique, only a minority of patients with local or regional recurrence underwent salvage surgery. Disease stage, tumor location, and patient's general condition at the initial diagnosis seemed to be the main factors influencing the decision to attempt surgical salvage. For patients with initially resectable disease who undergo radical nonsurgical treatment, more effective follow-up is needed to favor early detection of treatment failure, which may lead to a timely and effective salvage surgery. © 2004 Wiley Periodicals, Inc. Head Neck27: 182,186, 2005 [source] Ruptured internal jugular vein: A postoperative complication of modified/selected neck dissectionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2003Suzanne S. Cleland-Zamudio MD Abstract Background. Postoperative hemorrhage from the internal jugular vein after a modified or selective neck dissection is an infrequent, yet potentially life-threatening, complication. Despite the increasing frequency of modified or selective neck dissections, this complication has not been previously highlighted in the literature. Setting. Tertiary referral academic center. Material and Methods. The records of six patients who experienced this complication were reviewed and analyzed for risk factors that might predict its occurrence. Results. Common risk factors included postoperative pharyngeal fistula formation, significant tobacco history, and poor nutritional status. A more complete circumferential dissection of the vein low in the neck in the presence of hypopharyngeal fistula may place it at a higher risk for rupture. Conclusions. Patients who have a complete circumferential dissection of the internal jugular vein low in the neck and go on to have fistulas develop may be more prone to internal jugular vein rupture. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] Ventral based dartos flap for the prevention of the urethrocutaneous fistula urethroplastyINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2007Yutaro Hayashi Background: Urethrocutaneous fistula is a common complication of urethroplasty for hypospadias even when a microsurgical technique is applied. Methods: From January 1999 to November 2006, we applied the ventral based dartos flap wrapping technique to prevent the occurrence of urethrocutaneous fistula in 34 patients with hypospadias. Results: Hypospadias was repaired without fistula formation in 31 patients while three patients developed a tiny fistula, which was later closed successfully by a simple procedure. Conclusion: We conclude that the ventral based dartos flap wrapping technique could be an alternative to the dorsal dartos flap for covering the neourethra with a vascularized flap because the procedure is very simple, and complications rarely occur. [source] Arteriovenous Fistula Leading to Severe Tortuosity and Aneurysm FormationJOURNAL OF CARDIAC SURGERY, Issue 2 2009Murat Ugurlucan M.D. In this report we present the images of a 58-year-old male patient with a 25-year history of gun shot injury and arteriovenous fistula formation at the femoral region. [source] Real-Time Monitoring of Luminal Esophageal Temperature During Left Atrial Radiofrequency Catheter Ablation for Atrial Fibrillation: Observations About Esophageal Heating During Ablation at the Pulmonary Vein Ostia and Posterior Left AtriumJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2006CHRISTIAN PERZANOWSKI M.D. Introduction: Left atrial radiofrequency catheter ablation (RFA) is gaining acceptance as treatment for drug-refractory atrial fibrillation (AF). This therapy has been associated with esophageal injury and atrioesophageal fistula formation causing death. Methods: We describe 3 patients undergoing catheter ablation for AF during real-time monitoring of luminal esophageal temperature. Results: We observed heating of the esophagus during short duration low power RFA, at either the left or right pulmonary vein ostia. Cryoablation at the pulmonary vein ostium in one patient resulted in esophageal cooling. Furthermore, we observed that fluoroscopic localization of the ablation catheter at a site apparently distant from the esophagus is not adequate to assure avoidance of ablation-induced esophageal heating. Conclusions: Real-time monitoring of luminal esophageal position and temperature is feasible, enhances recognition of esophageal heating, and may add useful information beyond that provided by fluoroscopic assessment of esophageal position. There is a potential role for esophageal monitoring to help avoid thermal injury to the esophagus during catheter ablation for atrial fibrillation. [source] Histopathological observations of human periimplantitis lesionsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2004Tord Berglundh Abstract Objective: The aim of the present study was to analyze some characteristics of advanced and progressive periimplantitis lesions in man. Material and methods: Soft tissue biopsies were obtained from 12 implants in six patients. The implants had been in function between 4 and 21 years and were, with one exception, located in the maxilla. The radiographic examination performed prior to biopsy revealed that all sites exhibited advanced bone loss. Further, clinical signs of severe inflammation, such as suppuration, swelling and/or fistula formation were detected in the majority of sites and seven of the 12 implants were found to be mobile at biopsy. Each biopsy was following fixation embedded in epoxy resin and sections were prepared for histometric and morphometric analysis. Results and conclusion: It was demonstrated (i) that all soft tissue units harbored large inflammatory cell infiltrates (ICT) that extended to a position apical of a pocket epithelium and (ii) that about 60% of the lesions were occupied by inflammatory cells, among which plasma cells dominated. Numerous amounts of PMN cells occurred not only in the pocket epithelium and adjacent connective tissue areas, but were also present in peri-vascular compartments in more central areas of the ICT. [source] Esophageal Causes of Sudden and Unexpected DeathJOURNAL OF FORENSIC SCIENCES, Issue 2 2006Roger W. Byard M.D. ABSTRACT: Gastrointestinal conditions are uncommon causes of sudden and/or unexpected death as compared to cardiovascular diseases, motor vehicle trauma, or suicide, and may involve an array of fatal mechanisms. Lethal esophageal conditions are encountered even less often, the manifestations of which include acute upper airway occlusion from tumors or foreign material, intraluminal hemorrhage from vascular abnormalities, or perforation with fistula formation resulting in hemorrhage and sepsis. When encountered at autopsy, a particular condition may also be a manifestation of a disease that does not primarily involve the esophagus. For this reason, a detailed autopsy investigation is required for evidence of systemic or remote disease when lesions are found within the esophagus. In this report, possible life-threatening esophageal conditions are reviewed with a description of lethal mechanisms, mention of rare associated diseases, and comment on difficulties that may arise at autopsy in the evaluation of such cases. [source] Ingested magnets and gastrointestinal complicationsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2007Abdulrahman M Alzahem Abstract: Multiple magnet ingestion is an unexpected health hazard in children that can lead to significant gastrointestinal morbidity. The magnets are attracted to each other across the bowel wall and this may lead to pressure necrosis, resulting in perforation, fistula formation, and/or intestinal obstruction. We report herein a case of small bowel obstruction following ingestion of two magnets. The public and clinicians should be aware of the health hazard of such devices. [source] Long-term pancreatic endocrine function following pancreatoduodenectomy with pancreaticogastrostomyJOURNAL OF SURGICAL ONCOLOGY, Issue 6 2008Yoshiaki Murakami MD Abstract Background and Objectives The aim of this study was to evaluate long-term pancreatic endocrine function following pancreatoduodenectomy with pancreaticogastrostomy. Methods Records of 52 patients who had survived for three or more years following pancreatoduodenectomy with pancreaticogastrostomy were studied retrospectively. Serum HbA1c levels had been measured prior to and at 3- to 6-month intervals after surgery. Results Three of 42 patients with normal preoperative serum HbA1c levels (,5.8%), and five of 10 patients with elevated preoperative serum HbA1c levels (>5.8%) showed deterioration of glucose tolerance. Five of these eight patients developed a pancreatic fistula postoperatively. However, the average serum HbA1c levels of patients with normal preoperative serum HbA1c levels have remained within the normal range for 3,10 years after surgery. Conclusions Pancreatic endocrine function was maintained for a long-term period after pancreatoduodenectomy with pancreaticogastrostomy. Impaired glucose tolerance appeared to be associated with postoperative pancreatic fistula formation. J. Surg. Oncol. 2008;97:519,522. © 2008 Wiley-Liss, Inc. [source] Reconstruction of the hypopharynx with the free jejunum transferJOURNAL OF SURGICAL ONCOLOGY, Issue 6 2006Joseph J. Disa MD Abstract Microsurgical techniques have revolutionized pharyngolaryngeal reconstruction. Free flap reconstruction with the free jejunal flap enables one stage reconstruction with minimal morbidity and mortality. This review will examine indications, operative technique, postoperative management, and expected outcomes for the hypopharyngeal reconstruction with the free jejunum flap. This procedure allows for maintenance of oral sections and rapid return of per-oral feeds and swallowing. The vast majority of patients resume swallowing and can maintain adequate nutrition without the need for supplemental enteral feeding via a tube. The free jejunal transfer can be rapidly harvested in most instances and transplanted to the hypopharyngeal region with a greater than 95% success rate. The jejunum fee flap is most useful for circumferential defects of the hypopharynx, but can also be used for partial defects. The most common local complications are stricture and fistula formation. A history of preoperative radiation therapy increases the risk of local complications. J. Surg. Oncol. 2006;94:466,470. © 2006 Wiley-Liss, Inc. [source] Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesityBRITISH JOURNAL OF DERMATOLOGY, Issue 4 2009K. Sartorius Summary Background, Hidradenitis suppurativa (HS) is a long-standing disease with abscess and often fistula formation, predominantly in the axillae and groins. The disease is difficult to treat and has a severe impact on quality of life. A clinically relevant system for scoring disease severity is lacking in HS. Objectives, To evaluate the modified Hidradenitis Suppurativa Score (HSS) and to study the impact of body mass index (BMI) and smoking habits on disease severity. Methods, Two hundred and fifty-one consecutive patients with HS referred to a clinic with special interest in the disease were included, of whom 115 were scored. Points were given for regions involved, types of lesion (nodules, fistulas), total area involved and whether lesions were separated by normal skin. Background characteristics included BMI and smoking habits. Two hundred and forty-six patients completed the Dermatology Life Quality Index (DLQI). Results, The median (interquartile range, IQR) HSS for all patients was 38 (18,66): women 38 (18,71) and men 37 (19,51). Median (IQR) HSS for smokers was 41 (22,75·5), former smokers 27 (16,53) and nonsmokers 22 (10,57). Median (IQR) HSS for patients with BMI < 25 kg m,2 was 32 (12,54), BMI 25,30 kg m,2 44 (22,56) and BMI , 30 kg m,2 50 (18,86). Mean ± SD DLQI for the whole group of patients was 10·3 ± 7·5, median 9, and showed no significant differences between the groups studied. There was a significant positive correlation of fair degree between HSS and DLQI. There were significant differences in HSS between nonsmokers and smokers as well as between women of normal weight compared with obese women. Conclusions, The modified HSS is simple and practical and it extracts important clinical information. A connection between disease severity and BMI as well as smoking habits in patients with HS is presented. The results suggest that the HSS may be a relevant outcome measure in future therapeutic trials in HS. [source] Influence of hysterectomy on fistula formation in women with diverticulitisBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2010D. Altman Background: Diverticulitis is a risk factor for fistula formation but little is known about the influence of hysterectomy in this association. A population-based nationwide matched cohort study was performed to determine the risk of fistula formation in hysterectomized women with, and without, diverticulitis. Methods: Women who had a hysterectomy between 1973 and 2003, and a matched control cohort, were identified from the Swedish Inpatient Register. Incidence of diverticulitis and fistula surgery was determined by cross-linkage to the Register, and risk was estimated using a Cox regression model. Results: In a cohort of 168 563 hysterectomized and 614 682 non-hysterectomized women (mean follow-up 11·0 and 11·5 years respectively), there were 14 051 cases of diverticulitis and 851 fistulas. Compared with women who had neither hysterectomy nor diverticulitis, the risk of fistula surgery increased fourfold in hysterectomized women without diverticulitis (hazard ratio (HR) 4·0 (95 per cent confidence interval (c.i.) 3·5 to 4·7)), sevenfold in non-hysterectomized women with diverticulitis (HR 7·6 (4·8 to 12·1)) and 25-fold in hysterectomized women with diverticulitis (HR 25·2 (15·5 to 41·2)). Conclusion: Diverticulitis, and to a lesser extent hysterectomy, is strongly associated with the risk of fistula formation. Hysterectomized women with diverticulitis have the highest risk of developing surgically managed fistula. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Clinical Immunology Review Series: An approach to the patient with recurrent superficial abscessesCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 3 2008S. L. Johnston Summary Patients may be referred to the immunology clinic for investigation of recurrent superficial abscess formation. In the majority of adult patients this clinical presentation does not equate with an underlying primary immune deficiency. Nevertheless, recurrent mucocutaneous abscesses can be associated with significant morbidity and long-term complications, including scarring and fistula formation, and may be associated with underlying immune-mediated disease. This review sets out an approach to the patient with recurrent superficial abscesses, focusing on the differential diagnoses, investigation and management of both the common causes and those associated with specific immune deficiency. [source] | ||||||||||