Current management of fistulizing perianal Crohn's disease based on serum anti-tumor necrosis factor levels and magnetic resonance imaging monitoring / Manejo atual da doença de Crohn perianal fistulizante com base nos níveis séricos de fator de necrose antitumoral e no monitoramento por ressonância magnética

ABSTRACT Perianal fistulizing Crohn's disease (PFCD) is one of the most complex challenges in the colorectal surgery nowadays, because, even with combined clinical and surgical treatment, the rate of healing of the fistulas is approximately 50%. In this context, the monitoring of serum levels of anti-Tumor Necrosis Factor (anti-TNF) drugs appears as a crucial tool for the optimization of treatment, since there is a probable correlation between higher serum levels of infliximab and adalimumab with better outcomes of the disease, higher healing rates and lower recurrence rates. This review describes evidence on the use of serum anti-TNF levels and their relationship to clinical and radiological efficacy.

RESUMO A Doença de Crohn Perianal Fistulizante (DCPF) configura-se como um dos desafios mais complexos da cirurgia colorretal atualmente, isso porque, mesmo com tratamento clínico e cirúrgico combinados, a taxa de cicatrização das fistulas é de aproximadamente 50%. Nesse contexto, a monitorização de níveis séricos de drogas anti-Fator de Necrose Tumoral (anti-TNF) surge como ferramenta crucial para a otimização do tratamento, uma vez há provável correlação entre maiores níveis séricos de infliximabe e adalimumabe com melhores desfechos da doença, maiores taxas de cicatrização e menores índices de recorrência. Nesta revisão são descritas evidências sobre o uso dos níveis séricos de anti-TNF e sua relação com a eficácia clínica e radiológica.

Absceso pulmonar con fístula neumocutánea / Pulmonary abscess with pneumocutaneous fistula

Lung abscess is a rare entity in pediatric age, but it generates significant morbidity. Even less frequent is the presence of this with spontaneous drainage to the skin, generating an abscess in the chest wall, reason for consultation, of the present clinical case. Subsequently, the presence of lung abscess with extension to the chest wall without pleural involvement was documented by imaging studies, an extremely rare and unusual entity, with only one case described in the world literature within our reach and in an adult patient.

El absceso pulmonar es una entidad infrecuente en la edad pediátrica, pero que genera una morbilidad importante. Aún menos frecuente es la presencia de este con drenaje espontáneo a piel, generando un absceso en pared torácica, motivo de consulta, del presente caso clínico. Posteriormente y por estudios imagenológicos se documentó la presencia de absceso pulmonar con extensión a pared torácica sin afectación pleural, una entidad extremadamente rara e inusual, con un solo caso descrito en la literatura mundial a nuestro alcance y en un paciente adulto.

Aspiration with or without lavage in the treatment of acute suppurative thyroiditis secondary to pyriform sinus fistula

ABSTRACT Objective There is currently no consensus regarding the optimal management of acute suppurative thyroiditis (AST) secondary to pyriform sinus fistula (PSF). To investigate the benefits and adverse events of aspiration with or without lavage for the treatment of AST secondary to PSF. Subjects and methods This was a retrospective analysis of consecutive patients with AST secondary to PSF who were admitted at the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University between August 2012 and December 2018. Clinical information, procedural data, and imaging data were analyzed. Results Seven patients (five women; mean age, 16.9 ± 6.3 years; range, 8-26 years) were included. The patients most presented with anterior neck pain and swelling (n = 7), fever (n = 7), or odynophagia (n = 5). Six cases of AST occurred on the left side of the thyroid and 1 on the right. All patients had thyroid abscess. AST was diagnosed by ultrasound-guided needle aspiration cytology in all cases. PSF was diagnosed during the inflammatory stage in five patients and during the quiescent stage in two. All patients were treated with empiric antibiotics. Needle aspiration without lavage was performed in three cases. Needle aspiration with lavage was performed in four cases. Repeat aspiration was performed in three cases. All patients recovered completely, with no procedure-related complications. During 18.3 ± 7.8 months of follow-up, AST recurred in one case. Excision of the PSF was performed in another case. Conclusion Ultrasound-guided aspiration with or without lavage had a good treatment effect and without adverse events for the management of AST secondary to PSF.

Factores de riesgo en la aparición de fístula faringocutánea / Risk factors in the apparition of pharyngocutaneous fistula

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).

Correção de fissura palatina com retalho músculo mucoso de bucinador: resultados de 6 casos após 27 anos / Correction of palatine fistulas with a musculo-mucosal buccinator flap: results of 6 cases after 27 years

Introdução: O retalho miomucoso de músculo bucinador, descrito em 1989, pode ser utilizado para corrigir fístulas palatinas, fissuras com alongamento do palato mole ou cobrir áreas cruentas após ressecções de tumores. Métodos: Trata-se da análise do resultado após 27 anos de 6 casos de pacientes operados no Hospital de Base e na Santa Casa de São José do Rio Preto, no período de 1984 a 1989, e reavaliados em 2016, nos quais foram realizados retalhos miomucosos de bucinador para correção de fissura palatina. Resultados: Dos 36 casos operados, 6 foram reavaliados após 27 anos, dos quais 5 trataram-se de correção primária e 1 de correção secundária (fístula após fechamento de fissura palatina). Todos os casos obtiveram resultados satisfatórios no crescimento maxilar, na correção da fistula palatina e na função da fala. Conclusão: Apesar de estatisticamente não significativo, o presente estudo demonstrou que o retalho miomucoso de músculo bucinador para correção e alongamento do palato é um procedimento adequado, com resultados de crescimento maxilar normal ou próximo disso e fala praticamente normal, mesmo sem adequado tratamento fonoaudiológico.

Introduction: The buccal musculo-mucosal patch, described in 1989, can be used to correct palatine fistulas and fissures with stretching of the soft palate, or to cover bloody areas after tumor resection. Methods: This is an analysis of the 27-year postoperative results for 6 patients who underwent operation at Base Hospital and Santa Casa de São José do Rio Preto between 1984 and 1989, and reassessed in 2016, when a myo-buccinator mucosa was used for cleft palate correction. Results: Of the 36 operated cases, 6 were reevaluated after 27 years, of which 5 had primary correction and 1 had a secondary correction (fistula after cleft palate closure). All the cases had satisfactory results in terms of maxillary growth, correction of the palatine fistula, and speech function. Conclusion: Although not statistically significant, the present study demonstrated that the buccal musculo-mucosal flap is an adequate procedure for correction and stretching of the palate, with normal or near-normal maxillary growth and practically normal speech even without adequate phono-audiological treatment.

Tratamento endovascular de aneurisma de aorta abdominal com fístula aorto-cava utilizando oclusor vascular concomitante a endoprótese bifurcada: relato de caso / Endovascular treatment of an abdominal aortic aneurysm with aortocaval fistula using a vascular occluder and a bifurcated endograft in a single intervention: case report

As fístulas aorto-cava são entidades raras e de etiologia variada, estando frequentemente associadas a significativa morbimortalidade. Acredita-se que o aumento da tensão da parede nos grandes aneurismas resulte em reação inflamatória e aderência à veia adjacente, culminando na erosão das camadas aderidas e na formação da fístula. O tratamento cirúrgico convencional tem altas taxas de mortalidade. Embolia pulmonar paradoxal e o vazamento são complicações temidas do tratamento endovascular. O uso de oclusor vascular associado a endoprótese bifurcada é boa opção no tratamento do aneurisma de aorta abdominal com fístula aorto-cava

Aortocaval fistulae are rare entities with a variety of etiologies and are very often associated with significant morbidity and mortality. It is believed that increased tension in the walls of large aneurysms can cause an inflammatory reaction resulting in adhesion to the adjacent vein and culminating in erosion of the adherent layers and fistula formation. Conventional surgical treatment has high mortality rates. Paradoxical pulmonary embolism and endoleaks are the most concerning complications linked with endovascular treatment. Using a vascular occluder in combination with a bifurcated endograft is a good option for the treatment of an abdominal aortic aneurysm with aortocaval fistula

Malformaciones anorrectales: diagnóstico y tratamiento, cinco años de experiencia, Honduras / Anorectal Malformations: diagnosis and treatment. A five years experience. Honduras

Introducción: Las malformaciones anorrectales (MAR) son un espectro de trastornos raros del recto y del ano, con anatomía variable y resultados impredecibles a largo plazo. El objetivo de este estudio fue revisar retrospectivamente la clasificación, el diagnóstico y la experiencia quirúrgica de las malformaciones anorrectales. Material y métodos: Incluimos en este estudio todos los pacientes con malformación anorrectal nacidos en el periodo 2010-2015. Resultados: En este estudio se incluyó a una serie de 70 niños, de los cuales 31 eran hombres y 39 mujeres. En los pacientes varones, 38,71% (12) tenían fístulas perineales, 25,81% (8) tenían fístulas uretrales y 25,81 (8) tenían fístulas rectocuellovesical, sin fístula 9,68% (3). En las mujeres, el 7,69% (3) tenían fístulas perineales, el 61,54% (24) tenían fístulas rectovestibulares. Cinco pacientes no presentaron fístula (12,82%). Las anomalías asociadas estaban presentes en 35,71% (25) pacientes, y la mayoría de las anomalías asociadas fueron genitourinarias y cardiovasculares. Las complicaciones postoperatorias se relacionaron con Anorrectoplastia Sagital Posterior (PSARP) en el 40% (9,3%) de los pacientes. No hubo mortalidad. Discusión: La Malformación anorrectal en la etapa neonatal puede abarcar un amplio espectro de malformaciones asociadas, que afectan tanto a niños como a niñas. Se han producido avances significativos en el manejo de las malformaciones anorrectales, sin embargo, muchos pacientes aún presentan complicaciones en la técnica operatoria, con frecuencia catastróficas, potencialmente evitables...(AU)

Broncho-Pleural Fistula with Hydropneumothorax at CT: Diagnostic Implications in Mycobacterium avium Complex Lung Disease with Pleural Involvement

OBJECTIVE: To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. MATERIALS AND METHODS: We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. RESULTS: The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/microL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. CONCLUSION: In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.

Manejo de pacientes con fístulas enterocutáneas / Management of enterocutaneous fistulas

Introducción: A pesar de los avances en el manejo, las Fistulas Enterocutáneas (FE) son responsables de un morbi-mortalidad elevada en los serviciosde cirugía. El objetvo de esta investgación es determinar las característcas clínicas y los resultados de los pacientes con FE en nuestra insttución.Métodos: Se realizó un análisis retrospectvo, descriptvo, en el Insttuto de Seguro Social en los años 2009 a 2011. Se incluyeron variables demográ-fcas y clínicas: estado nutricional, característcas de la FE, terapias adyuvantes insttuidas, terapia y resultado fnal: cierre espontaneo o intervenciónquirúrgica y morbi-mortalidad.Resultados: Se presentaron un total de 13 casos, 77% masculinos, la albumina se encontró baja en el momento de diagnostcar la FE en el 77% de loscasos, el 62% fueron fstulas de gasto alto, el cierre espontaneo se dio en el 30%. Durante el tratamiento 67% de los pacientes presentó morbilidad,principalmente neumonía nosocomial. La mortalidad del estudio es de 46%.Conclusión: La FE es una patología de difcil manejo. En nuestro estudio, el 77% de los pacientes presentan hipoalbuminemia, la morbilidad es del 67%y la mortalidad del 46%.

Background: Despite advances in management, enterocutaneous fstula (EF) is responsible for signifcant morbidity and mortality. The aim of this studywas to determine clinical characteristcs and outcomes of patents with EF in our insttuton.Methods: A retrospectve analysis, from 2009 to 2011 of patents with EF at the Social Security Insttute. Demographic and clinical variables were included:nutritonal status, fstula characteristcs, therapy, adjuvant therapies, and outcome: spontaneous or surgical closure; morbidity and mortality.Results: Thirteen patents were evaluated, 77% were male; albumin levels were below normal in 77% of the patents at the tme of EF diagnosis, 62%were high output fstulas and 30% remited with spontaneous closure. Associated morbidity occurred in 67%, especially nosocomial pneumonia. Mortalityrate was 46%.Conclusions: Treatment of EF contnues to be a difcult task; in our study 77% of the patents had albumin levels below normal at the tme of EF diagnosis,morbidity was 67% and mortality was 46%.

Chronic Radiation Colitis with Rectopelvic Fistula Diagnosed 30 Years after Radiation Therapy / 대한소화기학회지

No abstract available.

Iliocaval Fistula Presenting with Paradoxical Pulmonary Embolism Combined with High-Output Heart Failure Successfully Treated by Endovascular Stent-Graft Repair: Case Report

A 51-yr-old man presented exertional dyspnea as a consequence of iliocaval fistula combined with paradoxical pulmonary embolism and high-output heart failure. Endovascular stent-graft repair was performed to cover iliocaval fistula and restore the heart function. After the procedure, dyspnea was improved and procedure related complication was not seen. A 6-month follow-up computed tomography showed regression of pulmonary thromboembolism and well-positioned stent-graft without graft migration, aortacaval communication or endoleak. Stent graft implantation should be considered an alternative of open repair surgery for treament of abdominal arteriovenous fisula, especially in patient with high risk for surgery.

Fístula aorta-átrio direito, simulando CIV, com fechamento percutâneo por prótese CERA / Percutaneous closure of aorta to right atrial fistula,simulating VSD, with CERA occluder

Fístulas entre a aorta e o átrio direito podem ser de origem congênita ou adquirida. As fístulas aortocamerais congênitas são raras anomalias do coração que podem ser confundidas com outros defeitos como comunicações interventriculares ou interatriais. São raros canais vasculares extra cardíacos e sua história natural, apresentação clínica e tratamento adequado ainda são obscuros. As fístulas adquiridas são, em geral, decorrentes de ruptura do seio de valsalva pós-infecciosa. Neste relato apresentamos um caso de difícil diagnóstico ecocardiográfico, no qual o diagnóstico de fístula aorta-átrio direito foi confundido com o de comunicação interventricular perimenbranosa e só confirmado após estudo hemodinâmico.

Aorta to right atrium fistula can be a congenital or condition. Congenital fistulas are uncommon heart diseases and can be mistaken by other heart lesions like interventricular septal defect or atrial septal defect. They seem to be are extra-cardiac vascular channels and their natural history, clinical presentation and treatment remain uncertain. Acquired fistula between aorta and right atrium is usually due to a post infeccious rupture of sinus of valsalva. The authors present a case of aorta-right atrium fistula that had been mistaken by perimenbranous interventricular septal defect during echocardiography examination and confirmed by cardiac catheterization.

Absceso tiroideo con fístula del seno piriforme: tres casos clínicos / Thyroid abscess with pyriform sinus fistulae: 3 clinical cases

Thyroid abscess is an infrequent, potentially life-threatening condition. It accounts for 0,1 to 0,7 percent of thyroid pathology, usually occurring in patients with preexisting disease of the gland or more commonly, associated to local anatomical defects, such pyriform sinus fistulae. Three cases of thyroid abscess in children are presented, in which no bacterial etiology was confirmed. Intravenous antibiotics were used, cefotaxime, cloxacillin or clindamicin. Recurrence was confirmed in 2 of them, and a pyriform sinus fistulae was demostrated by esophagogram.

El absceso tiroideo es un cuadro infrecuente y una emergencia endocrina potencialmente fatal. Representa el 0,1 a 0,7 por ciento de las patologías tiroideas. Habitualmente se produce en pacientes con patología preexistente de la glándula o más frecuentemente, asociado a defectos anatómicos locales, como una fístula del seno piriforme. Presentamos 3 casos de abscesos tiroideos en escolares. Recibieron tratamiento antibiótico endovenoso de amplio espectro, a pesar de lo cual dos de ellos recidivaron precozmente. En dos de ellos se demostró una fístula del seno piriforme con esofagograma que se manejó quirúrgicamente.

Avaliação por ressonância magnética das fístulas perianais: ensaio iconográfico / Magnetic resonance imaging evaluation of perianal fistulas: iconographic essay

A fístula perianal é uma condição incomum com tendência a recorrência, que usualmente é decorrente de infecção prévia não observada à cirurgia. A ressonância magnética mostra com acurácia a anatomia da região e a relação da fístula com o diafragma pélvico e a fossa isquiorretal, classificando-a em cinco tipos. A ressonância magnética é superior a qualquer outra modalidade para a detecção de focos infecciosos na região perianal, incluindo a exploração cirúrgica. Tem a capacidade de guiar o procedimento cirúrgico, reduzindo a taxa de recorrência em 75 por cento em pacientes com doença complexa.

Fistula in ano is an uncommon condition that has a tendency to recur despite seemingly appropriate surgery. Recurrent fistula in ano is usually caused by infection that was missed during surgical exploration. Magnetic resonance imaging has been shown to accurately demonstrate the anatomy of the perianal region as well as the fistula's relationship with the pelvic diaphragm and ischiorectal fossa, allowing the classification of fistulas into five types. Magnetic resonance imaging depicts infectious foci in the perianal region better than any other investigation modality, including surgical exploration. Magnetic resonance image-guided surgery helps to reduce postoperative recurrence by 75 percent in patients with complex disease.

[Tracheo-innominate artery fistula as a late onset tracheotomy complication: a case report]

Tracheo-innominate artery fistula [TIF] is a rare, life threatening and catastrophic complication, which may occur 7 to 14 days after surgery. The Incidence Rate of TIF is 0.1-1% and survival rate of patient is 14.3%. Herein, we describe TIF in a patient 50 days post tracheotomy, based on our research, it appears that our case is the first finding with the latest onset of TIF after tracheotomy, which now has been improved by early diagnosis and surgical treatment