Seudoquiste mediastinal y fistulización pleural, excepcional complicación de una pancreatitis / Mediastinal pseudocyst and pleural fistulization, exceptional complication of pancreatitis

Resumen Introducción: Las complicaciones torácicas secundarias a pancreatitis aguda son excepcionales y más aún la presencia de un pseudoquiste mediastinal. Caso Clínico: Hombre de 36 años. Consumidor de marihuana y alcohol. Historia de 6 meses de dolor abdominal y adelgazamiento de 20 kilos. Instalando en la evolución sintomatología respiratoria. Discusión: Se discuten las formas de presentación de esta entidad. Sus etiologías más frecuentes. Se hace énfasis en el rol de la imagenología así como en el análisis del líquido pleural. El enfoque terapéutico es conservador al inicio y en algunos pacientes es quirúrgico en la evolución; con diversas opciones.

Introduction: The thoracic complications secondary to acute pancreatitis are exceptional and even more so the presence of a mediastinal pseudocyst. Case report: 36 year old man. Marijuana and alcohol consumer. History of 6 months of abdominal pain and weight loss of 20 kilos. Installing respiratory symptomatology evolution. Discussion: The forms of presentation of this entity are discussed. Its most frequent etiologies. Emphasis is placed on the role of imaging as well as the analysis of pleural fluid. The therapeutic approach is conservative at the beginning and in some patients it is surgical during evolution; with several options.

Ressonância de fala e complicações cirúrgicas após palatoplastia primária com veloplastia intravelar em pacientes com fissura de lábio e palato / Speech resonance and surgical complications after primary palatoplasty with intravelar veloplasty in patients with cleft lip and palate

INTRODUÇÃO: A correção cirúrgica primária do palato é de fundamental importância na reabilitação do indivíduo com fissura labiopalatina e visa tanto a restauração anatômica local, com o fechamento da comunicação existente entre a cavidade nasal e oral, como a restauração funcional do anel velofaríngeo por meio do reposicionamento dos músculos palatinos. Ao longo dos anos, as técnicas de fechamento de palato foram evoluindo progressivamente, utilizando, cada vez mais, o procedimento de reposicionamento da musculatura responsável pelo fechamento do esfíncter velofaríngeo, denominado veloplastia intravelar. Tal procedimento favorece o funcionamento sinérgico da musculatura velar e faríngea, evitando, assim, os sintomas decorrentes da insuficiência velofaríngea. No entanto, apesar de todos os esforços no sentido de conseguir o funcionamento velofaríngeo adequado, intercorrências intraoperatórias e complicações pós-operatórias imediatas e/ou tardias podem contribuir para o insucesso da palatoplastia primária e, consequentemente, levar ao aparecimento de hipernasalidade. MÉTODOS: Sessenta pacientes submetidos à palatoplastia primária com veloplastia intravelar. Intercorrências intraoperatórias e complicações pós-operatórias imediatas e tardias foram investigadas. A presença e localização de fístula ou deiscência do palato foi feita por meio de avaliação clínica. Os pacientes foram submetidos, também, à gravação em áudio de amostra de fala, as quais foram analisadas por três fonoaudiólogas. As intercorrências intraoperatórias e as complicações pós-operatórias foram analisadas de forma descritiva. A associação entre as intercorrências intraoperatórias e complicações imediatas e tardias com a formação de fístulas, bem como a associação entre a ocorrência de fístulas e deiscências com a presença e ausência de hipernasalidade, foram analisadas por meio de Teste de Fisher. RESULTADOS: Verificou-se 5% de intercorrências intraoperatórias, 20% de complicações imediatas e 13,3% de complicações tardias. O índice de fístulas foi de 16,67%. A proporção de hipernasalidade foi de 18,6%. CONCLUSÃO: A palatoplastia com veloplastia intravelar utilizada no presente estudo demonstrou ser uma técnica segura, de fácil execução, eficiente para a fala e com baixos índices de complicações.

INTRODUCTION: The primary surgical correction of the palate is of fundamental importance in the rehabilitation of individuals with labiopalatine cleft and aims for local anatomical restoration and closure of the existing communication between the nasal and oral cavities, such as functional restoration of the velopharyngeal ring through repositioning of the palatine muscles. Palate closure techniques have evolved progressively over the years and increasingly involve repositioning of the muscles responsible for closing the velopharyngeal sphincter, called intravelar veloplasty. This procedure encourages the synergistic operation of the velar and pharyngeal musculature, thereby avoiding the symptoms resulting from velopharyngeal insufficiency. However, despite efforts to achieve adequate velopharyngeal function, intraoperative events and immediate postoperative and/or late complications may contribute to primary palatoplasty failure and consequently lead to hypernasality. METHODS: Sixty patients underwent primary palatoplasty with intravelar veloplasty. Intraoperative events and immediate and late postoperative complications were investigated. The presence and location of palatal fistula or dehiscence was assessed by clinical evaluation. The patients also made an audio recording of their speech that was analyzed by three speech therapists. The intraoperative events and postoperative complications were descriptively analyzed. The association between intraoperative events and immediate and late postoperative complications with the formation of fistulae as well as that between the occurrence of fistulae and dehiscences and the presence and absence of hypernasality was analyzed using Fisher's exact test. RESULTS: Overall, there was a 5% incidence of intraoperative events, 20% incidence of immediate complications, and 13.3% incidence of late complications. Fistulae and hypernasality were found in 16.67% and 18.6% of cases, respectively. CONCLUSION: Palatoplasty with intravelar veloplasty is a safe and easily implemented technique that is efficient for speech and has low complication rates.

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%.

Guidelines for the Management of Crohn's Disease / 대한소화기학회지

Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) with uncertain etiopathogenesis. CD can involve any site of gastrointestinal tract from the mouth to anus and is associated with serious complications such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies are currently applied for diverse clinical situations of CD. However, a lot of decisions on the management of CD are made depending on the personal experiences and personal dicision of physicians. To suggest preferable approaches to diverse problems of CD and to minimize the variations according to physicians, guidelines for the management of CD are needed. Therefore, IBD Study Group of the Korean Association for the Study of the Intestinal Diseases has set out to develop the guidelines for the management of CD in Korea. These guidelines were developed using the adaptation methods and encompass the treatment of inflammatory disease, stricturing disease, and penetrating disease. The guidelines also cover the indication of surgery, prevention of recurrence after surgery, and CD in pregnancy and lactation. These are the first Korean guidelines for the management of CD and the update with further scientific data and evidences is needed.

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.

Lactiferous fistula in the axillary breast

Lactiferous fistulae are uncommon post inflammatory conditions usually occurring around the areola of nipple. A young nursing mother presented with milk discharge from the site of a previous infection in left anterior axillary discharge whenever baby suckled. Ultrasound of right breast and axilla showed a fistulous track coursing between skin and a lactiferous duct in the axillary tail of breast. Due to the nursing state, local care was advised deferring surgery to post lactation period. The fistula remained quiescent after the nursing period ended. Follow up ultrasound and examination 18 months later showed complete healing

Pharyngocutaneous fistula after laryngectomy: incidence, predisposing factors, and outcome

fistula is a common and troublesome postoperative complication after total laryngectomy. The objective of this report was to determine the incidence, predisposing factors, and outcome of postlaryngectomy pharyngocutaneous fistula in patients operated on in our department and to describe the management of the complication. The medical records of 146 consecutive patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx between 1990 and 2005 were assessed. All patients had similar preoperative/postoperative care. We studied a number of factors that could influence fistula formation such as age, gender, smoking, systemic disease, preoperative radiotherapy, previous tracheotomy, site of tumor, surgical procedure, positive surgical margins, type of closure [T vs. vertical], concurrent neck dissection, suture material, clinical stage, histologic grade, and experience of surgeon [consultant vs. resident]. A pharyngocutaneous fistula was observed in 13% [19/146] of the patients within a mean time of 9.6 days from surgery. Spontaneous closure with local wound care was noted in 17 [89%] patients whereas a surgical closure was necessary in two. One patient required surgical closure by direct suture of the pharyngeal mucosa. Pectoralis major myocutaneous flap was used in another one. Our findings showed that fistula formation was significantly more common in patients who received previous radiotherapy or who had positive surgical resection margins or had a systemic disease. The mean healing time was 26 days. We concluded that pharyngocutaneous fistula remains a troublesome complication of the early postoperative period after total laryngectomy. There are many conflicting reports in the literature concerning the predisposing factors, but our data showed that the presence of systemic diseases, previous radiotherapy, and positive surgical margins can all be important predisposing factors, or at least underlying causes. Our experience confirmed that most fistulas can be successfully managed with conservative treatment

Fístulas aortoentéricas primarias: presentación de dos casos y revisión de la literatura / Aortoenteric primary fistulas: report of two cases and review of literature

Las fístulas aortoentéricas son una entidad clínica infrecuente. Se clasifican en dos tipos: primarias y secundarias. Las primarias, más raras, consisten en una comunicación espontánea de la luz del aneurisma y el tubo digestivo, frecuentemente el duodeno. Las secundarias, más frecuentes, se presentan en pacientes con aneurismas que han sido tratados. El signo clínico de presentación más habitual de las fístulas aortoentéricas es la hemorragia digestiva alta. La sospecha clínica de esta entidad es fundamental para su diagnóstico. La endoscopía y la tomografía computarizada son las técnicas complementarias más usadas para el diagnóstico, aunque en la mayoría de las ocasiones son negativas y el diagnóstico se realiza en la cirugía. El tratamiento de elección es la cirugía, si bien existen casos descritos tratados mediante técnicas endovasculares. Presentamos dos casos de fístulas aortoentéricas primarias y revisamos la literatura publicada al respecto.

Multiple congenital coronary artery fistulae draining into the left ventrice / Físulas coronariias congénitas múltiples drenando el ventrículo izquierdo

Coronary artery fistula between a coronary artery and a cardiac chamber is a rare condition, especially when multiple fistulas communicate with the left ventricle. Herein we report a case of an elderly woman with multiple diffuse coronary artery-left ventricular fistulas diagnosed by angiography. Since the coronary artery-cardiac chamber communications were multiple and diffuse neither surgery nor transcatheter coil occlusion was considered in this case.

Las fístulas de las arterias coronarias que drenan a las cavidades cardíacas son una anomalía infrecuente, especialmente cuando son múltiples y drenan hacia el ventrículo izquierdo. Presentamos el caso de una mujer octogenaria con múltiples fístulas difusas que se originan de la coronaria izquierda y que drenan al ventrículo izquierdo. El hecho de que fuesen múltiples y difusas imposibilitó una intervención quirúrgica o percutánea como se recomienda en estos casos. (Arch Cardiol Mex 2004; 74:45-48).

Fístulas crânio-nasais do líquido céfalo-raquiano. Estudo de 17 casos / Cerebrospinal fluid cranio-nasal fistulae. Report of 17 cases

Os autores estudam uma série de pacientes com fístula do líquido céfalo-raquiano (LCR). Analisam as etiologias mais comuns desse tipo de fístula e as classificam didaticamente em dois grandes grupos: espontâneas e traumáticas. O objetivo deste estudo é discutir a conduta terapêutica e chamar a atenção para as principais dificuldades no diagnóstico dessas lesões.

V-shaped glanular flap: avoidance of metal stenosis after hypospadias repair by urethral mobilization

Thirty patients presenting with distal penile hypospadias were treated by urethral mobilization technique of Koff in the period between 1992 and 1994. Results indicated that complication occurred in three cases only. Otherwise, the results were good with a wide meatus and normal forward stream. It was concluded that with the V glanular flap, orthotopic vital elastic tissue of the glans in integrated into the distal urethra

Conservative management of empyema thoracis and broncho-pleural fistula.

One hundred and eight cases of empyema with and without broncho pulmonary fistula (BPF) were studied to analyse the efficacy of conservative management (aspiration/s and/or ICD). It was successful in 87.04% cases. Among those treated with intercostal drainage, the tube was removed within 2 months in 61.22%, 5 months in 71.42%, and 24 months in 85.71% cases. Only 14.29% cases showed persistent air leak even after 2 years of closed drainage. It was concluded that all cases of simple empyema and most cases of empyema with BPF can be managed successfully with conservative methods including aspirations and closed intercostal tube drainage.

Transcatheter embolization of a coronary artery fistula.

A coronary artery fistula from left anterior descending coronary artery to right ventricle was successfully occluded by transcatheter embolization using steel coils. Transcatheter embolization seems to be the treatment of choice for coronary artery fistulas.

Fistula gastrocolica una rara secuela de ulcera peptica benigna: informe de dos casos / Gastrocolic fistula a rare sequel of benign peptic ulcer: report of 2 cases

Se presentan dos casos de fistula gastrocolica como complicacion de ulcera peptica benigna; ademas se hace la revision de la literatura al respecto. Con los casos aqui registrados se eleva el numero de esta rara complicacion a 110. Se discuten su fisiopatologia, presentacion clinica y enfoque de tratamiento. La conducta que se sigue con mayor frecuencia es remover en bloque el estomago y el colon comprometidos, y restablecer la continuidad en forma primaria

Fistula aorto-sigmoide primaria: relato de um caso / Primary aortosigmoid fistula: report of a case

Os autores relatam a conduta terapeutica e o seguimento de uma paciente portadora de tumor carcinoide maligno de reto com metastase hepatica, e fazem uma bibliografia do assunto. Salientam que o tumor retal era assintomatico, embora apresentasse invasao da camada muscular do orgao, tendo sido diagnosticado posteriormente ao achado de sua metastase. Justificam a resseçao local do tumor devido a presença de disseminaçao para o figado. A paciente tem, no momento, um ano de segmento pos-operatorio, e nao apresenta sinais clinicos ou radiologicos de recidiva ou intraperitoneal.