Study on the management of granulation during surgery for congenital preauricular fistula infection stage / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the management of granulation tissue during surgery for infected congenital preauricular fistula and to assess the surgical outcomes. Methods:To summarize the surgical methods and the treatment of granulation methods in 140 cases of congenital preauricular fistula during the period of infection treated in our department from January 2018 to September 2022. The study divided patients into an observation group （79 patients） undergoing fistulectomy without granulation treatment, and a control group （61 patients） where fistulectomy and granulation resection were performed concurrently.. After six months of follow-up, the wound healing, recurrence rates, and the aesthetic assessment of granulation healing were evaluated using the Stony Brook Scar Evaluation Scale（SBSES）. Results:The two surgical approaches were applied to a total of 140 patients with infected congenital preauricular fistula. There was no statistical difference in wound healing and recurrence rates between the observation group and the control group. However, the observation group exhibited smaller scars. Conclusion:In cases of infected congenital preauricular fistula, surgical removal without excising granulation tissue is feasible, leading to effective healing and lesser scar formation.

Neumoencéfalo recurrente post quirúrgico, a raíz de dos casos / Post-surgical late pneumoencephalus, based on two cases

El neumoencéfalo es una patología que comúnmente se presenta después de cirugía neuroquirúrgica y ocasionalmente endonasal. Estos se suelen manejar de manera conservadora, sin embargo, se pueden asociar a distintas etiologías las cuales los hacen recurrir. En este reporte presentamos dos casos de neumoencéfalo tardío post quirúrgico asociado a fístulas de LCR de bajo flujo, donde se discute su clínica, etiología y manejo posterior.

Pneumocephalus is a pathology that commonly occurs after endonasal surgery, these are usually managed conservatively, however they can be associated with different etiologies which make them recur. In this report we present two cases of post-surgical late pneumocephalus associated with low-flow CSF fistulae, where its symptoms, etiology, and subsequent management are discussed.

One-stage operation surgical efficacy observation of congenital preauricular fistula infection and static period of inflammation in children / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the clinical effect of surgical treatment of congenital preauricular fistulas in children during the local infection period and static inflammatory period. Methods:Forty children with congenital preauricular fistula infection treated in our hospital from January 2020 to December 2022 were selected as the experimental group, and 39 children with congenital preauricular fistula inflammation at static period were selected as the control group. The fistula of the two groups of children aged between 1-14 years old was located in front of the foot of the ear wheel or the foot of the ear wheel, and all were unilateral fistulas. The postoperative follow-up was 6 months to 2 years, and the efficacy of the two groups was compared. Results:There was no significant difference in the healing rate of stage Ⅰ and stage Ⅱ between the two groups（P>0.05）. There was no significant difference in fistula recurrence rate and satisfaction with the preauricular scar between the two groups after treatment（P>0.05）. There was no significant difference in postoperative hospital stay between the experimental group and the control group（P>0.05）. Conclusion:The effect of surgical treatment of congenital preauricular fistula in the infected period is similar to that of surgical treatment in the static period of inflammation, and it can reduce the pain of dressing change under local anesthesia in children, avoid the second operation in children, and reduce the economic cost. This treatment method is worthy of clinical promotion. Appropriate incision and resection method were designed according to the fistula and infection sites.

The clinical value of recurrent laryngeal nerve dissection in the surgical treatment for congenital pyriform sinus fistula / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the clinical value of recurrent laryngeal nerve dissection in the surgical treatment for congenital pyriform sinus fistula（CPSF）. Methods:The clinical data of 42 patients with CPSF were retrospectively analyzed. All patients were diagnosed and treated in the First Affiliated Hospital of Guangdong Pharmaceutical University. Results:During the operation, all patients' recurrent laryngeal nerves were dissected successfully, and fistulas were resected completely,no patients had complication of recurrent laryngeal nerve's damage.There were no recurrence cases during the 13 to 48 months of follow-up. Conclusion:The trend of congenital pyriform sinus fistula is closely related to recurrent laryngeal nerve, it's important to dissect the recurrent laryngeal nerve during the operation for congenital pyriform sinus fistula.

Total hip arthroplasty for post-firearm hip arthritis complicated by coloarticular fistula: A case report / 中华创伤杂志(英文版)

Hip firearm injuries are rare injuries that could lead to serious complications, such as posttraumatic hip arthritis and coloarticular fistula. We report a case of a 25-year-old male who sustained a pelvic injury caused by a single bullet which led to a bilateral acetabular fracture, concomitant with a colon injury treated on an emergency basis by a diverting colostomy; acetabular fractures were treated conservatively by traction. After the patient recovered from the abdominal injury, he was presented with bilateral hip pain and limited motion; plain radiographs showed bilateral hip arthritis with proximal migration of the femoral head and bilateral acetabular defect classified as Paprosky type ⅢA. Reconstruction of the hips was performed using the same technique: impaction bone grafting for acetabular defect reconstruction and a reversed hybrid total hip arthroplasty (THA) 6 months apart. The patient presented with loosening of the left THA acetabular cup 3 years later, which was revised; then he presented with a discharging sinus from the left THA with suspicion of coloarticular fistula, which was confirmed using CT with contrast material. A temporary colostomy and fistula excision were performed, and a cement spacer was applied to the hip. After clearing the infection, a final revision THA for the left hip was performed. Treating post-firearm hip arthritis by THA is challenging, especially in the situation of neglected cases with the presence of an acetabular defect. Concomitant intestinal injury increases the risk of infection with the possibility of coloarticular fistula formation, which could present later. Working with a multidisciplinary team is paramount.

Double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula in uncircumcised patients with distal hypospadias / 亚洲男科学杂志(英文版)

Urethrocutaneous fistula may complicate hypospadias repair. We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula. The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula. A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital (Amman, Jordan). Boys who were aged between 6 months and 5 years, diagnosed with distal hypospadias, and not circumcised were included. The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The results showed a total of 163 boys with distal hypospadias; among them, 116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap, and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month, 6 months, and 12 months (6.9% vs 0, 10.3% vs 0, and 5.2% vs 0, respectively), and the difference after 6 months was statistically significant (P = 0.02).

Fístula colecistocutánea espontánea / Spontaneous Cholecystocutaneous Fistula

Introducción: La incidencia de fístula colecistocutánea ha disminuido debido al abordaje quirúrgico precoz de los pacientes con litiasis vesicular. Objetivo: Presentar un caso de fístula colecistocutánea secundaria a colecistopatía litiásica crónica. Caso clínico: Paciente femenina de 87 años de edad que fue atendida en los servicios de urgencia de cirugía luego de haber sufrido, 2 semanas antes, dolor en hipocondrio derecho acompañado de aumento de volumen progresivo de dicha región. Al examen físico se constató secreción espontánea de bilis oscura de carácter continuo por orificio fistuloso. Se decide llevar al salón de operaciones y se le realizó colecistectomía de cuello a fondo y colangiografía transcística visualizándose litos. Se procedió a realizar coledocotomía, extracción de cálculos con lavado de la vía biliar y se colocó sonda en T. La evolución fue satisfactoria. Conclusiones: El tratamiento combinado de cirugía y antibioterapia es curativo(AU)

Introduction: The incidence of cholecystocutaneous fistula has decreased due to the early surgical managment of patients with vesicular lithiasis. Objective: To present a case of cholecystocutaneous fistula secondary to chronic lithiasic cholecystopathy. Clinical case: An 87-year-old female patient was attended in the emergency surgical services after having suffered, two weeks earlier, pain in the right hypochondrium accompanied by progressive increase in volume in that region. Physical examination revealed spontaneous discharge of dark bile continuously through a fistulous orifice. The patient was decided to be taken to the operating room, where she was performed a profound infundibulum cholecystectomy and transcystic cholangiography, lithiasis being visualized. The next considered step was choledochotomy for stone extraction with bile duct lavage, and a T-tube was placed. Evolution was satisfactory. Conclusions: The treatment combining surgery and antibiotic therapy is curative(AU)

Morbimortalidad de pacientes sometidos a cirugía bariátrica en el Hospital Nacional de Itauguá: experiencia años 2017 a 2021 / Morbidity and mortality of patients undergoing bariatric surgery at the Hospital Nacional Itauguá: experience years 2017 to 2021

Introducción: la prevalencia de sobrepeso y obesidad en Paraguay es del 58 % en la población adulta, y 34,5 % en niños y adolescentes. Para enfrentar esta situación existen varios tratamientos, siendo el quirúrgico el medio terapéutico actual que permite obtener la mayor pérdida de peso y por tiempo más prolongado. Objetivo: describir la morbimortalidad de las cirugías bariátricas en el Hospital Nacional de Itauguá en el periodo comprendido entre enero 2017 y setiembre 2021. Metodología: estudio descriptivo, observacional, retrospectivo de corte transversal, con un muestreo no probabilístico de casos consecutivos de todos los pacientes con diagnóstico de obesidad que recibieron tratamiento quirúrgico entre enero 2017 a setiembre del 2021. Se recabaron 126 historias clínicas, 121 de ellos cumplieron los criterios de inclusión. Resultados: de 121 pacientes, 82 % eran mujeres y 18 % hombres, con una edad media de 37 años. Se realizó una gastrectomía vertical en 68 % y by-pass gástrico en 21 %, con una estadía hospitalaria promedio de 61 h. La fístula fue la complicación postoperatoria más frecuente (7 %) seguida de la dehiscencia de anastomosis (2 %). La morbilidad de la cirugía bariátrica fue 11 %, con una mortalidad del 1 %. Conclusión: la morbilidad de la cirugía bariátrica en el Hospital Nacional de Itauguá es baja, con una mortalidad aceptable. La técnica más realizada es la gastrectomía vertical y la fístula es la complicación más común.

Introduction: the prevalence of overweight and obesity in Paraguay is 58 % in the adult population, and 34.5 % in children and adolescents. There are several treatments to deal with these conditions, with surgery being the current therapeutic option that allows for the greatest weight loss and for the longest time. Objective: to describe the morbidity and mortality of bariatric procedures at the Hospital Nacional, Itauguá from January 2017 to September 2021. Metodology: descriptive, observational, retrospective cross-sectional study, with a non- probabilistic sampling of consecutive cases of all patients diagnosed with obesity who received surgical treatment between January 2017 and September, 2021. 126 medical records were collected, 121 of them met the inclusion criteria. Results: of 121 patients, 82 % were women and 18 % men, with a mean age of 37 years. Vertical gastrectomy was performed in 68 % and gastric bypass in 21 %, with an average hospital stay of 61 hours. Fistula was the most frequent postoperative complication (7 %) followed by anastomosis dehiscence (2 %). The morbidity of bariatric surgery was 11 %, with a mortality of 1 %. Conclusion: the morbidity of bariatric surgery at the Hospital Nacional, Itauguá is low, with an acceptable mortality rate. The most common technique is sleeve gastrectomy and fistula is the most common complication.

Presentación clínica y hallazgos radiográficos de pacientes con diagnóstico histopatológico de mastitis granulomatosa idiopática / Clinical presentation and radiological findings of patients with histopathological diagnosis of idiopathic granulomatous mastitis

INTRODUCCIÓN. La mastitis granulomatosa idiopática es una patología inflamatoria benigna de mama con clínica y hallazgos imagenológicos no específicos; usualmente confundida con cáncer de mama. El síntoma más frecuente es una masa mamaria palpable. El diagnóstico es histopatológico. OBJETIVO. Describir el perfil demográfico, presentación clínica y hallazgos radiográficos de pacientes con diagnóstico histopatológico de mastitis granulomatosa idiopática. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población de 1130 y muestra de 49 datos de historias clínicas electrónicas de pacientes con diagnóstico histológico de mastitis granulomatosa idiopática con el código CIE10 N61x Trastornos Inflamatorios de la mama, atendidas en la Unidad Técnica de Imagenología del Hospital de Especialidades Carlos Andrade Marín en la ciudad de Quito entre enero 2019 hasta diciembre 2021. El criterio de inclusión fue la confirmación histopatológica de mastitis granulomatosa idiopática. Los criterios de exclusión: antecedentes de neoplasia maligna de mama, antecedentes de HIV, patología inflamatoria sistémica como granulomatosis de Wegener, sarcoidosis, infecciones granulomatosas crónicas como tuberculosis, brucelosis, histoplasmosis, sífilis y reacciones a cuerpos extraños como material de implantes mamarios. Se analizaron datos demográficos, presentación clínica, hallazgos mamográficos, ecográficos y la categorización BIRADS. Se efectuó un análisis univarial; para las variables cualitativas se realizó frecuencias y porcentajes; para las variables cuantitativas se realizó medidas de tendencia central. La información recolectada fue analizada en el programa estadístico International Business Machines Statistical Package for the Social Sciences. RESULTADOS La mediana de la edad fue 36 años. El 94,00% de pacientes tenían por lo menos un hijo; 77,50% presentaron con una masa palpable; 55,10% se acompañaron de signos inflamatorios; 16,00% asociaron fístulas y 24,40% presentaron secreción. Solo 1 caso presentó afectación bilateral. CONCLUSIÓN En este estudio, la mastitis granulomatosa idiopática afecta a mujeres en edad reproductiva sin antecedentes de malignidad quienes presentan una masa mamaria palpable que puede estar acompañada de signos inflamatorios, colecciones y fístulas. La realización de una biopsia core eco guiada, para confirmar su diagnóstico.

INTRODUCTION. Idiopathic granulomatous mastitis is a benign inflammatory breast pathology with nonspecific clinical and imaging findings; usually mistaken for breast cancer. The most frequent symptom is a palpable breast mass. The diagnosis is histopathologic. OBJECTIVE. To describe the demographic profile, clinical presentation and radiographic findings of patients with histopathologic diagnosis of idiopathic granulomatous mastitis. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population of 1130 and sample of 49 data from electronic medical records of patients with histological diagnosis of idiopathic granulomatous mastitis with ICD10 code N61x Inflammatory disorders of the breast, attended at the Technical Imaging Unit of the Carlos Andrade Marín Specialties Hospital in the city of Quito between January 2019 and December 2021. The inclusion criterion was histopathological confirmation of idiopathic granulomatous mastitis. Exclusion criteria: history of malignant breast neoplasia, history of HIV, systemic inflammatory pathology such as Wegener's granulomatosis, sarcoidosis, chronic granulomatous infections such as tuberculosis, brucellosis, histoplasmosis, syphilis and reactions to foreign bodies such as breast implant material. Demographic data, clinical presentation, mammographic and ultrasound findings and BIRADS categorization were analyzed. Univariate analysis was performed; frequencies and percentages were used for qualitative variables; measures of central tendency were used for quantitative variables. RESULTS. The median age was 36 years. 94,00% of patients had at least one child; 77,50% presented with a palpable mass; 55,10% were accompanied by inflammatory signs; 16,00% were associated with fistulas and 24,40% presented with discharge. Only 1 case presented bilateral involvement. CONCLUSION. In this study, idiopathic granulomatous mastitis affects women of reproductive age with no history of malignancy who present with a palpable breast mass that may be accompanied by inflammatory signs, collections and fistulas. The performance of an echo-guided core biopsy to confirm the diagnosis.

Manejo de las fracturas maxilofaciales y sus complicaciones / Management of maxillofacial fractures and its complications

RESUMEN Antecedentes: el trauma maxilofacial corresponde a toda lesión traumática del macizo facial. Actualmente representa uno de los problemas de salud más importantes en el mundo. Nuestro objetivo es realizar un análisis de nuestra experiencia en las intervenciones realizadas en pacientes internados y sus complicaciones. Material y métodos: se realizó un estudio descriptivo, retrospectivo y observacional de 205 pacientes con fracturas maxilofaciales desde el año 2011 hasta el año 2019. Resultados: el 81,46% fueron hombres (n: 167) y el rango etario más afectado osciló entre los 21 y 30 años con el 38,54% (n:79). El accidente de tránsito 56,1% (n:115) fue el mecanismo de trauma más frecuente. Los tipos de fracturas faciales fueron: panfaciales 12,2% (n: 25), tercio superior 1,46% (n:3), tercio medio 72,2% (n:148) y tercio inferior 14,15% (n:29). Dentro del tercio superior, el 66,67% (n:2) fueron fracturas del seno frontal asociadas al hueso frontal, en el tercio medio las combinadas en un 54,73% (n:81) y en el tercio inferior, las complejas en el 34,48% (n:10). Fueron intervenidos 199 pacientes (97,07%). Solo el 11,56% (n:23) presentó alguna complicación. No se observaron complicaciones graves. Discusión: según nuestra serie, la mayoría de los pacientes fueron hombres jóvenes; la causa más frecuente, el accidente de tránsito, y el tercio medio, el más afectado, resultados estos similares a los de otros estudios publicados. El tratamiento quirúrgico fue principalmente reducción abierta y fijación con material de osteosíntesis de titanio, un procedimiento seguro y fiable, que permite restablecer la funcionalidad previa al traumatismo, con un índice muy bajo de complicaciones posoperatorias.

ABSTRACT Background: Maxillofacial trauma corresponds to all traumatic injuries affecting the facial bones. Nowadays, it represents one of the main healthcare issues worldwide. The aim of this study is to analyze our experience in the interventions performed in hospitalized and their complications. Material and methods: We performed a retrospective and observational study of 205 patients with maxillofacial fractures from 2011 to 2019. Results: 81.46% were men (n = 167) and 38.54% (n = 79) of the patients were between 21 and 30 years of age. Traffic collision was the most common mechanism of trauma (56,1%, n = 115). The types of facial fractures were panfacial (12.2%; n = 25), of the upper-third (1.43%; n = 3), of the middle-third (72.2%; n = 148) and of the lower third (14.15%; n = 29). In the upper third of the face frontal sinus fractures associated with the frontal bone were the most common (66.67%; n =2); in the middle-third combined fractures were most prevalent (54.73%; n = 81) while complex fractures were most frequent in the lower third (34,48%; n = 10). One-hundred and ninety-one patients were operated on (97.07%). Complications occurred in only 11.56% (n = 23) and were not serious. Discusion: In our series, most patients were young men, traffic collisions were the most common cause of trauma, and the middle third of the face was the most affected region. These results are similar to our publications. Surgical management, mostly by open reduction and fixation with titanium-based osteosynthesis material, is an effective, safe and reliable procedure, which allows the restoration of pre-trauma function, with very low rate of postoperative complications.

Cierre de fístula traqueocutánea recidivante / Closure of Recurrent Tracheocutaneous Fistula

Introducción: La fístula traqueocutánea es la complicación más frecuente de la traqueostomía, que lleva a la necesidad de usar diferentes tipos de plastias para lograr un cierre definitivo. Objetivo: Mostrar una opción de tratamiento quirúrgico para garantizar un cierre definitivo de la fístula traqueocutánea recidivante. Caso clínico: Se presenta paciente masculino de 45 años con antecedentes de traqueostomía sin cierre espontáneo; quien desarrolló fístula traqueocutánea tratada con doble plastia de deslizamiento frontal tipo Szymanowski, con posterior recidiva, motivo por el que acude a consulta. Se realizó cierre directo de mucosa traqueal con plicatura de músculo platisma y avance de colgajos de piel rectangulares para reforzar cobertura de la pared anterior de la tráquea. Se logró corregir la fístula mediante un procedimiento simple, rápido y efectivo. Conclusiones: Este método evita las dificultades encontradas en otros procedimientos y garantiza la corrección funcional y estética con el empleo de una técnica simple con baja morbilidad(AU)

Introduction: Tracheocutaneous fistula is the most frequent complication of tracheostomy, leading to the need to use different types of plasties to achieve a definitive closure. Objective: To show a surgical treatment option for guaranteeing a definitive closure of recurrent tracheocutaneous fistula. Clinical case: We present the case of a 45-year-old male patient with a history of tracheostomy without spontaneous closure, who developed tracheocutaneous fistula managed through double plasty of anterior sliding of Szymanowski type, followed by recurrence. Direct closure of the tracheal mucosa was performed with platysma muscle plication and advancement of rectangular skin flaps for reinforcing coverage of the anterior wall of the trachea. Correction of the fistula was achieved by a simple, fast and effective procedure. Conclusions: This method avoids the difficulties found in other procedures, and guarantees functional and aesthetic correction with the use of a simple technique with low morbidity(AU)

Endoluminal Vacuum Therapy (EVAC) in Managing Esophagogastric Anastomosis Fistula / Terapia de vacío endoluminal (Endo-Vac) en el manejo de la fístula de anastomosis esofagogástrica

Abstract Endoluminal vacuum therapy (EVAC) is a promising alternative for the endoscopic management of gastrointestinal fistulas or perforations that do not respond to endoscopic procedures using clips and stents or are even refractory to surgical procedures. In this case report, we describe the successful endoscopic closure of an esophagogastric anastomotic fistula using EVAC, connected to a vacuum system through a probe in the cavity, which did not close with clip management given the friability and edema of the peri-wound tissue. In conclusion, it is a successful alternative to treat these complications, which are sometimes difficult to resolve.

Resumen La terapia de vacío endoluminal (Endo-Vac) es una alternativa promisoria en el manejo endoscópico de las fístulas o perforaciones gastrointestinales, que no responden a procedimientos endoscópicos cuando se utilizan técnicas como clips, stents o incluso refractarias a procedimientos quirúrgicos. En este reporte de caso describimos el cierre endoscópico exitoso de una fístula anastomótica esofagogástrica, utilizando la terapia Endo-Vac, conectada a un sistema de vacío mediante una sonda en la cavidad, que no presentó cierre inicial a manejo con clips, dada la friabilidad y el edema del tejido perilesional. Se concluye que esta es una alternativa exitosa en el cierre de estas complicaciones, que en ocasiones son de difícil resolución.

Factores de riesgo de fístulas palatinas en pacientes tratados quirúrgicamente mediante palatoplastias / Risk factors for palatal fistulas in patients surgically treated with palatoplasty

La fisura palatina es una malformación congénita que afecta al paladar. Una fístula es la falla en la cicatrización en el sitio de reparación quirúrgica. Está presente en nuestro medio en un importante número de fístulas oronasales posterior a palatoplastias. El objetivo del presente trabajo es determinar los factores de riesgo de fisuras palatinas en pacientes tratados quirúrgicamente mediante palatoplastias La población de estudio fueron 82 pacientes que ingresaron al Servicio de Cirugía Pediátrica del Hospital Materno Infantil. En los resultados, la media de edad en el grupo de pacientes con fístula fue 1 año 2 meses, en el grupo sin fístula fue de 1 año. El más afectado es el sexo masculino y aumentan el riesgo de fístula los grados moderado y severo en 1.22 veces. También la exposición a más de dos cirugías aumenta 2.65 veces, el grado 4 aumenta 3.1, la desnutrición representa 2.93 veces. La prevalencia de fístulas es del 13%. Los factores de riesgo son: grado de fisura palatina moderado y severo, haber estado sometido a más de dos cirugías. De acuerdo al defecto primario el grado 3 y el grado 4 y la desnutrición también son factores de riesgo.

Cleft palate is a congenital malformation that affects the palate. A fistula is the failure of healing at the site of surgical repair. It is present in our environment in a significant number of oronasal fistulas after palatoplasty. The objective of this study is to determine the risk factors for palatal clefts in patients surgically treated with palatoplasty. The study population consisted of 82 patients who were admitted to the Pediatric Surgery Service of the Maternal and Child Hospital. In the results, the mean age in the group of patients with fistula was 1 year 2 months, in the group without fistula it was 1 year. The most affected is the male sex and the moderate and severe degrees increase the risk of fistula by 1.22 times. Exposure to more than two surgeries also increases 2.65 times, grade 4 increases 3.1, malnutrition represents 2.93 times. The prevalence of fistulas is 13%. The risk factors are: moderate and severe degree of cleft palate, having undergone more than two surgeries. According to the primary defect, grade 3 and grade 4 and malnutrition are also risk factors.

Trombose de seio sigmoide secundária a fístula liquórica espontânea para osso temporal: um relato de caso / Sigmoid sinus thrombosis secondary to spontaneous temporal bone cerebrospinal fluid fistula: a case report

A fístula liquórica para o osso temporal constitui um evento raro que decorre da comunicação anormal entre o espaço subaracnóideo e as células da mastoide, permitindo que o líquido cefalorraquidiano flua para as porções pneumatizadas do osso temporal. Tem como consequência a hipotensão intracraniana espontânea, caracterizada por perda de líquor e pela manifestação clínica de cefaleia ortostática. Acredita-se que a hipotensão intracraniana espontânea crie condições hemodinâmicas favoráveis à ocorrência de trombose venosa cerebral, uma desordem potencialmente fatal e de difícil diagnóstico, visto a inespecificidade de sinais clínicos e sintomas. Dessa forma, é pertinente atentar para a possibilidade de trombose venosa cerebral em pacientes com fístulas liquóricas, especialmente quando houver mudança do padrão da cefaleia, que passa de ortostática a intensa e contínua.

Temporal bone cerebrospinal fluid fistula is a rare event that results from abnormal communication between the subarachnoid space and the mastoid cells, allowing the cerebrospinal fluid to flow into the pneumatized portions of the temporal bone. It leads to spontaneous intracranial hypotension, characterized by loss of cerebrospinal fluid and orthostatic headache as a clinical manifestation. Spontaneous intracranial hypotension is believed to create favorable hemodynamic conditions to the occurrence of cerebral venous thrombosis, a potentially fatal disorder of difficult diagnosis given the nonspecific clinical signs and symptoms. Therefore, it is pertinent to consider the possibility of cerebral venous thrombosis in patients with cerebrospinal fluid fistulas, especially when there is a modification in the headache pattern from orthostatic to intense and continuous pain.

Rol de las imágenes en la patología arterial no ateroesclerótica poco frecuente en el abdomen / Role of images in rare vascular pathology in the abdomen

Resumen La patología arterial no ateromatosa constituye un grupo de patologías poco frecuentes, pero de gran importancia debido a su morbilidad y mortalidad asociadas. La presentación clínica de estas entidades es inespecífica, por lo que el estudio inicial con imágenes es fundamental. Debido a esto, es muy importante reconocer los signos radiológicos característicos de cada una en las diversas modalidades imagenológicas para poder sospechar y orientar el diagnóstico.

Abstract Non-atheromatous arterial pathology constitutes a group of infrequent pathologies but of great importance due to their associated morbidity and mortality. In general, the clinical presentation of these pathologies is quite nonspecific, so the clinician decides to perform imaging studies thinking of more common entities. It is for this reason that it is very important to recognize characteristic radiological signs in the various imaging modalities to be able to suspect and orient a pathology of this kind.

Economic burden of obstetric fistula among patients in the National Obstetric Fistula Centre, Nigeria

Background: Obstetric fistula (OF) continues to be a major health problem in developing countries such as Nigeria. It is a communication between the vagina and bladder/rectum following prolonged obstructed labor that leads to urine/and fecal leakage per vaginam. There is a paucity of information on cost of accessing care by women with OF. Objective: The study was to evaluate the cost implications of accessing care and treatment among women with OF in the National Obstetric Fistula Centre, Ningi Bauchi, state. Materials and Methods: A prevalence-based cost-of-illness approach was employed in this study to estimate the cost of fistula treatment from the patients' perspective. Data on costs of health-care utilization of services rendered to the patients in the facility and indirect costs were estimated. The data were analyzed with the Statistical Package for the Social Sciences (SPSS V21). Results: A total of 75 women participated in the study. The total costs incurred by all the 75 patients amounted to Nigerian Naira (NGN) 8211640.00 (USD 26923.41). The average cost of accessing care for fistula per patient was NGN109488.50 (USD 358.98). Direct cost accounted for 5751740.00 (USD 18858.16), whereas the indirect cost was 2785600.00 (USD9133.11). There was a significant difference in cost of care between patients that were teenagers compared to those who were not (P = 0.04) and the type of treatment (P < 0.001). Conclusions: The cost of illness of OF is high in the studied area, and the patients are from the low socioeconomic background. Both the direct and indirect costs were high relative to the national minimum wage in Nigeria. The age of the patients and the type of treatment received by the patient accounted for the differences in cost of illness between the patients.

"Massive hemoptysis" and shock after fever and cough / 中国当代儿科杂志

A boy, aged 11 years, was admitted due to intermittent fever for 15 days, cough for 10 days, and "hemoptysis" for 7 days. The boy had fever and cough with left neck pain 15 days ago, and antibiotic treatment was effective. During the course of disease, the boy developed massive "hemoptysis" which caused shock. Fiberoptic bronchoscopy revealed a left pyriform sinus fistula with continuous bleeding. In combination with neck and vascular imaging examination results, the boy was diagnosed with internal jugular vein injury and thrombosis due to congenital pyriform sinus fistula infection and neck abscess. The boy was improved after treatment with temperature-controlled radiofrequency ablation for the closure of pyriform sinus fistula, and no recurrence was observed during the follow-up for one year and six months. No reports of massive hemorrhage and shock due to pyriform sinus fistula infection were found in the searched literature, and this article summarizes the clinical features, diagnosis, and treatment of this boy, so as to provide a reference for the early diagnosis of such disease and the prevention and treatment of its complications.

Análisis de factores predictivos en la aparición de fístulas faringocutáneas poslaringectomía total / Analysis or predictive factors associated with pharingocutaneous fistulas after total laryngectomy

RESUMEN Antecedentes: la fístula faringocutánea es la complicación más común luego de una laringectomía total. Los factores implicados en su aparición son estudiados por numerosos autores sin obtener resultados concluyentes. Objetivo: Evaluar las causas de aparición de fístula faringocutánea y describir los factores de riesgo implicados en la aparición de fístulas faringocutáneas en la población estudiada. Material y métodos: estudio retrospectivo, observacional, con análisis estadístico de variables. Se consideraron 55 pacientes a quienes se les realizó una laringectomía total inicialmente o como rescate, desde enero de 2000 hasta diciembre de 2019, con una proporción hombre/mujer de 48/7. La edad media fue de 61,3 años. El 96,36% con diagnóstico anatomopatológico de carcinoma epidermoide. Análisis estadístico (prueba de chi cuadrado-prueba de Mann-Whitney) de variables relacionadas con la aparición de fístula faringocutánea. Resultados: la incidencia de fístulas alcanzó el 20% de los pacientes laringectomizados. Cerraron espontáneamente el 72,73% de las fístulas y requirieron el uso de colgajos, 3 (27,27%) pacientes. De los pacientes fistulizados, el 63,64% tenían radioterapia previa. El uso de sonda nasogástrica para alimentación se prolongó en dichos pacientes por más de 15 días. El tiempo de internación promedio de los pacientes fistulizados fue de 23 días. Conclusión: en nuestro medio, el factor más asociado a la aparición de fístulas tras laringectomía fue el uso de radioterapia previa. La fístula en estos pacientes tardó más tiempo en cerrarse y requirió en algunos casos reconstrucciones más complejas.

ABSTRACT Background: Pharyngocutaneous fistula is the most common complication after total laryngectomy. The factors associated with its development have been studied by several authors without conclusive results. Objective: To evaluate the causes for the development of PCF and to describe the risk factors associated with PCF in the population studied. Material and methods: We conducted a retrospective and observational study with statistical analysis of the variables. A total of 55 patients undergoing initial or salvage total laryngectomy from January 2000 to December 2019 were included. Male-to-female ratio was 48/7. Mean age was 61.3 years. The pathological diagnosis was epidermoid carcinoma in 96.36% of the cases. Statistical analysis: (chi square test and Mann-Whitney test) of the variables related with the development of pharyngocutaneous fistula. Results: The incidence of fistula in patients with laryngectomy was 20%. Spontaneous closure occurred in 72.73% and 3 patients (27.27%) required the use of flaps. In patients with fistula, 63.64% had previous radiotherapy. In these patients, the use of nasogastric tube feeding lasted > 15 days. Mean length of hospital stay in patients with fistula with 23 days. Conclusion: In our environment, previous radiotherapy was the most significant factor associated with the development of fistula. In these patients, fistula took longer to close and required more complex reconstructions in some cases.

Diagnosis and treatment of deep neck abscess due to congenital piriform sinus fistula in children / Diagnóstico e tratamento de abscesso cervical profundo por fístula congênita do seio piriforme em crianças

Abstract Introduction: Congenital piriform sinus fistula is a relatively rare type of disease in clinical practice, most occurring during childhood, but doctors have insufficient knowledge regarding this disease, easily misdiagnosing it. Objectives: This study aimed to identify the characteristics of deep neck abscess due to congenital piriform sinus fistula in children. Methods: We performed a retrospective study of 21 cases from January 2016 to August 2018 in our hospital. The onset age, clinical characteristics, auxiliary examination and clinical treatment of the patients was summarized to analyze the diagnosis, treatment characteristics and prognosis. Results: Children from 11 days to 12 years-old were enrolled, with an average age of 3.5 years. Twenty patients had left congenital piriform sinus fistula and 1 had right congenital piriform sinus fistula. Cervical enhanced computed tomography imaging showed gas-liquid equilibrium or air-shadow in the abscesses in 18 cases, and neck ultrasound demonstrated gas echo in the thyroid region in 10 cases. All patients underwent low temperature plasma to seal the internal fistula and returned to the hospital for electronic laryngoscope and neck ultrasound examination at 3 months, 6 months and 1 year after the surgery. No recurrence occurred in any patient. Conclusion: Congenital piriform sinus fistula is an important cause of deep neck abscess in children. The presence of purulent gas-liquid equilibrium or air shadow in cervical-enhanced computed tomography or ultrasound suggests a high possibility of the presence of an internal fistula, and endoscopic low temperature ablation can be done at the same time as the diagnostic endoscopy.

Resumo Introdução: A fístula congênita do seio piriforme é uma doença relativamente rara na prática clínica; a maioria se manifesta na infância; entretanto, os médicos geralmente têm conhecimento insuficiente sobre essa condição clínica e seu diagnóstico é facilmente feito de forma errônea. Objetivo: Identificar as características do abscesso cervical profundo devido à fístula congênita de seio piriforme em crianças. Método: Estudo retrospectivo de 21 casos de janeiro de 2016 a agosto de 2018 em nosso hospital. Idade de início, características clínicas, exames auxiliares e tratamento clínico dos pacientes foram resumidos para analisar o diagnóstico, as características do tratamento e o prognóstico. Resultados: Foram incluídas crianças de 11 dias a 12 anos, com média de 3,5 anos. Vinte pacientes tinham fístula congênita de seio piriforme no lado esquerdo e um no lado direito; a tomografia computadorizada cervical com contraste mostrava distribuição líquido-gasosa ou sombra aérea nos abscessos em 18 casos. O ultrassom cervical demonstrou eco gasoso na região da tireoide em 10 casos. Todos os pacientes foram submetidos a plasma de baixa temperatura para queimar a fístula interna e retornaram ao hospital para exame com laringoscópio eletrônico e ultrassonografia cervical aos 3 meses, 6 meses e um ano após a cirurgia. Não houve recorrências. Conclusão: A fístula congênita de seio piriforme é uma causa importante de abscesso cervical profundo em crianças. A presença de conteúdo líquido-gasoso purulento ou sombra gasosa na tomografia computadorizada ou no ultrassom cervical sugere uma alta possibilidade da presença de uma fístula interna e a ablação endoscópica a baixa temperatura pode ser feita ao mesmo tempo que a endoscopia diagnóstica.