Coronaro Cameral Fistula: Literature Review, Diagnosis and Management, about a Case

A coronary fistula is defined as a direct connection between a coronary artery and a heart chamber, great vessel, or other vascular structure that "bypasses" the myocardial capillary bed. This is a rare pathology that is usually not discovered until later in life, and exceptionally not during childhood. We report the case of a young patient who was hospitalized for chest pain and shortness of breath and who was found to have a coronary fistula on angiography. A 66-year-old patient. Hypertension on dual therapy for 16 years and diabetes on OAD (Oral Antidiabetic) for 4 years. He was hospitalized with typical angina pectoris and dyspnea, and the stress test was positive. Laboratory examination revealed a good general condition with NYHA stage 3 dyspneic angina pectoris extending to the upper extremities and no evidence of heart failure. Looking at the balance, we see a slight increase in troponin. ECG returns to regular sinus rhythm, with electrical LVH (left ventricular hypertrophy) and ambient negative waves, no rhythm or conduction abnormalities. Transthoracic echocardiography (TTE) reverses hypertensive heart disease with good global and partial contractility without significant valvular disease associated with systolic pulmonary arterial pressure (SPAP) at 35 mmHg. Coronary angiography is performed and shows evidence of minor involvement of the central CX artery and a coronary camera fistula from the first diagonal artery draining into the left ventricle. Management was about optimizing medical care. The patient received an appointment and was declared discharged. Coronary camera fistulae are rare, found in approximately 0.3% of coronary angiographic studies performed. Most are congenital and may occur primarily due to trauma, erosive infection of the vessel wall, or iatrogenicity during transluminal coronary angioplasty, myocardial biopsy, or valve replacement. In many cases, simple but complex forms can be described. The gold standard for confirming the diagnosis remains coronary angiography, which highlights both the affected arteries and drainage sites. Cardiac scanners occupy an increasingly important position, especially as they provide morphologically accurate information. Surgical or percutaneous treatment of the fistula with a coil is recommended in symptomatic adult patients, especially those with significant or complicated right-to-left shunts. The authors suggest treatment with ?-blockers when multiple sinusoidal fistulas associated with ventricular wall hypertrophy are present. Close monitoring is recommended for asymptomatic small fistula. Corneal fistula is a rare congenital or acquired condition that is mostly asymptomatic and discovered in adulthood. Coronary angiography and heart scan can be used to confirm the diagnosis. Treatment is usually surgical or endovascular. However, in some cases, drug treatment with beta-blockers may help.

Reconstrução de palato com malha de polipropileno e prótese acrílica para correção de fístula oronasal adquirida em cão / Palate reconstruction with polypropylene mesh and acrylic prosthesis in dog for correcton of acquired oronosal fistulae

As fístulas oronosais adquiridas são defeitos que permitem a comunicação anormal entre as cavidades oral e nasal. Inúmeras causas podem ser atribuídas à etiologia de tal defeito. O presente trabalho visa relatar o caso de um cão com fístula oronasal adquirida que foi submetido à reconstrução cirúrgica do palato com o uso de malha de polipropileno e prótese acrílica. Após estabilização do quadro clínico e remoção manual das larvas, o paciente foi encaminhado para o desbridamento cirúrgico das lesões orais e correção do defeito no palato. A palatoplastia foi realizada com o uso da malha e resina de polimetilmetacrilato autopolimerizável. A malha foi suturada sobre o defeito palatino com pontos simples separados e fio náilon 3-0 nas extremidades da ferida. Em seguida, a resina foi preparada e, ao atingir consistência adequada, foi aplicada e modelada sobre o a malha de polipropileno com o auxílio de um descolador de Molt, sendo também suturada nas bordas da fístula com pontos simples separados e fio náilon 3-0. No mesmo tempo cirúrgico foi inserida uma sonda esofágica para alimentação enteral. Devido complicações cirúrgicas no pós operatório, o paciente foi submetido a mais duas intervenções cirúrgicas para desfecho satisfatório do tratamento. Conclui-se que associação entre a tela de polipropileno e a prótese acrílica foi uma alternativa exequível para a palatoplastia em cão.

Acquired oronosal fistulae are abnormal communication between the oral and nasal cavities. A oronasal fistula can be the result of different causes, like oral myiasis. The objetctive of these paper is to report the case of a dog with acquired oronasal fistula that underwent surgical reconstruction of the palate using polypropylene mesh and acrylic prosthesis. After stabilization of the patient ́s clinical condition and mecanic removal of the larvae, the dog was referred for surgical debridement of the oral lesions and correction of the defect in the palate. Palatoplasty was performed using a mesh and polymethylmethacrylate resin. The mesh was sutured over the palatal defect with separate simple suture and 3-0 naylon thread at the ends of the wound. Then, the resin was prepared and, upon reaching adequate consistency, it was applied and shaped over the polypropylene mesh with Molt peeler. It was also sutured on the edges of the fistula with separate simple suture and 3-0 nylon suture. At the same surgical time, an esophageal tube was inserted for enteral feeding. Due to complications, the dog underwent two more surgical interventions for a satisfactory treatment outcome. It is concluded that the association between the polypropylene mesh and the acrylic prosthesis was a practical alternative for palatoplasty in dogs after oral myiasis.

The effect of percutaneous transluminal angioplasty in the treatment of autogenous arteriovenous fistula stenosis and influencing factors of restenosis/loss of function after PTA / 中国医师杂志

Objective:To analyze the effect of percutaneous transluminal angioplasty (PTA) in the treatment of autogenous arteriovenous fistula (AVF) stenosis and influcing factors of restenosis/loss of function after PTA.Methods:The medical records of 104 patients with AVF stenosis treated by PTA in People′s Hospital of Huadu District from March 2019 to July 2020 and the 1-year follow-up were retrospectively analyzed. Kaplan-meier curves were used to analyze the primary patency rates at 3 months, 6 months and 1 year. COX regression was used to analyze the influencing factors of restenosis/loss of function after PTA.Results:The primary patency rates of AVF at 3, 6 and 12 months after PTA were 86.2%, 83.2% and 64.7%, respectively. Guide wire entry into the distal end of radial artery, the use of two balloons in stepwise mode, postoperative dilatation diameter, and dialysis blood flow after PTA were independent risk factors for restenosis/loss of fuction after PTA for AVF stenosis (all P<0.05). Conclusions:The guide wire into the distal end of the artery and passive use of more than two balloons are important factors affecting AVF restenosis/loss of function after PTA .

Closure of Oronasal Fistulae Post Palatoraphy with Tongue Flap in Bilateral Complete Cleft Lip Palate Patient: A Case Report

ABSTRACT@#Oronasal fistulae are common complication following palatoraphy. There are several surgical procedures to repair oronasal fistulae. However, conventional oronasal fistulae closure technique is not always possible, especially when the surrounding tissue is replaced by fibrotic tissue due to previous palatoraphy. Tissue defects in oronasal fistulae should be replaced with tissues providing good vascularisation such as pedicle tongue flap. A case of pedicle tongue flap used to close oronasal fistulae was reported. Eleven-year-old girl, presented with oronasal fistulae and bilateral alveolar cleft after previous palatoraphy. The oronasal fistulae were closed with pedicled tongue flap. The healing was uneventful, and the division of the pedicle tongue flap was done three weeks later and closed primarily. There was no dehiscence of the wound and masticatory functions were recorded. Vascularised flap such as pedicle tongue flap is a preferred technique to close oronasal fistulae after palatoraphy.

Fechamento de comunicação buco-sinusal utilizando o corpo adiposo bucal: Relato de Caso Clínico / Closure of oroantral communications using buccal fat pad: technique report

Introdução: As comunicações buco-sinusais (CBS) são complicações cirúrgicas relativamente frequentes na prática odontológica, relacionadas à extração dos molares superiores. As CBS permitem a passagem de alimentos e outras substâncias para o interior do seio maxilar, propiciando, assim, quadros infecciosos conhecidos como Sinusites. O tratamento das CBS é desafiador. Objetivo: Relatar um caso clínico de fístula bucossinusal tratada pela técnica de fechamento com o corpo adiposo bucal. Relato de caso: paciente do gênero masculino, 59 anos, leucoderma, sem alterações de ordem sistêmica, compareceu ao ambulatório de Pós-graduação da Universidade do Sagrado Coração relatando como queixa principal o fato de "sair líquidos pelo nariz" durante alimentação e havia iniciado após realizar exodontia de raiz residual do dente 16. O mesmo relatou que após a exodontia foi realizada uma tentativa de fechamento da fístula buco-sinusal através do reposicionamento do retalho vestibular e não foi obtido sucesso. Após 45 dias de condicionamento da mucosa do seio maxilar através de irrigações com soro fisiológico e clorexidina a 0,12% foi proposto ao paciente e realizado o fechamento da fístula buco-sinusal através da utilização do corpo adiposo bucal. Conclusão: atualmente para se alcançar o alto índice de sucesso no fechamento de comunicações busco-sinusais utilizamos esta técnica descrita, por ser um procedimento simples e que porprociona resultados satisfatórios ao paciente.

Introduction: Bucosinusal communications are relatively frequent surgical complications in dental practice. Although several conditions are related to this type of communication, the exodontia of upper posterior teeth presents as the main etiological factor. They are diagnosed through fistulas, which communicate the buccal and sinus cavities, thus allowing the passage of food and other substances into the maxillary sinus, thus providing infectious pictures known as Sinusites. Objective: through the report of a clinical case of buccosalusal fistula, we will focus on the success of the closure of buccomasinal communication with Bichat Adipose Body. Technique report: male patient, 59 years old, leucoderma, with no systemic alterations, who attended the University of the Sacred Heart Postgraduation outpatient clinic reporting as a main complaint the fact of "getting fluids through the nose" during feeding and that this had started after performing a residual root exodon of element 16. It also reported that after the exodontia, an attempt was made to close the buccosinusal fistula through the repositioning of the vestibular flap and no success was achieved. After 45 days of conditioning the maxillary sinus mucosa through irrigations with saline solution and 0.12% chlorhexidine, the patient was proposed and the buccosinusal fistula was closed using the Bichat Adipose Body. Conclusion: Today, in order to achieve the high success rate in the closure of buscossinusal communications, we use the Bichat Adipose Body, because it is a simple procedure and provides satisfactory results for the patient.

“Ligation of Intersphincteric Fistula Tract (Lift)" The Solution in Perianal Fistulae? – A Prospective Observational Study in 30 Simply Randomised Cases

Ligation of Intersphincteric Fistulous Tract (LIFT) is a novel and promising technique in the management of Fistula in ano. We tried to assess the outcome of LIFT procedure in our institute in terms of healing rate, incontinence and recurrences. Methods: A prospective observational study was performed in the Department of General Surgery, IPGMER and SSKM Hospital, Kolkata, India between January 2016 and August 2017. Thirty patients were selected with simple randomization after applying all inclusion and exclusion criteria and all underwent LIFT procedure. Results: Among the 30 patients included in our study, the healing rate varied from 76.7% in 2-week follow-up to 93.3% on 6 months follow-up. One patient had Grade B incontinence from which he recovered within 1 month. One diabetic patient had recurrence of the disease. Conclusion: LIFT is a promising procedure for both simple or complex fistulas with single or multiple tracts with minimum incidence of incontinence or recurrence. However, larger randomised controlled trials with large study population is required.

Outcomes of Infected versus Symptomatic Sterile Walled-Off Pancreatic Necrosis Treated with a Minimally Invasive Therapy

BACKGROUND/AIMS: Acute pancreatitis complicated by walled-off necrosis (WON) is associated with high morbidity and mortality, and if infected, typically necessitates intervention. Clinical outcomes of infected WON have been described as poorer than those of symptomatic sterile WON. With the evolution of minimally invasive therapy, we sought to compare outcomes of infected to symptomatic sterile WON. METHODS: We performed a retrospective cohort study examining patients who were undergoing dual-modality drainage as minimally invasive therapy for WON at a high-volume tertiary pancreatic center. The main outcome measures included mortality with a drain in place, length of hospital stay, admission to intensive care unit, and development of pancreatic fistulae. RESULTS: Of the 211 patients in our analysis, 98 had infected WON. The overall mortality rate was 2.4%. Patients with infected WON trended toward higher mortality although not statistically significant (4.1% vs 0.9%, p=0.19). Patients with infected WON had longer length of hospitalization (29.8 days vs 17.3 days, p<0.01), and developed more spontaneous pancreatic fistulae (23.5% vs 7.8%, p<0.01). Multivariate analysis showed that infected WON was associated with higher odds of spontaneous pancreatic fistula formation (odds ratio, 2.65; 95% confidence interval, 1.20 to 5.85). CONCLUSIONS: This study confirms that infected WON has worse outcomes than sterile WON but also demonstrates that WON, once considered a significant cause of death, can be treated with good outcomes using minimally invasive therapy.

Fístulas arteriovenosas congénitas en Ecuador / Congenital arteriovenous fistulae in Ecuador

Introducción: El Síndrome de Klippel Trenaunay es uno de los síndromes congénitos neuro-cutáneos con afecciones vasculares, es de presentación poco frecuente y caracterizado por angioma o nevus flammeus, hipertrofia asimétrica de tejidos blandos y várices, aunque se pudieran observar otras alteraciones asociadas. Objetivo: Identificar la frecuencia y las características de las fístulas arteriovenosas en Ecuador. Métodos: De un total de 3 000 enfermos atendidos por distintas causas vasculares, se detectaron y estudiaron 23 pacientes diagnosticados con fístulas arteriovenosas congénitas por examen clínico y estudios complementarios (escaniometría de miembros, gasometría venosa comparativa de miembros, presión de oxígeno y angiotomografía axial computarizada dinámica). Se analizaron las siguientes variables: edad, sexo, localización de las fístulas y tratamiento. Resultados: Se encontró una elevada frecuencia de fístulas (34,7 por ciento) en menores de un año, seguidos de grupo de edades entre 6 a 10 años (26 por ciento). Se constató que la localización más frecuente (86,6 por ciento) correspondió a los miembros inferiores y el tratamiento médico fue el más utilizado. Conclusiones: En Ecuador existe una alta frecuencia de fístulas arteriovenosas congénitas, sobre todo en las edades tempranas de la vida. En el diagnóstico de esta enfermedad se destaca la importancia de la clínica y de la gasometría venosa comparativa(AU)

Introduction: Klippel Trenaunay syndrome is an infrequent congenital neurocutaneos syndrome causing vascular conditions, and characterized by angioma or nevus flammeus, asymmetric hypertrophy of soft tissue and varicose veins, although other associated alterations might be observed. Objective: To identify the frequency and characteristics of arteriovenous fistulae in Ecuador. Methods: Out of 3 000 patients, who were seen because of various vascular causes, 23 patients were detected and studied. They had been diagnosed with congenital arteriovenous fistulas based on clinical examination and complementary studies (of limb scanning, comparative venous blood gasometry to determine oxygen pressure and dynamic axial angiotomography. The following variables were analyzed: age, sex, location of fistulas and treatment. Results: High frequency of fistulas (34.7 percent) was found in children aged less than one year, followed by 6- 10 years age group (26 percent). The most frequent location (86.6 percent) was in lower limbs and medical treatment was the most widely used. Conclusions: In Ecuador, there is high frequency of congenital arteriovenous fistulae, above all at early ages of life. Clinic study and comparative venous blood gasometry are important for the diagnosis of this disease(AU)

Síndrome de Hemivagina Obstruida, Útero Didelfo y Agenesia Renal Ipsilateral (OVHIRA), Drenado Parcialmente por Fístula Útero-Uterina Espontánea / Obstructed Hemivagina Syndrome, Uterus didelphys and Ipsilateral Renal Agenesis (OVHIRA), Partially Drained by Spontaneous Uterine-Uterine Fistula

RESUMEN Antecedentes: El síndrome de hemivagina obstruida, útero didlefo y anomalía renal ipsilateral (OVHIRA) es una malformación mülleriana infrecuente. Objetivo: Se presenta un caso con una complicación no antes descrita y se hace una revisión de la literatura hasta la fecha. Caso clínico: Mujer de 12 años de edad con antecedentes de diagnóstico de útero bicorne y agenesia renal derecha en la infancia. Veintidós meses post menarquia consulta por algia pelviana y dismenorrea premenstrual. Ecografía revela hematómetra en cuerpo uterino izquierdo, de 142 x 69 x 61 mm. Resonancia nuclear magnética (RNM) describe además un hematocolpos de 7 x 10 cm y un tabique vaginal transverso de hemivagina izquierda. Se diagnostica OHVIRA y se planifica cirugía para resecar el tabique. Días antes del la cirugía, la paciente tiene episodio de metrorragia. Ecográficamente se constata una disminución considerable del volumen de hematómetra. En la cirugía se pesquisa fístula uterina que comunica útero obstruido izquierdo con útero no obstruido derecho por donde había drenado espontáneamente la hematómetra. Al resecar el tabique vaginal izquierdo se termina de drenar hematómetra y hematocolpos. Al alta, paciente se maneja con dilatación vaginal progresiva por seis meses para evitar la estenosis del tabique. Conclusión: Se presenta una complicación no descrita, fístula útero uterina, de una malformación mülleriana infrecuente (OVHIRA). El proceso diagnóstico meticuloso, la cirugía bien planificada y la dilatación vaginal prolongada permitieron tener éxito en su manejo.

ABSTRACT Background: Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome (OHVIRA) is an uncommon Müllerian anomaly. Objective: A case is described and the main complications related to the syndrome are reviewed. Case report: Female, 12 years old, with a medical history of a bicornuate uterus and right renal agenesis diagnosed at birth. Twenty-two months post menarche she seeks medical attention due to pelvic pain, menometrorrhagia and premenstrual dysmenorrhea. An ultrasound revealed a hematometra, of 142 x 69 x 61 mm, in the left uterus. Magnetic resonance imaging also described a 7 x 10 cm hematocolpos and a transverse vaginal septum of the left hemivagina. OHVIRA is diagnosed and surgery is planned to resect the septum. Two days before the surgery, the patient has an episode of abundant metrorrhagia. Ultrasonographically a considerable decrease in the volume of the hematometra is observed. In surgery, a uterine fistula is discovered which communicates the left obstructed uterus with the right unobstructed uterus, where the hematometra had been partially drained. During the procedure, the left vaginal septum is resected, which completes the drainage of the hematometra and hematocolpos. At discharge, the patient undergoes progressive vaginal dilation for six months to avoid stenosis of the septum. Conclusion: An utero-uterine fistula has not been previously described as a complication of OHVIRA. The meticulous diagnostic process, the well planned surgery and the prolonged vaginal dilation allowed for a successful management.

Tongue flap combined with local mucosal flap for repairing palate fistulae / 中华医学美学美容杂志

Objective To introduce a modified surgical technique for repairing palate fistulae.Methods Based on the clinical categories of palate fistulae,local mucosal flap was designed,if possible,to reduce the area of the fistulae and reshape the fistulae.Then the thin tongue flap with anterior pedicle was designed for repairing the palate fistulae,without much limitation of tongue movement and excessive tension of tongue flap pedicle short lingual frenulum correction was performed firstly to release the motion of tongue,if necessary.The donor site was closed directly.Three weeks later division of the tongue flap,as well as detailed appearance correction of tongue,was carried out at the same time.Results 12 cases were treated,and followed up for 6-12 months.For all the cases,the defect of fistulae was totally repaired,while aesthetics appearance of tongue was satisfactory,and no interference with speech with the use of tongue as donor site.Oral hygiene and mastication were unimpaired.No patient described disability of sensory or gustatory postoperatively.Conclusions Tongue flap has sufficient blood supply,while impairment of donor site is minimal.The planning and procedure of surgery are relatively simple.It is an ideal flap in treatment of palate fistulae.

Supra-auricular versus Sinusectomy Approaches for Preauricular Sinuses

Abstract Introduction Several surgical techniques and modifications have been described to reduce the high recurrence rate after excision of preauricular sinus. Objectives The aim of this study is to review the literature regarding surgical approaches for preauricular sinus. Data Synthesis We performed searches in the LILACS, MEDLINE, SciELO, PubMed databases and Cochrane Library in September, 2015, and the key words used in the search were "preauricular sinus," "sinusectomy," "supra-auricular approach," "methylene blue," and/or "recurrence." We revised the results of 17 studies, including 1270 preauricular sinuses that were surgically excised by sinusectomy in 937 ears and by supra-auricular approach in 333 ears. Recurrence with supra-auricular was 4 (1.3%) while sinusectomy was 76 (8.1%) with significant difference (p< 0.0001). There were no reported facial nerve paresis or paralysis in any of the approaches. The sinusectomy approach showed significantly more complications (p= 0.0048). Conclusion Supra-auricular approach had significantly less recurrence rate than tract sinusectomy approaches. Thus, it could be regularly chosen as the standard procedure for preauricular sinus excision. As such, it would be helpful for surgeons to be familiar with this approach.

The formation of bronchocutaneous fistulae due to retained epicardial pacing wires: A literature review.

Temporary epicardial pacing wires during open‑heart surgery are routinely used both for diagnostic and treatment purposes. In complicated cases where patients are unstable or the wires are difficult to remove, the pacing wires are cut at the skin level and allowed to retract by themselves. This procedure rarely causes complications. However, there have been cases reporting that retained pacing wires are linked to the formation of sterno‑bronchial fistulae, which may present a while after the date of operation and are usually infected. This review aims to study the cases presenting sterno‑bronchial fistulae due to retained epicardial pacing wires and to highlight the important factors associated with these. It is important to note these complications, as fistulae may cause a variety of problems to the patient if undiagnosed and left untreated. With the aid of scans such as fistulography, fistulae can be identified and treated and will improve the patients’ health dramatically.

Osteomyelitis caused by Sporothrix schenckii in an immunocompetent patient

Abstract Sporotrichosis is the most common subcutaneous mycosis in South America and its association with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil. The disease most commonly presents as subacute or chronic cutaneous lesions, although dissemination to various organs and systems occurs in rare cases, mainly in immunosuppressed individuals. This report describes a case of sporotrichosis with severe bone and subcutaneous damage in an immunocompetent patient who did not exhibit the characteristic skin lesions of sporotrichosis, including ulcers, nodules, and lymphangitis.

Colgajo lingual excelente alternativa para el cierre de Fístulas Oronasales: reporte de un caso

Reportamos el caso de una paciente femenina de 24 años, de la ciudad de Cajamarca referida a nosotros, a quien evaluamos, preparamos y operamos quirúrgicamente con un colgajo lingual largo de base anterior, irrigado por la arteria lingual en el servicio de cirugía plástica y quemados del Hospital Nacional Arzobispo Loayza para lograr el cierre, en dos tiempos operatorios (día 0 y luego al día 22) de una gran fistula oronasal que provocaba rinofonía y reflujo nasal de los líquidos y alimentos; debido a la dehiscencia anterior de una palatoplastía realizada en su ciudad a la edad de 2 años en una campaña gratuita extranjera de labio y paladar fisurados

We report the case of a female patient of 24 years old from the city of Cajamarca referred to us, whom we evaluated, prepared and made a surgery with a tongue flap along the previous base, irrigated by the lingual artery in the Plastic Surgery and Burns Section at the Archbishop Loayza National Hospital to achieve the closing two stages (day 0 and then day 22 ) of a large oronasal fistula that caused rinofonía and nasal reflux of liquids and food; due to previous dehiscence Palatoplasty carried out in his city at the age of 2 years in a free foreign campaign of cleft lip and palate

A Surgical Technique for Congenital Preauricular Sinus

BACKGROUND: Preauricular sinuses represent a common congenital abnormality in children. Classically, a preauricular sinus manifests as a small opening, usually near the anterior limb of ascending helix. The difficulty in the surgical treatment of preauricular sinus is the high recurrence rate. The aim of this article is to review the outcomes of preauricular sinus and to introduce our surgical technique and its prognosis. METHODS: A single-institutional retrospective review was performed for all patients who had undergone excision of congenital periauricular sinus between October 2007 and April 2014. Medical records were reviewed for demographic information, wound complication, and recurrence rate. The sinus tract was visualized with the aid of preoperative dye instillation and intraoperative probe insertion. The skin next to the sinus opening was incised elliptically, and the tract itself was dissected medially to the end of the sinus tract and posteriorly to the cartilage of the ascending helix. RESULTS: The review identified 44 patients for a total of 57 preauricular sinus tracts. The mean age at time of operation was 16.3 years with a range from 9 months to 65 years. Unilateral preauricular sinus tract was present in 31 patients (11 right and 20 left preauricular tract), and 13 patients had bilateral sinus tract. None of the patients had experienced wound issues postoperative, and there were no recurrent sinus tract formation or infection. CONCLUSION: Using a combination of dye instillation, probe insertion, and modified dissection, we were able to achieve a recurrence free series of preauricular sinus tract excision among a heterogenous group of patients. A large patient series is necessary to replicate the results of this study.

Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: A case series

Objective To describe a novel technique of repairing the VVF using the transperitoneal-transvaginal approach. Materials and Methods From June 2011 to October 2013, four patients with symptoms of urine leakage in the vagina underwent robotic repair of VVF with the transperitoneal-transvaginal approach. Cystoscopy revealed the fistula opening on the bladder. A ureteral stent was placed through the fistulous tract. After trocar placement, the omental flap was prepared and mobilized robotically. The vagina was identified and incised. The fistulous tract was excised. Cystorrhaphy was performed in two layers in an interrupted fashion. The vaginal opening was closed with running stitches. The omentum was interposed and anchored between the bladder and vagina. Finally, the ureteral catheters were removed in case they have been placed, and an 18 Fr urethral catheter was removed on the 14th postoperative day. Results The mean age was 46 years (range: 41 to 52 years). The mean fistula diameter was 1.5 cm (range 0.3 to 2 cm). The mean operative time was 117.5 min (range: 100 to 150 min). The estimated blood loss was 100 mL (range: 50 to 150 mL). The mean hospital stay was 1.75 days (range: 1 to 3 days). The mean Foley catheter duration was 15.75 days (range: 10 to 25 days). There was no evidence of recurrence in any of the cases. Conclusions The robot-assisted laparoscopic transperitoneal transvaginal approach for VVF is a feasible procedure when the fistula tract is identified by first intentionally opening the vagina, thereby minimizing the bladder incision and with low morbidity. .

Post Closure Evaluation of Coronary Artery Fistulae.

Coronary artery fistula (CAF) is a rare congenital anomaly in which a communication is present between a coronary artery and cardiac chamber. Conventional coronary angiography is an invasive and expensive procedure, and cannot provide three-dimensional data. ECG gated multidetector CT (MDCT) is useful for non-invasive evaluation of coronary artery fistulae. Objectives: In this paper, we describe ten postclosure cases of coronary artery fistulae. The aim of this study is to demonstrate the effectiveness of 128 sliceMDCT in demonstrating the precise anatomy and post closure follow-up of coronary artery fistula. Methods: 10 pediatric subjects underwent MDCT as well as conventional coronary angiography. Good quality images were obtained in all patients to analyze the coronary artery fistulae and their anatomic course. Results: MDCT not only provided precise details of post closure CAF but also clearly delineated anatomy of other coronary arteries. Catheter-related risks like bleeding at puncture site, hematoma formation were completely eliminated. Advances in Knowledge: MDCT may provide additional precise details of CAF. It also eliminates minor as well as more serious complications of catheter angiography and a small but definite incidence of mortality. The procedure is carried out as an outpatient procedure. Thus, MDCT is considered as a good alternative to echocardiography and coronary angiography for diagnosis as well as follow-up of CAF.

Living with Obstetric Fistula: Perceived Causes, Challenges and Coping Strategies among Women Attending the Fistula Clinic at Mulago Hospital, Uganda.

Aims: To determine perceived causes, challenges and coping mechanisms of women living with obstetric fistula (OF) in Uganda. Study Design: Cross-sectional study. Place and Duration of the Study: Mulago National Referral Hospital Uganda – January to July 2009. Methodology: Thirty women with OF were interviewed on challenges, coping mechanisms and perceived causes of OF using semi-structured questionnaires. Two focus group discussions were held with 10 caretakers of the women with OF and key informant interviews with 10 health care providers. Results: Majority of the women (21; 70%) were young (<25 years) had primary education (20; 67%) and had lived with OF for 2-9 years (20; 67%). The main perceived causes of OF were injury by surgeon (8; 27%), delivery of a big baby (7; 23%) and prolonged labor (4; 13%). Nearly all women with OF (27; 90%) reported that OF had detrimentally affected their health and well being; 26 women (87%) lost their children at birth or within the neonatal period. Families were affected by high cost of treatment (13; 43%); provision of basic items (10; 32%), and suffered stress (17; 55%). Women coped with OF by hiding from the general public (27; 90%), maintaining strict hygiene (25; 83%), ignoring people’s comments (23; 75%) or resorting to prayer (18; 57%). Conclusion: Women with OF experienced physical, emotional and socio-economic challenges and coped with OF through non-effective social measures. There is need to strengthen strategies to prevent OF and enhance OF rehabilitation services for affected women and their families.

Traumatic arteriovenous fistula of the superficial temporal artery / Fístula arteriovenosa traumática de artéria temporal superficial

Arteriovenous fistulae of the superficial temporal artery are rare, and their principal cause is traumas. Complications include pulsatile mass, headache, hemorrhage and deformities that compromise esthetics. Treatment can be performed using conventional surgery or endovascular methods. The authors describe a case of a 44-year-old male patient who developed a large pulsating mass, extending from the preauricular region to the right parietotemporal and frontal regions after a motorcycle accident. The treatment chosen was complete surgical removal of the pulsatile mass and ligature of the vessels feeding the fistula.

As fístulas arteriovenosas de artéria temporal superficial são raras, sendo o trauma sua etiologia principal. Suas complicações incluem massa pulsátil, cefaleia, hemorragia e deformidade estética. O tratamento pode ser realizado por cirurgia convencional ou endovascular. Os autores relatam o caso de um paciente de 44 anos que evoluiu com massa pulsátil extensa desde região pré-auricular até região parietotemporal e frontal direita após acidente motociclístico. Optou-se por remoção cirúrgica completa da massa pulsátil e ligadura dos vasos nutridores da fístula.