Aortoenteric fistulas - our experiences with surgeons' nightmare.

BACKGROUND: Aortoenteric fistula (AEF) is a rare medical emergency, but one of the most difficult and threatening complications of gastrointestinal (GI) bleeding. METHODS: A retrospective observational study was performed on patients hospitalised with GI bleeding and a definitive AEF diagnosis. We collected operative reports and medical records of patients operated on with an AEF diagnosis. The literature data and our data were analysed and discussed. RESULTS: We admitted eight patients who were definitively diagnosed with AEF after reviewing our hospital records. All patients were male except one. Their ages ranged from 28 to 82, with a mean of 64. All but two patients had secondary AEF (SAEF). Four SAEF cases had open aortic surgery and three had a history of endovascular procedure. The main complaints of the patients on admission were poor general condition, abdominal pain, and GI bleeding. Melena was found in all patients. Hematemesis and hematochezia were other significant GI bleeding findings. Infected grafts were removed in all but one patient; extra-anatomical bypass surgery and bowel repairs were performed. One patient underwent endovascular repair. In all patients, the 30-day in-hospital mortality rate was 50%. CONCLUSION: In patients presenting with GI bleeding, an aortoenteric fistula should be considered. The outcome depends on early diagnosis, the patient's medical status, the severity of infection, and the anatomic location of the affected aorta. A multidisciplinary approach, appropriate treatment planning and close follow-up after treatment lead to positive outcomes.

Quality of life in chronic kidney disease: effects of treatment modality, depression, malnutrition and inflammation.

In the present study, our aim is to investigate the effects of the treatment modality, depression, malnutrition and inflammation on quality of life (QoL) in chronic kidney disease (CKD). Twenty-six patients with CKD on conservative management, 68 patients on haemodialysis (HD), 47 patients on continuous ambulatory peritoneal dialysis (CAPD) and 66 healthy controls were enrolled in the study. QoL was measured by means of the Short Form-36 (SF-36) and subscale scores were calculated. All patients were evaluated for the presence of depression using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders - Clinician Version. The severity of depression was evaluated by means of the Beck Depression Inventory (BDI). Serum C-reactive protein (CRP), ferritin, albumin, haemoglobin and haematocrit (Hct) levels were measured. All the SF-36 subscale scores were lower in the patient groups compared with control group. The SF-36 scores were higher and BDI scores were lower in the CAPD group than CKD and HD groups. In patients with depression, all SF-36 subscale scores were lower than that of the patients without depression. There was a significant negative correlation between all the SF-36 subscale scores and the BDI scores. There was a significant positive correlation between the SF-36 physical and total summary scores and the Hct value and serum albumin levels, but an inverse correlation between the SF-36 physical, mental and total summary scores and the serum CRP level in the HD patients. The authors suggest that the treatment modality, depression, malnutrition and inflammation have an important role on QoL in CKD.