Variant Types of Preauricular Sinuses: Classifications, Clinical Presentation and Management.

OBJECTIVE: To make surgeons aware of the differing types of preauricular sinuses (PAS), we summarize our experience with diagnosis and treatment of varying types of PAS. METHODS: We retrospectively reviewed clinical data from patients who had undergone preauricular fistulectomy between March 2015 and March 2020. These patients were categorized into two groups according to locations of congenital fistula pit. RESULTS: Twelve patients with variant PAS accounted for 6.8% (12/177) of all patients. The variant types of PAS could be classified into three types (from type 1 to type 3), based on the location of the fistula pit. Type 1 (seven patients; eight ears) patients had pits located on the ascending helix crus, whereas type 2 (four patients, four ears) and type 3 (one patient, one ear) patients had pits located on the external auditory canal (EAC) and lobule, respectively. Fistular tracts penetrated the cartilage of the helix crus in seven of the type 1 variant ears. Swelling and discharge were located at the ascending helix crus (in four ears), cavum concha (in two ears), and posterior to the auricle (in one ear). In four of the type 2 ears, the fistular tracts were located at the anterior margin of the ascending limb of the helix. CONCLUSION: Fistula tracts where fistula pit occurred on the ascending helix crus were more likely to penetrates through the cartilage, and fistula tracts with fistula pits that occurred on the EAC were adjacent to the cartilage of the ascending helix and tragus. Meticulous dissection and complete removal of fistula tissue are critical to avoid postoperative recurrence. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:3839-3845, 2024.

Resultados del uso del irrigador transanal en la disfunción intestinal asociada a malformaciones anorrectales / Results of the use of the transanal irrigator in intestinal dysfunction associated with anorectal malformations

Introducción: Existen múltiples herramientas para optimizar la función defecatoria en pacientes con malformación anorrectal (MAR): hábitos, laxantes, irrigaciones retrógradas o anterógradas. Estas se adecuan de forma progresiva y combinada. El objetivo de este estudio fue evaluar la incorporación del dispositivo de irrigación transanal (ITA) al tratamiento del estreñimiento y la incontinencia fecal en pacientes con MAR. Materiales y métodos: Estudio retrospectivo en pacientes con MAR con indicación del ITA según el protocolo de manejo intestinal del consultorio de patología colorrectal desde el 2015 al 2022. Tras usarlo más de 3 meses, los pacientes o sus cuidadores completaron un cuestionario telefónico propio aprobado por el comité de ética. Resultados: 39 pacientes con MAR: 11 fístulas rectouretrales, 6 rectovesicales, 16 cloacas, 2 rectovaginales, 2 perineales y 2 vestibulares. El 44% presentó un Índice Sacro < 0,4. El 62% presentaban estreñimiento y el 38% incontinencia. Debido al uso del ITA, mejoró la sensación de confianza y seguridad en muy alto y alto grado en el 89% de los pacientes. Disminuyó mucho el tiempo dedicado a su manejo intestinal en el 68%. El 79% refiere mejoría en su calidad de vida con 9 y 10 puntos. El 92% calificaron su satisfacción general con ITA con un valor de 8, 9 y 10 siendo 10 completamente satisfecho. El 100% lo recomiendan. Conclusión. El ITA es una buena alternativa para el manejo intestinal de la incontinencia fecal y el estreñimiento.(AU)

Introduction: There are multiple tools available to optimize defecation in patients with anorectal malformation (ARM), such as habits, laxatives, and retrograde or anterograde irrigations, which are usually adapted in a progressive and combined fashion. The objective of this study was to assess the incorporation of transanal irrigation (TAI) to constipation and fecal incontinence treatment in patients with ARM. Materials and methods: A retrospective study of ARM patients with indication of TAI according to the colorectal pathology unit’s intestinal management protocol from 2015 to 2022 was carried out. Following use for over 3 months, patients or their guardians completed a phone survey of our own approved by the ethics committee. Results. 39 ARM patients participated in the study. Pathologies included 11 rectourethral fistulas, 6 rectovesical fistulas, 16 cloacae, 2 rectovaginal fistulas, 2 perineal fistulas, and 2 vestibular fistulas. 44% of them had a sacral index < 0.4. 62% had constipation, and 38% had incontinence. Thanks to TAI, confidence and safety improved in a very high and a high degree in 89% of the patients, whereas time devoted to intestinal management decreased a lot in 68% of them. 79% reported a 9- and 10-point quality-of-life improvement. 92% rated overall satisfaction with TAI with a score of 8, 9, and 10 –10 meaning “completely satisfied.” 100% recommend TAI. Conclusion. TAI is a good alternative for the intestinal management of fecal incontinence and constipation.(AU)

Low incidence of milk fistula with continued breastfeeding following radiologic and surgical interventions on the lactating breast.

BACKGROUND: Milk fistula is a potential complication of radiologic and surgical procedures on the lactating breast, though its incidence is unknown. Some postulate that larger defects and/or closer proximity to the nipple increase the risk of fistula. OBJECTIVE: This study aimed to estimate the incidence of milk fistula and characterize risk factors in patients who continued breastfeeding after surgical or radiological procedures. METHODS: A retrospective cohort analysis of pregnant or lactating women treated at a multidisciplinary breast clinic from July 2016 through August 2019 was performed. Demographic and clinical variables were analyzed using ANOVA and Pearson's Chi-square. RESULTS: Two pregnant and 43 lactating patients underwent 71 interventions. The incidence of milk fistula within one week of intervention was 1.4%. One fistula was diagnosed six days after retroareolar abscess drainage. The fistula closed successfully with continued breastfeeding. When categorized by the caliber of the most invasive intervention (large-caliber: mass excision, n = 7; medium-caliber: percutaneous drain insertion, n = 18; small-caliber: stab incision, aspiration, core needle biopsy, n = 20), patients were similar in age, race/ethnicity, weeks postpartum, and frequency of central versus peripheral interventions. The low incidence of fistula prevented quantitative evaluation of potential risk factors. CONCLUSIONS: Milk fistula is a rare occurrence following radiologic or surgical breast interventions performed during pregnancy or lactation. Indicated procedures should not be deferred, but periareolar approaches should be avoided when possible. Cessation of lactation is not mandatory for fistula closure, and continued breastfeeding should be recommended.

Clinical Characteristics of Patients with Cochlear Fistulas Caused by Chronic Otitis Media with Cholesteatoma.

OBJECTIVES: To analyze the clinical characteristics of cochlear fistulas (CFs) and propose a new fistula classification system with regard to the cochlea. MATERIALS AND METHODS: A retrospective chart review was conducted between January 2008 and December 2015 to identify patients who had undergone surgery for cholesteatoma with an associated CF. The following data were collected: preoperative symptoms, findings of temporal bone computed tomography (TBCT), fistula stage, cholesteatoma classification, surgical technique, and pre- and postoperative pure-tone audiometry. RESULTS: We analyzed a total of 159 patients, out of which 9 (5.7%) were diagnosed with a CF. The average duration of the chronic otitis media was 19.8 years. Cholesteatomas that induced CF rarely existed in the nonaggressive state; recurrent otorrhea was observed in all but one of our subjects. All the patients with CF had a distinct origin of cholesteatoma that developed from the retraction of posterior pars tensa; further, 88.9% cholesteatomas extended to and filled the sinus tympani. Preoperative audiometry revealed total hearing loss in 4 (44.4%) patients. Further, five patients with residual hearing before surgery had stage I fistulas, and the bone conduction thresholds remained stable after surgery. CONCLUSION: Cochlear fistulas were often detected in patients with (1) a history of chronic otitis media (exceeding 10 years), (2) frequently recurring otorrhea, and (3) pars tensa cholesteatomas that extended to the posterior mesotympanum and filled the sinus tympani. Such patients can suffer from potentially severe and irreparable sensorineural hearing loss.

[Research progress of congenital preauricular fistula].

Congenital preauricular fistula can be sporadic or genetic. When inherited, it exhibits incomplete autosomal dominant genetic patterns. It can occur alone or with other diseases such as branchio-oto-renal syndrome. According to the position of fistula opening, congenital ear fistula can be divided into four categories: congenital preauricular fistula, congenital posterior ear fistula, congenital auricular fistula and congenital external auditory canal fistula. Congenital auricle fistula can be subdivided into congenital auricular fistula, congenital teal fistula, congenital earlobe fistula and so on. The diagnosis of preauricular fistula should be based on its clinical manifestation, and the diagnosis and treatment of special type of preauricular fistula should be emphasized. The treatment methods of congenital preauricular fistula include medicine, incision and surgical excision. According to the clinical practice of us and other scholars, surgical treatment is recommended in the period of acute infection, and the recurrence rate is not increased. The operation method of preauricular fistula, the application of microscope, dye tracer, probe and general anesthesia, and the clear surgical visualization are all helpful to reduce the recurrence rate.

Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal.

PURPOSE: The aim of the study is to determine the predisposing factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) or extended TL and, secondarily, to propose a new severity-based classification system. METHODS: This is a retrospective study of 400 patients who underwent TL or extended TL. Major fistula was defined as a fistula (1) persisting for ≥ 4 weeks, (2) requiring surgical treatment, or (3) associated with perioperative mortality. RESULTS: PCF formation occurred in 93 patients (23.3%) and major fistula in 72 (18.0%). Extended surgery with partial or total pharyngectomy, previous treatment with radiotherapy, and postoperative hemoglobin levels < 99 g/L were associated with a significantly higher risk of developing major fistula. CONCLUSIONS: We propose a new PCF classification system according to clinical severity. Predictors of major fistula were the type of surgery, previous radiotherapy, and low (< 99 g/L) postoperative hemoglobin levels. We consider the use of onlay flaps in irradiated patients who require partial pharyngectomy.

Incidence of Palatal Fistula at Time of Secondary Alveolar Cleft Reconstruction.

OBJECTIVE: We aim to establish consistent time points for evaluating palatal fistula incidence to standardize reporting practices and clarify prospective literature. DESIGN: An institutional retrospective chart review was conducted on 76 patients with unilateral or bilateral complete cleft lip and palate who underwent secondary alveolar bone grafting between 2006 and 2015. MAIN OUTCOME MEASURES: Early fistula incidence rates were reported prior to maxillary expansion, and late fistula rates were reported at the time of alveolar bone grafting. Fistula recurrence rates after primary repair were also measured. RESULTS: We found an early fistula incidence rate of 20% (n = 15) and a late fistula rate of 55% (n = 42) at the time of secondary ABG. Fistulae recurred after initial repair in 43% of cases. Fistulae were classified using the Pittsburgh Classification System as type III (33%), type IV (60%), or type V (7%). The presence of a bilateral cleft ( P = 0.01) and history of early fistula repair ( P < 0.01) were associated with late fistula incidence in a univariate analysis. In a logistic regression model, only early fistula repair was associated with late fistula incidence (OR = 17.17) and overall likelihood of recurrence (OR = 70.89). CONCLUSIONS: Early fistulae should be reported prior to orthodontic expansion of the maxillary arch. Late fistulae should be reported at the time of ABG, following palatal expansion. Patients who develop an early fistula after palatoplasty are likely to experience recurrent fistula formation.

Fístulas perianales: caracterización con resonancia magnética / Perianal fistulas: magnetic resonance classification

Las fístulas perianales constituyen una problemática frecuente en la consulta médica actual, con un gran impacto en la morbilidad. Su tratamiento no está exento de complicaciones, como la recurrencia local y la incontinencia fecal. La resonancia magnética (RM) cumple un rol fundamental en la planificación preoperatoria de estos casos, ya que la notable resolución espacial de los equipos de última generación permite generar un mapa de la anatomía de la pelvis menor, señalando el número y la relación de los trayectos con el esfínter anal. El objetivo del presente trabajo es identificar los distintos tipos de fístulas en base a sus características por RM, haciendo énfasis en la anatomía de la región y la técnica de estudio de esta entidad.

Perianal fistulas are a prevalent problem in current medical practice, with a high impact on morbidity. The treatment is not exempt from complications, such as local recurrence and faecal incontinence. Magnetic resonance imaging (MRI) performs an essential role insurgical planning of these patients, since the high spatial resolution of the latest equipment provides more precise information of the pelvis anatomy, indicating the number and relationship of the fistulous tracks with the anal sphincter. The aim of this work is to identify the different types of fistulas based on MRI classification, with particular emphasis on the local anatomy and study techniques.

Parity as a predictor of obstetric fistula classification.

INTRODUCTION AND HYPOTHESIS: Obstetric fistulas are injuries to the genital tract in women without emergency obstetric services. Parity may predict the characteristics of fistulas that affect closure success and residual incontinence. Circumferential fistulas may predispose patients to postoperative incontinence. We hypothesized that primiparous women have more distal fistulas than multiparous women, leading to more scarring and circumferential fistulas. METHODS: A retrospective observational study was conducted on 1,856 women with obstetric fistula evaluated at three sites by three providers. Fistulas were classified using the Goh classification system. Women aged 10 to 55 years were classified as primiparas or multiparas. Analysis by parity of fistula type and size, degree of scarring, and presence of circumferential defect used the Chi squared or Fisher's exact test, and binary logistic regression. RESULTS: Of the 1,841 (99.2 %) women included, 878 (47.7 %) were primiparas and 963 (52.3 %) were multiparas. Primiparas were more likely to have distal fistulas, type 4 being most common (31.5 %), whereas multiparas were more likely to have proximal fistulas, most commonly type 1 (48.1 %). Primiparas were more likely to have moderate to severe scarring (11.7 % vs 5.6 %; p < 0.001), and category III (57.1 % vs 39.2 %; p < 0.001), but not to develop circumferential fistulas (5.6 % vs 4.0 %; p = 0.127), be present for repeat surgery (7.1 % vs 7.6 %; p = 0.721), or have ureteric involvement (1.5 % vs 2.2 %; p = 0.301). Multivariate analyses confirmed increased risk with primiparity for distal fistula and scarring. CONCLUSIONS: As hypothesized, primiparas were more likely to have distal fistulas and more scarring, but were not more likely to have circumferential fistulas. Surgeons should plan accordingly.

Valoración de la implantación del seguimiento ecográfico del acceso vascular autólogo / Assessment to the implementation of an ultrasound monitoring of autologous vascular access

Un acceso vascular adecuado es imprescindible para el tratamiento renal sustitutivo mediante hemodiálisis. Las enfermeras participan de forma fundamental en el seguimiento del mismo. El acceso vascular autólogo es considerado el acceso vascular de elección, pero también es el que más complicaciones iniciales presenta. El objetivo de este trabajo es valorar la eficacia del ecógrafo para el seguimiento y punción de estos accesos vasculares. Material y Métodos: Estudio observacional retrospectivo de octubre 2014 a febrero 2015. Se incluyeron 53 pacientes con fístula autóloga. 31 con acceso vascular en uso y 22 con acceso de nueva creación. Se inició el uso del ecógrafo previa formación específica en ecografía doppler de tres enfermeras y un nefrólogo. Se realizaron 73 ecografías en las que se determinaron flujo arterial, diámetro y profundidad venosa, anomalías anatómicas y disfunciones. Resultados: Se identificaron 9 accesos autólogos de nueva creación con flujos arteriales por debajo de parámetros de normalidad. Se asociaron a accesos vasculares menores de 3 meses, flujos menores de 500 ml/min. De 15 estenosis identificadas hubo un mayor porcentaje en accesos radiocefálicos, también se confirmaron 2 trombosis completas y 1 parcial. Se realizaron 9 punciones ecoasistidas en fístulas autólogas de nueva creación y se modificaron zonas de punción habituales en 8 pacientes. Conclusiones: El ecógrafo ha demostrado ser un instrumento útil para facilitar las punciones y seguimiento del acceso vascular. Permite identificar nuevas zonas de punción. Permite una valoración objetiva de los AV autólogos mediante parámetros ecográficos favoreciendo su seguimiento y alertando de forma temprana sobre posibles disfunciones, posibilitando el tratamiento precoz de éstas. Permite establecer protocolos de seguimiento de acceso vascular más estrecho en sus tres primeros meses de vida y de forma estandarizada a lo largo de la vida del AV (AU)

An adequate vascular access is essential for renal replacement therapy by hemodialysis. Nurses participate in the monitoring of this fundamentally. Autologous vascular access is considered the preferred vascular access, but also the one with more initial complications. The aim of this study is to evaluate the efficacy of ultrasound for monitoring and puncture of this vascular access. Methods: A retrospective observational study from October 2014 to February 2015 was carried out. Fifty-three patients with autologous fistula were included: 31 already in use and 22 newly implanted vascular access. The use of ultrasound scanner was initiated prior specific training to three nurses and a nephrologist at Doppler echography. Seventy-three ultrasound scans which determined blood flow, venous diameter and depth, anatomical abnormalities and dysfunctions were carried out. Results: Nine newly-implanted autologous vascular accesses with arterial flows below normal parameters were identified. Puncture sites were modified in 8 cases. 9 ultrasound assisted punctures were performed in newly-implanted autologous fistulas. Fifteen stenosis were identified. Two full and one partial thrombosis were confirmed. An association between vascular accesses (VA) younger than 3 months and flows below 500 ml / min was found. Increased percentage of stenosis in radiocephalic VA was identified. Conclusions: The ultrasound scanner has proven to be a useful tool to facilitate punctures and monitoring of vascular access. It identifies new areas of puncture and allows an objective evaluation of autologous AV by ultrasound parameters favoring its monitoring and alerting on possible malfunctions early, allowing early treatment of these. This allows establishing protocols for monitoring in narrow VA during its first three months and in a standardized manner throughout the life of the VA (AU)

Cuantificación del deterioro funcional durante seis meses en pacientes renales en estadio terminal / Quantificación of functional impairment for six months in hemodialysis patients

Introducción: Los pacientes en tratamiento de diálisis presentan una disminución de la función física, sin embargo, no hay estudios que demuestren el ritmo al que se produce este deterioro funcional. El objetivo principal es cuantificar el deterioro funcional de los pacientes en tratamiento de diálisis durante seis meses. Métodos: 43 pacientes en tratamiento de diálisis de dos centros de Valencia (España) (edad 61.3 (14.7) años) fueron analizados después de 6 meses. Los participantes completaron el Short Physical Performance Battery, equilibrio monopodal, el Timed Up and Go Test, Sit to stand to Sit Test 10 y 60, dinamometría de mano; elevación de talón y 6 minutos marcha. Además se recogieron datos de las historias clínicas y de las analíticas. Resultados: Tres de las pruebas mejoraron significativamente tras el periodo de 6 meses de observación: el Sit To Stand 10, la dinamometría de la mano derecha y la dinamometría de la mano izquierda, pero sin alcanzar un cambio clínico relevante. Por otro lado, otras medidas no obtuvieron un deterioro significativo como fueron el Short Physical Performance Battery, el Sit to Stand 60, la elevación del talón izquierdo y el 6 minutos marcha. Conclusiones: Después de 6 meses, en ninguna de las pruebas de capacidad funcional se observa un deterioro significativo. Se recomienda a los centros de hemodiálisis realizar un seguimiento de capacidad funcional anualmente, ya que con un periodo de 6 meses no se encuentran cambios significativos (AU)

Introduction: Patients in dialysis treatment present a decrease in physical function. However, we cannot find in the literature the rhythm of the functional deterioration. The main aim is quantify the functional deterioration in patients undergoing haemodialysis during six months period. Methods: 43 patients in dialysis treatment from two centres from Valencia (Spain) (age 61.3 (14.7) years old) were recruited and monitored after the 6 months period. Study participants performed the Short Physical Performance Battery, one leg stand, TUG, Sit to Stand 10 and 60, handgrip dynamometry, the one leg heel rise and the 6 minutes walking time. Outcomes: Three tests improve significantly: the Sit to Stand 10, the right and the left Handgrip Dynamometry. Nevertheless, we cannot observe a significant deterioration as the Short Physical Performance Battery, the Sit to Stand 60, the one leg heel rise in the left leg and the 6 minutes walking time. Conclusions: After 6 months, we have not observed a significant deterioration in the tests. We recommended the different units to follow the functional capacity of the patients yearly, because with a period of 6 months we have not find significantly changes (AU)

Outcome of patients after single-stage repair of perineal fistula without colostomy according to the Krickenbeck classification.

PURPOSE: The aim of the study is to assess the characteristics and outcome of anorectal malformation (ARM) patients who underwent single-stage repair of perineal fistula without colostomy according to the Krickenbeck classification. METHODS: From 2002 to 2013, twenty-eight males and four females with perineal fistula who underwent single-stage repair without colostomy in our institute were included in this study. Patients with perineal fistula who underwent staged repair were excluded. Demographics, associated anomalies, and operative complications were recorded. The type of surgical procedures and functional outcome were assessed using the Krickenbeck classification. RESULTS: Six patients had associated anomalies, including two patients with renal, two with cardiac, one with vertebral, and one with limb abnormalities. Thirteen patients underwent perineal operation, and fourteen patients underwent anterior sagittal approach in the neonatal period. One patient underwent anterior sagittal approach, and four patients underwent PSARP beyond the neonatal period. One patient had an intra-operative urethral injury and one a vaginal injury. Complications were not associated with the type of surgical procedure (p=0.345). All perineal wounds healed without infection. By using the Krickenbeck assessment score, all sixteen children older than five years of age had voluntary control. One patient had grade 1 soiling, and no patient had constipation. CONCLUSIONS: Single-stage operation without colostomy was safe with good outcomes in patients with perineal fistula. The use of Krickenbeck classification allows standardization in assessment on the surgical approach and on functional outcome in ARM patients.

Non-cameral coronary artery fistulae after pediatric cardiac transplantation: a multicenter study.

BACKGROUND: Cameral coronary artery fistulae (C-CAFs) are common after heart transplantation (HTx) and typically drain into the right ventricle. The development of CAFs to non-cameral structures after HTx has not been systematically investigated. We studied the incidence, anatomic distribution, and natural history of non-cameral CAFs (NC-CAFs) in a multicenter pediatric population. METHODS: Medical records from pediatric HTx patients at 2 centers from January 1, 1999, to August 31, 2009 were reviewed. A classification system for CAF size was developed, and serial angiograms were evaluated for CAF presence, size, and anatomy. Risk factors and outcomes were determined. RESULTS: Identified were 100 patients with a median age at HTx of 8.7 years. Median follow-up was 4.2 years. NC-CAFs occurred in 52 patients, C-CAFs in 20, with both types noted in 11. NC-CAFs originated from coronary arteries and drained predominantly into ipsilateral recipient pulmonary vasculature. Multiple NC-CAFs occurred in 19 patients (19%) for a total of 77 fistulae in 52 patients. Fistulae were classified as small (56%), moderate (36%), and large (8%). NC-CAFs were present at the first post-HTx angiogram in 95% of cases (median 1 year after HTx). Longer donor ischemic time was associated with the development (p = 0.043) and size (p = 0.05) of NC-CAFs. NC-CAFs were not associated with rejection, death, re-transplantation, or coronary revascularization, and none required intervention. CONCLUSIONS: Fistulae from donor coronary arteries to recipient pulmonary vasculature develop frequently and early after pediatric HTx. These correlate with graft ischemic time, but are not associated with early graft loss or death.

Importancia de la exploración física y técnicas de imagen en la valoración diagnóstica de las fístulas de ano / Importance of physical examination and imaging techniques in the diagnosis of anorectal fistulae

Objetivos: Se diseña un estudio para valorar el papel de exploración clínica y métodos de imagen en el diagnóstico de la fístula de ano. Material y métodos: Efectuamos un estudio observacional con recogida prospectiva de datos en 120 pacientes, mediante evaluación clínica por un explorador experimentado (EE), un cirujano sin especial dedicación a la coloproctología (EC) y una exploración con anestesia (EQ), ultrasonografía endoanal (UEA) y resonancia magnética (RM), usando como referencia los hallazgos durante la cirugía. Resultados: La EQ fue significativamente mejor que la del EE o EC para detección de orificio interno (OFI), trayecto primario y cavidades abscesuales (CA). La UEA fue significativamente más sensible y exacta que el EE para identificar OFI y CA, pero no respecto a la EQ. La RM fue más sensible que el EE en la identificación de OFI, trayectos transesfinterianos, supraesfinterianos y CA sin diferencias significativas con la UEA, y más sensible que la EQ para detectar CA. Conclusiones: La exploración bajo anestesia sigue teniendo un importante lugar en la evaluación de pacientes con fístula de ano. Los métodos de imagen son complemento ocasional de una valoración clínica que puede ayudar a los menos experimentados a decidir el tratamiento apropiado y fundamentalmente cuando se sospecha de una fístula compleja (AU)

Aim: The study was designed to determine the role of clinical examination and imaging techniques in the diagnosis of anorectal fistula. Material and methods: We performed an observational study with prospective recruiting using the data of 120 patients, by means of clinical evaluation by an experienced coloproctologist surgeon (EE), a surgeon without special training in coloproctology (CE), and examination under anaesthesia (SE), endoanal ultrasound (EAU) and magnetic resonance (MR), using the surgical findings as a reference. Results: SE was significantly better than EE or CE for detecting an internal opening (IO), primary track and abscess cavities (AC). EAU was significantly more sensitive and accurate than the EE in identifying an IO, and AC, but not compared to the SE. MR was more sensitive than the EE in the identification of the IO, transphincter and suprasphincter tracks and AC with no significant differences compared to EAU, and more sensitive than the SE to detect AC. Conclusions: Examination under anaesthesia still has a place in the evaluation of anorectal fistula. Imaging methods are an occasional complement to a clinical evaluation that can help the less experienced to decide the appropriate treatment, particularly when a complex fistula is suspected (AU)

"Spontaneous" perilymph fistula: a case report.

A surgically documented case of barotrauma-induced perilymph fistula is presented in this case report. A brief review of the literature on this entity confirms the difficulty of making a definitive preoperative diagnosis in most instances. Clinical, audiometric, radiologic, and intraoperative findings are presented, and the classic presumed mechanisms for this uncommon cause of sudden sensorineural hearing loss are discussed. The presence of intact evoked otoacoustic emissions in an ear demonstrating a severe cochlear-type loss was considered helpful in narrowing the differential diagnosis in this case, and may suggest a productive avenue for future study.

Three different types of congenital lacrimal sac fistulas.

Three different symptoms in 4 patients with congenital lacrimal sac fistulas are presented. The first symptom was epiphora since birth, the second symptom was infection of the lower eyelid, and the third symptom was tearing from the eye in a 76-year-old patient. This patient had nasolacrimal obstruction at the canal level and no symptoms of congenital lacrimal sac fistula. She had undergone excision, including dacryocystorhinostomy. Three of the 4 patients underwent excision of the fistulous tract. The fistula originated from the lacrimal sac in all patients. Symptomatic congenital lacrimal sac fistulas can be treated successfully with excision alone or with excision and dacryocystorhinostomy in cases of nasolacrimal obstruction.

Clinical classification of vesicouterine fistula.

UNLABELLED: OBJECTIVE AND METHODSs: The aim of this paper is to propose a classification of vesicouterine fistula based on the routes of menstrual flow. RESULTS: Three types of the fistula are distinguished: type I - with menouria; type II - with dual flow via both the bladder and vagina; and type III - with normal vaginal menses. CONCLUSIONS: There is relevance of such division to both diagnosis and treatment. The simplicity and clinical utility of this classification warrant its widespread use.

Fístula liquórica.

Apresenta texto sobre fístulas liquóricas, com classificação (rinorréia liquórica - RL e otorréia liquórica - OL), fisiopatologia (RL traumática, RL não traumática, OL traumática e OL não traumática), diagnóstico (sintomas da RL e da OL, diagnóstico do liquor extracraniano e localização do sítio da fístula), tratamento (fístula liquórica não traumática de alta pressão, de pressão nl, e pós traumática), acessos cirúrgicos (intracraniano e extracraniano), tratamento cirúrgico em locais específicos (teto do etmóide - placa cribiforme, seio frontal, seio esfenoidal e ouvido), técnica endoscópica, resultados e highlights. Documento em formato PDF, requer Acrobat Reader.