Case Of Fistula Research Articles

Lymphography using microbubbles and contrast-enhanced ultrasound (CEUS) before lymphatic supermicrosurgery for severe lymphorrhea of lower extremity

Lymphaticovenous anastomosis (LVA) is an effective surgical treatment for lymphorrhea. However, the traditional indocyanine green (ICG) fluorescent lymphography mapping for lymphatic vessels has limitations, it can only depict the initial capillary lymphatic network localized in the dermis of the skin, which cannot visualize lymphatics deeper than 1.5cm. A new mapping technique, microbubbles and contrast-enhanced ultrasound (CEUS) can address the problem. In one case of lymphocutaneous fistula, for the first time, we used microbubbles and CEUS technique for preoperative localization for LVAs. Microbubbles and CEUS can identify deep lymphatic vessels and better evaluate the function of lymphatic vessels. The patient's symptoms of edema and lymphorrhea improved clinically. Microbubbles and CEUS is an effective methods for identifying lymphatic vessels in lower limbs.

EPH168 Regional Variation in Patient Characteristics and Treatment Patterns for over 17 Million COVID-19 Patients in the United States

According to the CDC, as of December 2022, almost one in three Americans had confirmed COVID-19 infection; yet only a small portion generated healthcare claims related to COVID-19. Higher burden of COVID-19 cases in Northeastern states compared to other US regions has been documented. This study examined the regional variation in demographic characteristics and treatment patterns among patients with a claim for COVID-19 in a nationwide US claims database. Analysis of data from over 277 million patients in IQVIA’s longitudinal medical and pharmacy claims databases resulted in a cohort of 17,682,111 patients with COVID-19 diagnosis between 4/1/2020 and 4/30/2022. Demographic characteristics and treatment rates for key approved and un-approved COVID-19 therapies were assessed and stratified by region. Among patients in the database, 6.4% had a COVID-19 diagnosis. The proportion was higher in the Northeast (7.1%) and South (6.9%) compared with the West (4.8%). The highest proportion of patients were aged 18-44 years (32.7% in South to 35.2% in West). Over a fifth of the patients were ≥ 65 years old (US overall= 23.7%; 22.5% in Northeast to 25.8% in Midwest). Approximately 57% of the patients nationally and within each region were women. For approved medications, utilization ranged from 1.7% in Northeast to 2.7% in Midwest (overall:2.2%) for remdesivir; 0.7% in Northeast to 2.2% in South (overall: 1.5%) for casirivimab/imdevimab. For unapproved medications, utilization ranged from 0.9% in Northeast to 1.6% in South (overall:1.3%) for hydroxychloroquine and 0.4% in Northeast to 1.8% in South (overall:1.1%) for ivermectin. Less than one in five US cases of COVID-19 had a claim with diagnosis of COVID-19. Use of COVID-19 specific medications remained low throughout the pandemic. Despite the higher disease burden, proportion of patients with claims and receiving COVID-19 treatment were low nationally, particularly in the northeast US region.

Incidentally portal vein penetration during cannulation in endoscopic retrograde cholangiopancreatography: a case report

Abstract Portal vein cannulation is a very rare complication of endoscopic retrograde cholangiopancreatography (ERCP). In most reported cases, the event was managed safely with immediate catheter, guidewire withdrawn and procedure termination. Here, we report an unusual case of portobiliary fistula created during ERCP. To our knowledge, this is the first report of such case managed with immediate surgical biliary exposure.

Iatrogenic Fistula after Gynecological Operation in a Tertiary level Hospital

Background: Genitourinary fistula constitute a social calamity for the women in the developing countries.The most common cause being obstructed labor, as my study is on fistula due to iatrogenic cause, the most common cause is gynecological surgery. This study has been designed to find out the general information about iatrogenic genitourinary fistula and its outcome.
 Method: A cross-sectional descriptive study was done on 42 women suffering from urogenital fistula admitted in fistula corner in the department of Obs. & Gynae, Rajshahi Medical College Hospital from March to September 2015. A detailed history was taken to find out the casual factor. All the result had noted in pre-designed history sheet. The data has analyzed by SPSS version II and percentage were calculated.
 Results: Among 42 of total genitourinary fistula 19 cases of iatrogenic fistula were isolated after proper searching of detailed history. Among the 19 patients 11 (57.90%) patients developed fistula following total abdominal hysterectomy, 4 (21.05%) following laparotomy, 03 (15.79%) following vaginal hysterectomy with anterior colporrhaphy, and 1 (5.26%) patient developed fistula following repair of complete perineal tear. Among 11 patients with total abdominal hysterectomy, 06 were suffering from pelvic inflammatory diseases, 03 patients with fibroid uterus and of the rest 02 patients 01 with endometriosis and 01 patient with dysfunctional uterine bleeding. It was found in majority of the cases (68%) fistula developed within10 days. Among the iatrogenic genitourinary fistulas vesicovaginal type was found to be the most common (84.21%) in this study.
 Conclusion: The etiology of urogenital fistula is preventable. By utilizing basic principal of surgery, all types of urinary fistula can be repair.
 Central Medical College Journal Vol 6 No 1 January 2022 Page: 28-33

Eccentric cases of genitourinary fistula—Our ten years of experience

Eccentric cases of genitourinary fistula—Our ten years of experience

Gasless submental-transoral combined approach endoscopic thyroidectomy: a new surgical technique.

The development of transoral endoscopic vestibular approach thyroidectomy (TOETVA) has been limited by inherent defects, such as mental nerve injury and carbon dioxide (CO2)-related complications. Herein, we proposed a new technique without CO2 called gasless submental-transoral combined approach endoscopic thyroidectomy (STET) to solve the problems in TOETVA. We reviewed 75 patients who successfully underwent gasless STET using novel instruments at our institution from November 2020 to November 2021. A main incision of approximately 2 cm was made in the natural submental crease line and then combined with two vestibule incisions to complete the procedure. Demographic data, surgical technique and perioperative outcomes were retrospectively recorded. Thirteen male and sixty-two female patients with a mean age of 34.0 ± 8.1 years were enrolled in this study. Sixty-eight patients had papillary thyroid carcinomas and seven had benign nodules. We successfully performed all gasless STET without conversion to open surgery. The average postoperative hospital stay was 4.2 ± 1.8 days. One transient recurrent laryngeal nerve injury and two transient hypoparathyroidisms were observed. Three patients complained of slight lower lip numbness on the first postoperative day. One case of lymphatic fistula, subcutaneous effusion, and incision swelling occurred each, all of which were conservatively cured. One patient developed a recurrence six months after surgery. Gasless STET using our own designed suspension system is technically safe and feasible with reasonable operative and oncologic results.

Aortoesophageal fistula after endoscopic stenting of the esophageal tumor

This article describes 2 clinical cases of aorto-esophageal fistula (AEF) in patients after endoscopic stenting of the esophagus with a self-expanding mesh stent, which we encountered in our institution (City Clinical Oncology Center, St. Petersburg). In addition, a review of the available literature on this issue was carried out with a special focus on the risk factors for the development of AEF.

Factors associated with obstetric fistula among reproductive age women in Ethiopia: a community based case control study

BackgroundObstetric fistula is a major public health concerns in Ethiopia. It is the most devastating cause of all maternal morbidities.MethodData from the 2016 Ethiopian Demographic Health Survey (EDHS) was analyzed. A community-based unmatched case control study was conducted. Seventy cases and 210 non cases were selected using random number table. Data were analyzed by using STATA statistical software version 14. Multivariable logistic regression model was applied to determine the factors associated with fistula.ResultsThe majority of fistula cases were from rural residences. The multivariable statistical model showed that rural residence (Adjusted OR (AOR) = 5, 95% CI 4.26, 7.52), age at first marriage (AOR = 3.3, 95% CI 2.83, 4.60), poorest wealth index (AOR = 3.3, 95% CI 2.24, 5.01) and decision making for contraceptive use by husband alone (AOR = 1.3, 95% CI 1.124, 1.67) were factors significantly associated with obstetric fistula.ConclusionAge at first marriage, rural residence, poorest wealth index and decision making for contraceptive use by husband alone were significantly associated factors for obstetric fistula. Intervening on these factors will reduce the magnitude of obstetrics fistula. In this context there is in-need to improve on avoiding early marriage through awareness creation to the community and developing legal framework by the policymakers. Furthermore, information about the joint decision making to use contraceptives should be disseminated though mass-media and interpersonal channels.

Hybrid Management for Traumatic Iliac Arteriovenous Fistula

Traumatic arteriovenous fistulas are usually the evolution of non-treated contiguous arterial and venous injuries inflicted by firearm projectiles. As time passes, these fistulas can lead to systemic and local repercussions. Endovas-cular management offers great benefit in reducing the risks of open surgery for correcting these fistulas, but unfor-tunately some endovascular resources are not always available.In this situation, a hybrid management offering an endovascular strategy to control bleeding, while allowing an open disconnection of the affected artery and vein, may be useful in dealing with these complex injuries. In this article, the authors report a case of traumatic arteriovenous fistula between the common iliac vessels, managed with a hybrid strategy and make comments about practical issues regarding planning the open part of the procedure and anticipating possible complications when treating such injuries.

Utility of Photon-Counting Detector CT Myelography for the Detection of CSF-Venous Fistulas.

CSF-venous fistulas are an increasingly recognized type of CSF leak that can be particularly challenging to detect, even with recently improved imaging techniques. Currently, most institutions use decubitus digital subtraction myelography or dynamic CT myelography to localize CSF-venous fistulas. Photon-counting detector CT is a relatively recent advancement that has many theoretical benefits, including excellent spatial resolution, high temporal resolution, and spectral imaging capabilities. We describe 6 cases of CSF-venous fistulas detected on decubitus photon-counting detector CT myelography. In 5 of these cases, the CSF-venous fistula was previously occult on decubitus digital subtraction myelography or decubitus dynamic CT myelography using an energy-integrating detector system. All 6 cases exemplify the potential benefits of photon-counting detector CT myelography in identifying CSF-venous fistulas. We suggest that further implementation of this imaging technique will likely be valuable to improve the detection of fistulas that might otherwise be missed with currently used techniques.

Knowledge-integrated research is more disruptive when supported by homogeneous funding sources: a case of US federally funded research in biomedical and life sciences

Knowledge-integrated research is more disruptive when supported by homogeneous funding sources: a case of US federally funded research in biomedical and life sciences

P-021 DELAYED ENTEROCUTANEOUS FISTULA AND ENCAPSULATING MESH INFECTION AFTER COMPOSITE MESH REPAIR OF AN ABDOMINAL MIDLINE INCISIONAL HERNIA - COMPLICATIONS 12 YEARS LATER

Abstract Aim Mesh infection is a well-recognised complication of incisional hernia repair, however, is usually encountered within months after mesh insertion. Only a few cases have been published where an enterocutaneous fistula has presented many years after mesh repair of an incisional hernia. Here we describe a complicated case of enterocutaneous fistula and mesh infection 12 years after the primary surgery. Material & Methods A 44 year-old gentleman presented acutely with a worsening 4 month history of an umbilical discharging sinus with associated fever, intermittent abdominal pain and nausea. There was also an associated hard lump and skin erythema. He previously had a laparotomy, small bowel resection for tuberculosis and ileostomy formation 13 years ago, followed by ileostomy reversal and intraperitoneal incisional hernia repair with composite mesh 1 year later. Results Cross-sectional imaging showed a large volume of gas within the mesh with underlying small bowel and collection within anterior abdominal wall, suggesting an enterocutaneous fistula. The patient initially underwent ultrasound guided aspiration of the collection followed by nutritional optimisation prior to another laparotomy, mesh excision and small bowel resection. The mesh was found to have a thick biofilm initially thought to be encased in mycobacterium but further testing was negative for this. Conclusions Delayed mesh infection over more than a decade after mesh insertion is rare. It is likely that pre-existing risk factors such as previous TB and small bowel resection with adhesions increased the risk of enterocutaneous fistulation.

A novel corporoplasty technique with a urethral plate flap in hypospadias repair.

To report a novel corporoplasty technique with a urethral plate flap in hypospadias repair and evaluate its safety and efficacy for ventral lengthening. Data were retrospectively collected from consecutive patients with hypospadias who underwent urethral plate flap corporoplasty between July 2021 and March 2022. All patients underwent hypospadias repair using the Duckett technique. The corporoplasty procedure involved the following key steps: the half-spongiosum of the urethral plate was harvested as a flap (with a pedicle attached to the corpus cavernosum); a transverse incision of the tunica albuginea was made adjacent to the pedicle; and the flap was patched onto the corporal defect. The study included 10 patients, with a median age of 20 months. The initial meatal location was penile in two patients, penoscrotal in four patients, and scrotal in four patients. The median ventral curvature was 45° after degloving and urethral plate transection. The median ventral lengthening distance proportional to penis length was 0.21. During the median follow-up of 13.8 months, complications occurred in three cases, including two cases of fistula and one case of urethral stricture with secondary diverticulum. No cases of recurrent ventral curvature, meatal stenosis, or urethral dehiscence were noted. Postoperative ultrasonography showed a good continuation of the tunica albuginea and integrity of the stratum spongiosum at the corporoplasty site. Urethral plate flap corporoplasty is a simple and effective ventral lengthening procedure. The novel corporoplasty technique allows for anatomical and architectural repair of corporal disproportion.

Liabilities of virtual world developers as intermediary service providers: the case of Second Life

Through a review of the EU and the US regulation and case law, this article discusses the extent to which virtual world developers can be held liable as intermediary service providers with regard to potentially infringing user-created and user-uploaded virtual items. Among many virtual worlds, this study focuses on Second Life, developed by Linden, as it allows user-created and uploaded contents, and offers services such as the Marketplace and LindeX exchange, which enable users and the developer to financially benefit from these contents. The article argues that, beyond mere game developers, virtual world developers such as Linden are intermediary service providers and may be liable with regards to user-created and uploaded content on their services. Within the scope of the EU regime, Linden is too active to benefit from the E-Commerce Directive’s safe harbors. However, it should not be considered as an online content-sharing service provider within the scope of the DSM Directive because Second Life does not compete with other online content services for the same audiences. According to the comprehensive protection brought by the DMCA in the US, Linden can benefit from the safe harbors if it takes the necessary steps after becoming aware of specific infringing activity and fulfills the procedural measures listed in the act.

A Study on the ‘Patent Misuse’ as a Patent System that Encourages Innovation - Focusing on Discussion and Cases in US -

A Study on the ‘Patent Misuse’ as a Patent System that Encourages Innovation - Focusing on Discussion and Cases in US -

Primary tuberculosis of the breast from mankweng hospital

Object of study: To share our experience with a rare case of Primary Tuberculosis of Breast.
 The problem to be solved: Tuberculosis of the breast is a rare type of extrapulmonary tuberculosis and usually affects young lactating multiparous women. It accounts for less than 0.1 % of all breast pathologies. Tuberculosis of the breast is often misdiagnosed. Therefore, a high index of suspicion is needed when evaluating cases of breast abscesses, fistulae, or mass.
 Main scientific results: A case of a 27-year-old female with no known co-morbidities, HIV negative who presented to our Surgical Outpatient Department with a 1-year history of a painless left breast lump. No previous history of pulmonary tuberculosis was reported. Breasts ultrasonography indicated BIRADS (Breast Imaging-Reporting and Data System) V: lesion highly suspicious of malignancy. Histopathological analysis of the core biopsy showed features of a necrotizing granulomatous mastitis with adjacent fat necrosis. Ziehl-Neelsen stain was negative though histological results were worrisome of a mycobacterial infection. Patient responded well to antitubercular therapy as evidenced by lump regression, ulceration healed, peau d’orage currently resolved, and the overall size of the breast is going back to its normal state.
 The area of practical use of research results: Family medicine physicians, Primary health care center, District level or regional level hospital.
 An innovative technological product: a high index of suspicion tuberculosis is needed when evaluating cases of breast abscesses, fistulae, or mass. Awareness of this condition is important as it can clinically, and radiologically mimic breast carcinoma.
 Scope of application of an innovative technological product: Family medicine physicians, Primary health care center.

Therapies beyond Physiological Barriers and Drug Resistance: A Pilot Study and Review of the Literature Investigating If Intrathecal Trastuzumab and New Treatment Options Can Improve Oncologic Outcomes in Leptomeningeal Metastases from HER2-Positive Breast Cancer.

Leptomeningeal metastases (LM) are a rare but rapidly fatal complication defined by the spread of tumor cells within the leptomeninges and the subarachnoid space, found in approximately 10% of patients with HER2-positive breast cancers. This pilot study evaluated the efficacy of local treatment with intrathecal Trastuzumab (IT) added to systemic treatment. The oncologic outcome of 14 patients with HER2-positive LM is reported. Seven received IT, and seven received standard of care (SOC). The mean number of IT cycles administered was 12.14 ± 4.00. The response rate to CNS after IT treatment + SOC was 71.4%, and three patients (42.8%) obtained durable responses lasting more than 12 months. The median progression-free survival (mPFS) after LM diagnosis was six months, and the median overall survival (mOS) was ten months. The mean values of the PFS in favor of IT therapy (10.6 mo vs. 6.6 mo) and OS (13.7 vs. 9.3 mo) suggest a non-negligible investigation direction in the sense of exploiting intrathecal administration as a possible treatment modality in these patients. Adverse events reported were local pain related to intrathecal administration and one case of arachnoiditis, hematoma, and CSF fistulae. Intrathecal administration of Trastuzumab, alongside systemic treatment and radiotherapy, might improve oncologic outcomes in LM HER2-positive breast cancer with manageable toxicity.

Omental arteriovenous fistula after splenectomy treated with transarterial embolization

BackgroundLaparoscopic splenectomy for patients with portal hypertension is associated with a high risk of bleeding. The use of vessel-sealing devices and automatic sutures is important for bleeding control. However, a rare complication of abdominal surgery is the direct communication between the arterial and portal circulation related to surgical procedures such as simultaneous ligature of an artery and adjacent vein. We describe a rare case of omental arteriovenous fistula (AVF) after laparoscopic splenectomy treated with transarterial embolization.Case presentationWe report a case of a 46-year-old male patient with an omental AVF after a laparoscopic splenectomy 6 years ago for splenomegaly associated with alcoholic cirrhosis. Follow-up abdominal dynamic computed tomography accidentally revealed a vascular sac (25 mm in the major axis) that formed an omental AVF with anastomosis to the left colonic vein. The communication was considered to be caused by using a vessel-sealing device. No symptoms related to the AVF were observed. The AVF was embolized with microcoils using the transarterial approach. A 4-axis catheter system was used for accurate embolization due to the long and tortuous distance from the celiac artery. No recurrence or symptoms were observed after 6 months.ConclusionsTreatment of arterioportal fistula is mandatory, even in asymptomatic patients. Embolization is a less invasive alternative to surgical approaches. The 4-axis catheter system was useful for accurate embolization via a long and tortuous artery.

Onyx© Embolization of Dural Arteriovenous Fistulae at the Cranio-Cervical Junction (P8-5.024)

<h3>Objective:</h3> To report two cases of CRC fistula treated successfully with endovascular embolization with Onyx©. <h3>Background:</h3> Dural arteriovenous fistula (dAVF) are rare vascular malformations; a rare subset of this group are dAVFs located at the cranio-cervical junction. Subarachnoid hemorrhage (SAH) is one of the possible neurological complications of cranio-cervical (CRC) fistula rupture. Treatment options include radiosurgery, endovascular embolization and/or open surgery. The use of liquid embolic agent is a reasonable option for endovascular treatment. <h3>Design/Methods:</h3> A single institution retrospective case report identified two case of cranio-cervical junction (CRC) fistulae that were treated successfully with Onyx© embolization. <h3>Results:</h3> Two patients were identified to have cranio-cervical junction DAVF in which one patient presented with SAH, and the 2^nd patient presented with bulbar symptoms due to rapidly worsening edema in the brainstem. Both fistulas were supplied from the vertebral artery; one at the level of Dural ring of the vertebral artery and the other at the jugular foramen level which was also supplied by ascending pharyngeal artery. Onyx© embolization was the treatment of choice in both cases. The Onyx© embolization resulted in 80% reduction of the fistula nidus in the first case, and complete occlusion of the fistula in the second and the third case. The 6 months follow-up revealed complete occlusion of both fistulas with complete neurological recovery <h3>Conclusions:</h3> This case series suggests that the treatment of CRC fistulae with Onyx© embolization is efficacious with good clinical outcomes. <b>Disclosure:</b> Dr. Gharaibeh has nothing to disclose. Dr. Al-Chalabi has nothing to disclose. Dr. Oliver has nothing to disclose. Dr. Jumaa has nothing to disclose.

Comparative Analysis of Soft Power Between South Korea and the United States: A Theoretical Mechanism Approach

Since Nye’s introduction of the soft power concept, there have been scholarly debates on whether it is real and how it works. Despite the vast volume of studies, there is a void in the literature on theoretically explaining and empirically testing if soft power can be generated without the support of hard power. To fill this gap in the literature, we developed two theoretical mechanisms that describe the mechanism of US soft power (great power) and Korean soft power (small country). We applied these theories to the US and Korean cases to demonstrate that (1) soft power across countries is not generated in the same way because countries do not have the same level of hard power; and (2) soft power can be generated without the support of hard power.