Chronic Fistula Research Articles

Botulinum toxin type A treatment for a parotid gland injury in two adult horses

SummaryThe most common disorder affecting the salivary glands in horses is trauma to the parotid gland or duct. Several management techniques have been described, each with their own set of complications. The objective of this case report was to describe the direct injection of botulinum toxin type A into the parotid gland and its outcome in two clinical cases involving damage to either the parotid salivary gland or its duct. Both cases involved iatrogenic damage to either the parotid salivary gland or its duct. Treatment for both cases involved the injection of 200 units of botulinum toxin type A into the parotid gland in order to reduce salivary production and to prevent the potential development of a chronic fistula. Follow‐up assessment after the treatment was conducted via telephone consultation and photographs from the owners. In both clinical cases, a marked reduction in saliva production from the parotid gland was noted within 2 days after toxin injection and the wounds healed without complication. In the first case, the treatment was repeated after 3 weeks. No short‐ or long‐term side effects after injection were reported by the owners. Limitations were the small number of cases and the lack of literature regarding the dose and treatment regime for botulinum toxin type A in horses. It was concluded that the administration of botulinum toxin type A appears to be a safe and effective therapeutic alternative or complementary procedure for the treatment and prevention of parotid gland or duct fistulas in horses.

Perianal Mucinous Adenocarcinoma: A Case Report and a Systematic Review of the Literature.

Mucinous adenocarcinoma of anus is an uncommon neoplasm of the gastrointestinal tract. In most of the cases, early diagnosis of this disease is difficult since its symptoms frequently mimic benign inflammatory conditions. A systematic PubMed and Scopus search was conducted, a propos of a case report. One hundred fifty patients from 93 case reports were included. The mean age of the patients was 60.5years (range: 18-81). The majority of them were males (124 out of 150, 82.7%), while the main known risk factor was the history of chronic fistula (109 out of 150, 72.7%). Recurrent perianal sepsis and perianal pain were the principal symptoms at the time of presentation. No symptoms have been reported only in three patients (3 out of 150, 2%). Regarding the prior surgical history of the patients, multiple abscess drainage and perianal fistula's related interventions were present in 62 (41.3%) and 19 (12.7%) patients, respectively. Neoadjuvant chemoradiotherapy was administered in 53 out of 150 patients (35.3%), while the majority of them have been treated with combined treatment of chemotherapy and radiotherapy. APR and its variations were the most applied surgical treatment (68%). Adjuvant chemoradiotherapy was administered almost up to one-third of the included patients (34%). Recurrence of the disease was reported in 41 out of 150 patients (27.3%). Death was reported in 44 out of 150 patients (29.3%). Review of the available published literature suggests that perianal mucinous adenocarcinoma is an extremely rare neoplasia. Τhere is no consensus as far as the diagnosis and the treatment strategies, due to the rarity of this neoplasm. High degree of clinical suspicion as well as histopathological confirmation is the principal requisites for the diagnosis of mucinous adenocarcinoma, especially in the ground of chronic ulcero-proliferative perianal lesions.

Pain Assessment Among Chronic Kidney Disease Patients WithAv Fistulas During Hemodialysis: A Systematic Review

Pain Assessment Among Chronic Kidney Disease Patients WithAv Fistulas During Hemodialysis: A Systematic Review

815. FREE JEJUNAL GRAFT (FJG) FOR COMPLEX RECONSTRUCTION AFTER PHARINGO-LARINGO-ESOPHAGECTOMY

Abstract Background Pharyngo-esophageal reconstruction using free jejunal grafts has been widely used for the treatment of locally advanced carcinomas of the hypopharynx and cervical esophagus. However, the procedure is technically demanding and requires complex recontractions. The aim of this study was to evaluate our institutional outcomes of reconstruction using a free jejunal graft with vascular reconstruction in patients undergoing pharyngo laryngo esophagectomy with a multidisciplinary surgical team. Material and methods Unicentric retrospective case series between 2014-2023 with 6 patients that require complex reconstruction with free jejunal graft. Information was obtained from institutional database. Quantitative variables are expressed with median and interquartile range (IQR), and qualitative variables with percentage and absolute number. Results In our sample, all patients were male with median age of 62 (7) years old and had previous history of squamous cell carcinoma (SCC) treated with radical Qt/Rt with maximum radiotherapy dose who developed local recurrence at hypopharynx involving the cervical esophagus. Patients demographics and characteristics are shown in table 1. FJG was the primary procedure in five cases after PLPE, of which three were done as curative procedure and the rest as a palliative procedure. In one patients FJG was considered after gastric tube reconstruction with transhiatal esophagectomy. JFG vessels were commonly anastomosed to the common superior thyroid artery (42,9%) and the external jugular vein (21%) and thyroid vein (21,2%). Operative time was 440 (359) minutes. After FJG procedure time to oral intake reintroduction was 7 (6-20) days and hospital stay length was 20,5 (16) days. Pneumonia was the most frequent complication in four patients (57,2%). Leakage rate after FJG was 33% (2). Three patients required reintervention, (1) mesenteric graft bleeding, (1) graft anastomoses dehiscence and (1) graft necrosis. FJG failure rate was 33%, one due complete graft ischemia secondary to arterial thrombosis at 2nd POD and other due to failed conversative management of dehiscence of both anastomoses with partial ischemia. After failed FJG only one patient underwent reconstruction by transhiatal esophagectomy and gastric tube replacement. Two patients were readmitted before 30 days and two patients before 12 months after discharge. BMI after JFG was 22.7 (13,1) kg/m2. According to late complication, dysphagia was the most common complication (42,7%) also one patient cannot feed orally due to severe stenosis after chronic fistula. In-patient mortality was 0%. Overall survival was 19 (37) months. One patient with FJG failure died due to septic complications after pharingostoma, and one patient due to disease progression. Conclusion Free jejunal graft with vessel reconstruction for patients undergoing pharyngo-laryngo-esophagectomy is a safe procedure but with high complications rate which enhance the priority of centralize this pathology in high volume centers.

STUDY OF KAJJALIKODAYA MALAHARA FOR EVALUATION OF WOUND HEALING ACTIVITY

Introduction: Kajjalikodaya malahara, mentioned in the Rasatarangini text, is indicated in different types of wounds like chronic wounds and fistula in ano, which did not respond to other treatment modalities. So, this formulation was selected for the present study. Material and methods: The Kajjalikodaya malahara prepared as per reference -anagni (without fire) and also modified version- agni siddha (with fire) method and subjected for antimicrobial, acute dermal toxicity studies and also screened for wound healing efficacy in excision and incision wound healing models. Results: The trial drug prepared by both methods was found safe in an antimicrobial study and did not reveal any acute dermal toxic conditions. In excision and incision wound healing model showed better therapeutic efficacy. Conclusion: Both formulations were efficient in the wound healing model’s study. Compared to a modified version of the agni siddha test drug, classically prepared anagni siddha was better in therapeutic efficacy.

Primary anastomosis closure after endoscopic ultrasound-directed transgastric intervention.

Background and study aims Endoscopic ultrasound-directed transgastric intervention (EDGI) is a technique that creates an anastomosis between the gastric pouch or jejunum to the excluded stomach in Roux-en-Y gastric bypass (RYGB) anatomy to allow access to the pancreaticobiliary system. Thus far, management of anastomosis closure at the time of lumen-apposing metal stent (LAMS) removal has varied widely. This study aimed to assess the efficacy of primary closure at the time of LAMS removal using athrough-the-scope (TTS) tack-based suture system. Patients and methods This was a two-center retrospective study of RYGB patients who underwent single-stage EDGI using a 20-mm LAMS and subsequent primary anastomosis closure with the X-tack system at the time of stent removal. Patient demographics, procedure details, clinical outcomes, and imaging findings are reported. Results Nineteen patients (median age 63 years, 84% female) underwent single-stage EDGI with a median follow-up of 31.5 months. Adverse events occurred in two patients (11%) who had abdominal pain requiring hospitalization. The median LAMS dwell time was 32 days (range 16-86). All patients (100%) who underwent follow-up studies after LAMS removal had confirmed anastomosis closure (n = 18). Most patients had documented weight loss at the time of LAMS removal and at last follow-up (68%, n = 13). Conclusions Single-stage EDGI is an effective approach to managing RYGB patients with pancreaticobiliary pathology. Thus far, endoscopic TTS tack-based suturing appears to have a high success rate in anastomosis closure after LAMS removal and should be considered as a primary method for preventing chronic fistulae.

Endoscopic Management of Post-Sleeve Gastrectomy Complications.

Obesity is associated with several chronic conditions including diabetes, cardiovascular disease, and metabolic dysfunction-associated steatotic liver disease and malignancy. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, is an effective treatment modality for obesity and can improve associated comorbidities. Over the last 20 years, there has been an increase in the rate of bariatric surgeries associated with the growing obesity epidemic. Sleeve gastrectomy is the most widely performed bariatric surgery currently, and while it serves as a durable option for some patients, it is important to note that several complications, including sleeve leak, stenosis, chronic fistula, gastrointestinal hemorrhage, and gastroesophageal reflux disease, may occur. Endoscopic methods to manage post-sleeve gastrectomy complications are often considered due to the risks associated with a reoperation, and endoscopy plays a significant role in the diagnosis and management of post-sleeve gastrectomy complications. We perform a detailed review of the current endoscopic management of post-sleeve gastrectomy complications.

Transposition of the levator labii superioris muscle in two standing horses

SummaryOromaxillary fistulae are a complication of maxillary cheek teeth extraction in horses, particularly in cases where tooth repulsion is performed. Conservative treatment with debridement of the fistula, placement of a temporary alveolar plug and flushing of the sinus cavity can be unsuccessful. Transposition of the levator labii superioris muscle has been reported as an effective surgical option to treat chronic oromaxillary fistulae in anaesthetised horses. In this report, the surgical procedure was carried out on two standing horses, using sedation and local nerve blocks. Transposition of the levator labii superioris muscle can be safely and successfully performed in the standing sedated horse and may be considered for the management of cases with chronic refractory oromaxillary fistulae not responding to conservative treatment.

The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections

BackgroundDeep sternal wound infection (DSWI) is a rare, yet devastating complication after cardiac surgery. While the surgical treatment always implies the soft tissue and bone debridement, there is little data about this procedure. The aim of our study was to evaluate the impact of the radical sternectomy on the outcome in patients with DSWI and to identify the risk factors which could influence the result. The surgical techniques of piecemeal sternectomy and the newly developed en bloc sternectomy were also evaluated.MethodsThe study was developed as a retrospective cohort study. 86 patients with DSWI who received a radical sternal resection at our institution between March 2018 and December 2021 were included.ResultsThe average age of the cohort was 67.3 ± 7.4 years, and 23.3% of patients were female. The average length of stay trended shorter after en bloc sternectomy (median 26 days) compared to piecemeal sternectomy (37 days). There were no significant differences between the piecemeal and en bloc sternal resection techniques. Anticoagulant and antiplatelet drugs had no significant influence on bleeding and transfusion rates. Obese patients showed an increased risk for postoperative bleeding requiring reintervention. Transfusion of packed red blood cells was significantly associated with lower hemoglobin values before surgery and ASA Class 4 compared to ASA Class 3. The in-hospital mortality was 9.3%, with female sex and reintervention for bleeding as significant risk factors. Nine patients developed an infection relapse as a chronic fistula at the level of clavicula or ribs, with ASA Class 4 as a risk factor.ConclusionRadical sternectomy is a safe procedure to treat DSWI with compromised sternal bone. Both piecemeal and en bloc techniques ensure reliable results, while complications and mortality appear to be patient-related.

Neuronavigation and Endoscopy as Adjunctive Tools in Orbital Floor Implant Revision: Surgical Management of Infected, Misplaced Orbital Floor Implant with Chronic Eyelid Fistula and Sinusitis

Neuronavigation and Endoscopy as Adjunctive Tools in Orbital Floor Implant Revision: Surgical Management of Infected, Misplaced Orbital Floor Implant with Chronic Eyelid Fistula and Sinusitis

Digestive processes and microbiocenosis of intestinal contents in sheep when using a «protected» form of betaine in nutrition

In the process of maintaining the metabolic processes of the gastrointestinal tract of ruminants, an important link is to ensure a complete feeding diet. The study of the use of betaine supplements in a form "protected" from the indirect effects of the microflora of the rumen showed positive dynamics in relation to the digestive processes, the microbial composition of the rumen and the intestines of sheep. In the conditions of the physiological yard of the Federal Science Center for Animal Husbandry named after Academy Member L.K. Ernst conducted a physiological experiment on ramshanks of crossbreeds of the Romanov breed and katadins, aged 8-9 months, with chronic scar fistulas according to Basov (n=3). In the control period, the animals received the main diet, in the experimental 1 – the main diet + unprotected betaine at a dosage of 0.05 g / kg of live weight, in the 2nd experimental period a "protected" betaine supplement at a dosage of 0.05 g / kg of live weight. The duration of each period was 30 days. During the accounting period, average daily stool samples were taken according to the generally accepted method. To study cicatricial digestion, at the end of each period, samples of the contents were taken from animals through the fistula of the scar by Basov. As a result of the use of both the "protected" and native forms of betaine, the mass of microorganisms of the scar content became higher than in the control period. When the "protected" form of betaine was added to the diet of animals, the overall digestibility of feed nutrients tended to improve. In the 2nd experimental period, compared with the control, the level of bifidobacteria in the large intestine of sheep increased by 1.63 CFU/g, the level of pathogenic yeast fungi decreased several times.

Endoscopic vacuum therapy in minimally invasive treatment of esophageal perforations

To compare the results of endoscopic vacuum therapy (EVT) and open surgery for esophageal perforations. The study included 60 patients with esophageal perforations between 2010 and 2022. The main group included 29 patients who underwent minimally invasive treatment with EVT, the control group - 31 patients after open surgical interventions. Pneumonia occurred in 21 (72%) and 14 (45%) patients (p=0.04), esophageal stenosis within the perforation zone - in 4 (13.8%) and 1 (3.2%) patient, respectively (p=0.188). Chronic esophageal fistulas were significantly more common in the control group (6 (20.7%) versus 15 (48.4%) patients, p=0.032). The overall duration of treatment (median) among survivors was significantly shorter in the main group: 33 (23; 48) versus 71.5 (59; 93.7) days (p=0.5). However, length of ICU-stay was slightly higher (11 (6; 16) versus 8.5 (5; 12.75) days, p=0.32). Mortality rate was 13.8% (n=4) and 29% (n=9), respectively (p=0.213). Minimally invasive technologies decreased the risk of fatal outcome by 10 times (OR 10.123, 95% CI 1.491-124.97, p=0.035) compared to traditional surgery. EVT in complex minimally invasive treatment of patients with mechanical esophageal injuries is an effective method significantly reducing mortality and duration of inpatient treatment compared to traditional surgical approach.

Review of Scoring Systems for Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is an inflammatory disorder characterized by chronic deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in apocrine gland-bearing regions. Assessing its severity is challenging because of its clinical heterogeneity, lack of a standardized tool, and increasing severity scores. This article provides a chronological overview of HS grading scales to aid in the understanding and comparison of different scoring systems. A literature review of articles published in English on PubMed was conducted searched from 1989 to 2023. The review includes 15 scores that are the most relevant and widely used and acknowledges the existence of over 30 scoring systems for HS. The expanding landscape of HS scoring systems presents challenges when patients evaluated using different systems are compared. A universally accepted scoring system is required for consistent application across diverse populations. A comprehensive assessment should balance subjective and objective items, considering observer-reported signs and patient-reported symptoms to make meaningful treatment decisions.

Pharmaceutical-Analytical Study of Kajjalikodaya Malahara

Background The Kajjalikodaya malahara KJM is the less referred least practiced formulation mentioned in Rasa tarangini indicated in Vrana shodhana wound cleaning Vrana ropana wound healing Chira varna chronic wound Nadi vrana fistula etc.Objective Preparation of KJM as per classical method and preparation of a modified formulation and analyzing both these formulations using appropriate analytical parameters for topical application.Methods KJM was prepared by Anagni siddha classical- without using fire- and Agni siddha modified with the help of fire methods without varying ingredients and proportions. It was prepared with Kajjali Shodhita Mriddarashringa Shodhita Kampillaka Shodhita Tuttha Siktha taila in specific proportions as mentioned in the text were then subjected to analytical tests like pH LOD total fat content spreadability etc.Results The results were found to be in favor in terms of wound healing efficacy. The melting point rancidity tests etc. supported its genuinity stability in terms of shelf life. Conclusion The results indicate that the Kajjalikodaya malahara prepared by both the methods fulfil the standards for all the parameters tested are fit for external application and retain their credibility. The efficacy of Kajjalikodaya malahara prepared as mentioned in classics i.e. with Anagni siddha method was better compared to modified Agni siddha method.

Feed additive for cattle

Enzymes produced by the digestive tract of ruminants are unable to digest cellulose. Nevertheless, a large amount of fiber in the feed used by ruminants is broken down by the action of enzymes of the rumen microflora. This complex process not only destroys the fibrous material, but also releases the nutrients contained inside the cells, so that the digestive juices of the animal can more easily affect them. For experimental studies, 2 experimental groups were formed: the bull-calves of group I included mechanically ground sunflower husk in the diet, group II - sunflower husk fermented for 9 days in a bioreactor, at T = 39°C, pH = 6.9-7.0. Husk was introduced into the diet of bull-calves of groups I and II together with a concentrated part of the feed, replacing 10% by volume. The object of the study are bull-calves of the Kazakh white-headed breed with chronic rumen fistula, with an average weight of 340-345 kg, aged 15-16 months.

Validation of the Back-table Graft Arterial Anastomosis between the Splenic Artery and Superior Mesenteric Artery: Arterial Complications after a 21-year Single-center Experience of Pancreas Transplantation.

To determine the role of the arterial splenomesenteric anastomosis (ASMA) vascular reconstruction technique in terms of arterial vascular complications in pancreas transplant (PT) recipients. The ASMA technique was first described in 1992 by Hospital Clínic Barcelona group. Regardless that the iliac Y-graft technique is the most frequently used worldwide, evidence of arterial complications and implications of using a different back-table reconstruction is conspicuously absent in the literature. Descriptive review of 407 PTs performed at a single center (1999-2019) by analyzing the type of arterial reconstruction technique, focusing on ASMA. The endpoints were the management of arterial complications and long-term patient and graft survival. ASMA was performed in 376 cases (92.4%) and a Y-graft in 31 cases (7.6%). A total of 34 arterial complications (8.3%) were diagnosed. In the ASMA group (n=30, 7.9%) they comprised: 15 acute thrombosis; 4 stenosis; 1 pseudoaneurysm and 10 diverse chronic arterial complications while in the Y-graft group (n=4, 12.9%) 3 acute thrombosis and 1 chronic artery-duodenal fistula occurred. Graft salvage was achieved in 16 patients (53.3%) from the ASMA group and in 2 (50%) from the Y-graft. After a median follow-up of 129.2 (IQR 25-75%, 77.2 -182) months the overall graft and patient survival for the whole cohort at 1, 5, and 10 years was 86.7%, 79.5%, 70.5%, and 98.5%, 95.3%, 92.5%, respectively. The ASMA proves to be a safe and more easily reproducible technique and should therefore be considered for first-line back-table reconstruction in the PT population.

Sinus pilonidalis—elastic ligature as an optimal outpatient treatment

Abstract Background The incidence of pilonidal sinus shows a steadily rising tendency, especially in the patient age group of up to 40 years. Treatment of this condition is often protracted involving lengthy sick leave and an increased risk of recurrence. The optimal treatment of pilonidal sinus remains open to debate, but it should focus on decreasing the length of hospitalization, promoting a rapid return to daily life, maintaining low pain levels, and keeping costs at a minimum. Materials and methods In our study conducted between 2017 and 2021, we focused on treatment of pilonidal sinus. We performed 50 elastic ligature procedures with a median observation time of 30 months. The patients were divided into three groups according to the characteristics of pilonidal sinus: (1) acute primary abscess; (2) acute recurrent abscess; and (3) chronic fistula. Results Out of a total of 50 patients with a subsequent 30-month follow-up, we observed complete recovery in 47 patients and recurrence in three patients. Return to work was possible immediately after the operation, with an average total treatment time of 1 month for complete healing of the defect. Conclusion The current results suggest that the technique of elastic ligature is a desirable solution for pilonidal sinus, because of the initial low costs, no need for hospitalization, and good patient tolerance.

Staged Intracranial Free Tissue Transfer and Cranioplasty for a Refractory Nasal-cranial Base Fistula

Summary: After a transnasal endoscopic resection of a high-grade adenoid cystic carcinoma that underwent adjuvant chemoradiation, there was delayed recurrence managed by en bloc resection through an open craniofacial approach. Subsequently, the patient developed a chronic nasocranial fistula with secondary infection and bone flap resorption. This resulted in infectious episodes with secondary scalp incisional dehiscence and hardware exposure which required multiple bone debridement procedures, hardware removal, prolonged IV antibiotics, and hyperbaric oxygen treatment. The nasocranial fistula and chronic frontal bone osteomyelitis persisted despite the previous interventions. The patient underwent a frontal bone removal and obliteration of the anterior cranial base fistula with a free vastus lateralis muscle flap. At 4 weeks postoperatively, the intranasal portion of the muscle flap had completely mucosalized. After a 6-week course of IV antibiotics, a secondary cranioplasty using a custom-made poly-ether-ether-ketone implant was performed. The patient remained disease- and infection-free for the duration of follow-up (17 months).

Management of intraorbital metallic foreign body with lateral orbitotomy and c-arm guiding surgery: a challenging case

Introduction: Orbital trauma is an emergency condition that often occurs with increasing mobility and industry. An intraorbital foreign body is one of the traumas that occur in the orbit. An intraorbital foreign body is an entrapment of corpus alienum in the orbital cavity, either accompanied by orbital fracture or not accompanied by fracture. Case Report: We report a 31-year-old man who suffered ocular trauma and had a rusty hammer splinter foreign body stuck in the orbital cavity of the right intraconal region. The patient was found with an initial suspicion of IOFB, but investigations with a head CT scan could not detect the presence of IOFB. The treatment of choice for this patient is a lateral orbitotomy with C-arm fluoroscopy guiding. Panuveitis occurred in the patient's eye after the extraction of the corpus alienum was performed. Suspicion of inflammation caused by siderosis bulbi cannot been ruled out. Discussion: Suspicion of the presence of an intraorbital foreign body can be based on several clinical symptoms and patient complaints and the presence of port d' entry through the cornea, sclera, or eye adnexa. Management of intraorbital foreign body depends on the type of foreign body, its location in the orbit and the presence or absence of accompanying complications. Lateral orbitotomy with c-arm guiding in this patient successfully extracted an intraconal foreign body using the S-Stallar Wright incision technique. Avoid ocular complications due to intraorbital foreign body retention include orbital cellulitis, chronic cutaneous fistula, optic neuropathy, extraocular muscle rupture, bulbar perforation, intracranial penetration, intraorbital arteriovenous fistula, and chorioretinal atrophy. Conclusion: The management of intraorbital foreign bodies depends on the type of retained foreign body, whether inert or non-inert/toxic. So that it can prevent patients from threatening intraorbital and intraocular complications.

Chronic esophagotracheal fistula secondary to esophageal diverticulum successfully treated by endoscopic submucosal dissection and dual action tissue clip.

Chronic esophagotracheal fistula secondary to esophageal diverticulum successfully treated by endoscopic submucosal dissection and dual action tissue clip.