Permanent Fistula Research Articles

Painless Rectal Bleeding in a Patient With Prostate Cancer

Painless Rectal Bleeding in a Patient With Prostate Cancer

Transhepatic double lumen hemodialysis catheter in exhausted vascular access: Feasibility, functionality, and outcome among hemodialysis patients.

Permanent arteriovenous fistula and graft are considered the best options for hemodialysis in end-stage renal disease patients. Temporary access using the internal jugular or femoral veins is the feasible option in acute cases of dialysis and if permanent access is unavailable. Occasionally, however, these access sites are unusable after consecutive blockage of the upper and lower extremities veins. A transhepatic or translumbar approach might be the only unconventional way to ensure a sufficient blood flow for adequate dialysis. Retrospective data on all transhepatic catheters (THCs) in patients at the King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia were collected. The catheters were inserted over a 10-year period (2009-2019). A minimum of 1 year of follow-up from the last catheter insertion was considered for analysis. A total of 12 patients had THCs with a mean age of 42.5 ± 12.2 and pre-insertion mean dialysis duration of 130.0 ± 72.9 months. All catheters were functional from the start with no immediate complications. A total of 35 catheter replacements over guidewires were made with a median of 2.0 catheters (range of 0-10). The mean blood flow was 300 ± 30 ml/minute with a mean Kt/v of 1.4 ± 0.4. The median initial (primary) device service interval was 68 (range 6-1531 days) and the median total access site service interval was 392 (range 76-2698 days). Catheter complications included catheter migration, thrombosis, and bloodstream infection occurring at a rate of 0.12, 0.18, and 0.046 per 100 catheter days respectively. Transhepatic catheters provide safe, feasible access in patients with exhausted vascular access. Patients who undergo THC insertion should be worked up for innovative permanent vascular access or urgent transplantation utilizing unconventional vascular techniques to avoid death due to lack of access.

Supplementation of Aspergillus oryzae Culture Improved the Feed Dry Matter Digestibility and the Energy Supply of Total Volatile Fatty Acid Concentrations in the Rumen of Hu Sheep

The objective of the present study was to investigate the effects of feeding different amounts of Aspergillus oryzae culture (AOC) on the degradation rate of various feeds for 24 h, rumen fermentation parameters, microbial community, and blood cell composition of Hu sheep. Sixteen castrated and fattening adult Hu sheep with permanent rumen fistula were randomly divided into four groups (four sheep per group) based on body weight (64.62 ± 5.83 kg). The experiment was repeated for two periods to ensure eight replicates for each treatment, and each period consisted of 28 days, including a 7-d of transition, a 14-d of pre-feeding, and a 7-d of sample collection. The control group (CON) received a basal diet without AOC, and the other groups were fed basal diet supplemented with 10 g/d, 20 g/d, and 40 g/d AOC, respectively, every day before the morning feeding. Supplementation with 20 g/d and 40 g/d AOC significantly increased (P < 0.05) the total volatile fatty acids (TVFAs) content, the molar ratio of butyric acid, and the 24 h dry matter (DM) degradation rate of alfalfa hay and corn straw. When fed 40 g/d AOC, the DM degradation rate of corn germ meal and the relative abundance of Kiritimatiellaeota were significantly increased (P < 0.05), but the ratio of acetic acid to propionic acid (A/P) was significantly reduced (P = 0.04). In conclusion, supplementation with AOC for Hu sheep could improve feed DM digestibility and increase the energy supply of TVFAs concentration in the rumen. Based on the feed conditions of the present study, supplementation 40 g/d of AOC could increase the production efficiency of sheep while higher level have to further investigate.

Surgical treatment of deep-lying ano-/rectovaginal fistulas using a de-epithelialized “Singapore flap” (pudendal thigh flap)

Summary Background Rectovaginal fistulas represent 5% of all anorectal fistulas. For affected women, this pathology is associated with a reduction in quality of life (QoL) and self-esteem. Most commonly used methods of surgical closure have high recurrence rates or permanent perineal complaints, which in turn lead to negative effects on QoL and self-esteem. A fistula closure, using the “de-epithelialized Singapore flap” (SF), can be a good alternative therapy strategy. Method Our retrospective case series processes the long-term results of seven patients who were operated on for ano-/rectovaginal fistula using the SF. All patients underwent surgery at the University Hospital Graz, between May 2012 and July 2015. The data of the surgical follow-up examinations were collected and an additional telephone survey was carried out. The procedure is presented based on a structured description. All procedures were performed jointly by the Department of General Surgery and the Department of Plastic Surgery. Results The average age of the seven patients was 46.14 years (23–72 a). Five patients had a total of 12 previous operations with frustrating results. Of the seven patients treated, six had a permanent fistula closure (85.7%). The results of the telephone survey (n = 6) showed a high level of patient satisfaction (100%), and an improvement in QoL (83.3%), through our surgical method. In our cohort, neither urinary nor fecal incontinence occurred. Conclusion The treatment of an ano-/rectovaginal fistula using the “de-epithelialized pudendal thigh flap” (Singapore flap) is a promising treatment alternative. In particular, patients who have had previous proctological interventions show a benefit from this procedure.

Relationship between clinical remission of perianal fistulas in Crohn's disease and serum adalimumab concentrations: A multi-center cross-sectional study.

BACKGROUNDCrohn’s disease (CD) is complicated by perianal fistulas in approximately 20% of patients. Achieving permanent fistula closure remains a challenge for physicians. An association between serum anti-tumor necrosis factor-α concentrations and clinical outcomes in patients with CD has been demonstrated; however, little information is available on serum adalimumab (ADA) concentrations and remission of perianal fistulas in such patients.AIMTo study the relationship between serum ADA concentrations and clinical remission of CD-associated perianal fistulas.METHODSThis cross-sectional study of patients with CD-associated perianal fistulas treated with ADA was performed at four French hospitals between December 2013 and March 2018. At the time of each serum ADA concentration measurement, we collected information about the patients and their fistulas. The primary study endpoint was clinical remission of fistulas defined as the absence of drainage (in accordance with Present’s criteria), with a PDAI ≤ 4, absence of a seton and assessment of the overall evaluation as favorable by the proctologist at the relevant center. We also assessed fistula healing [defined as being in clinical and radiological (magnetic resonance imaging, MRI) remission] and adverse events.RESULTSThe study cohort comprised 34 patients who underwent 56 evaluations (patients had between one and four evaluations). Fifteen patients had clinical remissions (44%), four of whom had healed fistulas on MRI. Serum ADA concentrations were significantly higher at evaluations in which clinical remission was identified than at evaluations in which it was not [14 (10-16) vs 10 (2-15) μg/mL, P = 0.01]. Serum ADA concentrations were comparable at the times of evaluation of patients with and without healed fistulas [11 (7-14) vs 10 (4-16) μg/mL, P = 0.69]. The adverse event rate did not differ between different serum ADA concentrations.CONCLUSIONWe found a significant association between high serum ADA concentrations and clinical remission of CD-associated perianal fistulas.

MMP9 expression in intestinal fistula from patients with fistulizing CD and from human xenograft mouse model

ABSTRACT Fistula treatment represents a major unmet medical need in the therapy of Crohn’s disease (CD). Current medical therapies, such as anti-TNF antibody treatments, are often insufficient and do not achieve permanent fistula closure. Previously published data point toward a critical role for metalloproteinase-9 (MMP-9)/gelatinase B in fistula pathogenesis. The aim of this project was to investigate in detail MMP-9 expression in different fistula types and to confirm that MMP-9 is a potential target for fistula therapy in CD patients. Immunohistochemistry for total and active MMP-9, Cytokeratin 8 (CK-8) and co-staining of active MMP-9/CK-8 was performed in specimen derived from perianal fistulas, entero-enteric fistulas and fistulas from patients not responding to anti-TNF therapy. In addition, fistulas from the xenograft mouse model (anti-TNF treated or untreated) were analyzed. Total and active MMP-9 protein was detectable in cells lining the tracts of perianal and entero-enteric fistulas. Of note, total and active MMP-9 was also expressed in fistulas of CD patients non-responding to anti-TNF treatment. Interestingly, we detected considerable co-staining of active MMP-9 and CK-8 in particular in cells lining the fistula tract and in transitional cells around the fistulas. Furthermore, total and active MMP-9 are detectable in both anti-TNF treated and untreated xenograft fistulas. Taken together, our data suggest that MMP-9 is involved in fistula pathogenesis in CD patients, in fistulas of different origins and particularly in patients non-responding to anti-TNF therapy. Our xenograft fistula model is suitable for in vivo studies investigating a possible therapeutic role for MMP-9 targeting as fistula therapy.

The Management of the Open Abdomen - A Literature Review.

An essential component of the concept of "Damage control surgery", laparostomy is the procedure by which the abdomen is deliberately abandoned open, the visceroperitoneal contents being temporarily protected by multiple technical means. Actual classification: Grade 1, without viscero-parietal adhesions or fixity of the abdominal wall (lateralization), divided into: 1A clean, 1B contaminated and 1C enteral fistula -cutaneous skin is considered clean); Grade 2, which develops fixation is subdivided into: 2A clean, 2B contaminated and 2C enteral fistula; Grade 3, "frozen abdomen", is divided into: 3A clean and 3B contaminated; Grade 4, defined as enteroatmospheric fistula, is a permanent fistula associated with the presence of granulation tissue and a frozen abdomen. Indications of the open abdomen are: damage control surgery, abdominal compartment syndrome, peritonitis, severe acute pancreatitis, vascular emergencies. Temporary abdominal closure may be achieved by following methods: skin only closure, â??Bogota bagâ?Â, opsite Sandwich technique, absorbable mesh, non-absorbable mesh or commercial zipper, vaccum asisted closure, each with its own advantages and disadvantages. Regarding the definitive closure this can be achieved by non mesh and mesh mediated techniques. Component separation technique anterior and posterior should be considered the elective repair procedure in parietal defects after laparostomy. Although several studies have been published, there is still no consensus in the literature on the positioning of prosthetic material in relation to parietal planes. Some authors suggest better results (relative to the rate of recurrence and complications) for implantation in the "sublay" position. Open abdomen is an important tool in the arsenal of the emergency surgery. Classification, indications, methods of temporary abdominal closure are evolving, as well as management of enterocutaneous fistulas and fascial closure, therefore permanent update is neccessary to offer patients the best care.

Rectovaginal Fistula Repair 1 Year Later: Lessons Learned.

Rectovaginal (RV) fistulas are notoriously difficult to treat. Various methods for repair exist, and refinements in techniques can lead to "successful" outcomes. Review of the literature demonstrates that outcomes studies are scarce and mostly limited to comments on closure rate. We have experienced "success" in our own series with 100% closure rate, regardless of fistula etiology and comorbidities (radiation, inflammation, etc). However, long-term outcomes, including various complications and quality of life changes, have previously been underreported. Critical analysis of various outcomes after fistula repair in 14 patients was performed. Patients were surveyed and interviewed with regard to problems before and after fistula repair to obtain objective data focusing on their experience and outcomes. Conclusions are based on physician assessment and patient surveys 1 year after fistula repair and at least 6 months after ostomy reversal and are discussed within the context of data from the literature. Overall satisfaction rate after repairs was high. All patients would undergo attempt at repair again regardless of complications or functional changes (not present before repair). After repair, sexual dyspareunia affected 5 patients (36%); however, most abstained from sexual activity when their RV fistula became apparent. No patient admitted to dyspareunia before the development of their RV fistula. Anal sphincter and defecation function, as well as stool continence, were judged by surgeons and patients uniformly as adequate. However, 3 patients (21%) complained of intermittent problems with urination. A new/different type of pain affected 2 of 4 patients with Crohn disease. One of these patients subsequently developed a new postsphincteric RV fistula. Another patient noted new intermittent vaginal discharge after ostomy reversal, and magnetic resonance imaging suggested a residual fistula, which was not seen on follow-up sigmoidoscopy and "Blue Dye Test." We previously reported on algorithms for repair and refinements in techniques for "successful" repair of RV fistulas with zero recurrence rate. Long-term follow-up indicates, however, that although the overall satisfaction rate after surgery is high, true "success," defined as permanent fistula closure, is not necessarily problem free. Long-term morbidity and the management of other unique sequelae and problems are underreported.

Destructive per continuitatem spondylodiscitis after endovascular abdominal or thoracic aneurysm repair (EVAR/TEVAR): rare and untreatable?

IntroductionVery few publications have previously described spondylodiscitis as a potential complication of endovascular aortic procedures (EVAR/TEVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR/TEVAR based on our data base. Particular focus was laid on the complexity of disease treatment and grave outcome perspectives from a spine surgeon’s point of view in this seriously affected patient group.Materials and methodsA retrospective analysis and chart review was performed for 11 out of 284 consecutive spondylodiscitis patients who underwent EVAR/TEVAR procedure and developed destructive per continuitatem spondylodiscitis.ResultsAll 11 patients had single or more level destructive spondylodiscitis adjacent to the thoracic/lumbar stent graft. In mean, four surgeries were performed per patient to treat this rare complication. Six out of eleven patients (55%) died within 6 months of first identification of per continuitatem spondylodiscitis. In four patients due to persisting infection of the graft and recurrence of the abscess formation, a persisting fistula from anterior approach to the skin was applied.ConclusionsDestructive per continuitatem spondylodiscitis is a rare and severe complication post-EVAR/TEVAR. Clinical and imaging features of anterior paravertebral disease and anterior vertebral body involvement suggest direct continuous spread of the graft infection to the adjacent vertebral column. The mortality rate of these severe infections is extremely high and treatment with a permanent fistula may be one salvage procedure.

Effect of dietary gossypol supplement on fermentation characteristics and bacterial diversity in the rumen of sheep.

The tolerance of ruminants to gossypol, a natural phenolic compound derived from the cotton plant, is greater than that of monogastric animals, partially because of the gossypol-degrading bacteria in the rumen of the ruminants. In this study, we aimed to examine the effect of gossypol supplementation on fermentation characteristics, bacterial α-diversity and community structure in the rumen fluid of sheep to analyse the change of bacterial in response to gossypol. 8 sheep with permanent fistula were randomly divided into 2 groups, a control and gossypol acetate supplementation groups. Sheep in the latter group were supplemented with gossypol acetate at the levels of 600 mg and 1,200 mg/animal per day during the first (S1, days 1 to 27) and subsequent (S2, days 28 to 47) stages. Gossypol supplementation significantly increased the molar proportion of acetate, and decreased the molar proportion of isobutyric acid, butyric acid, and isovaleric acid in the rumen fluid. Gossypol supplementation have no significant effect on bacterial diversity in the rumen fluid. At the phylum level, gossypol had no effect on bacterial community. At the genus level, gossypol supplementation significantly increased the relative abundance of Treponema_2. However, there were no significant differences in the relative abundance of dominant bacterial genera. In conclusion, gossypol supplementation had an effect on molar proportion of acetate, isobutyric acid, butyric acid, and isovaleric acid, but had no significant effect on the bacterial diversity and relative abundance of dominant bacteria in rumen fluid of sheep.

Fistula surgery

Vesicovaginal fistulas are arare problem in the western world but are frequent occurrences in developing countries. In Germany the most frequent cause is hysterectomy. Vesicovaginal fistulas can be treated by the transvaginal or transabdominal approach depending on the characteristics of the fistula and the patient. The incidence and complexity of urorectal fistulas increase with the number of cumulative sequences of prostate cancer treatment. Overall there is no clear consensus about the optimal surgical approach route. The surgical treatment of both vesicovaginal and urorectal fistulas is associated with high permanent fistula closure rates; however, for both entities if the fistula is discovered early enough, conservative treatment with a temporary catheter drainage can be tried, depending on the underlying cause. For both conditions fistula repair in irradiated patients shows a much lower success rate. A spontaneous closure of fistulas in radiogenic fistulas is also not to be expected.

Use of different carbohydrate sources associated with urea and implications for in vitro fermentation and rumen microbial populations

Context Alternative feed sources have been investigated as replacements for green forages and cereal grains traditionally used in ruminant feed. We hypothesised that, when replacing sources of true protein with non-protein nitrogen (NPN) in the ruminant diet, the efficiency of utilisation of the NPN may be affected by the source of energy and that different energy resources used as alternatives to maize may improve efficiency and maximise ruminal fermentation characteristics. Aims The objective of this study was to evaluate the effects of diets containing different carbohydrate sources associated with urea on in vitro ruminal fermentation and rumen microbial profile. Methods Four diets based on Tifton 85 Bermuda grass hay (584 g/kg dry matter) were tested as substrates: cornmeal + soybean meal (C + SM, typical diet), cornmeal + urea (C + U), cassava scraping + urea (CS + U), and spineless cactus + urea (SC + U). The experimental design consisted of randomised blocks with four treatments and five blocks. Five adult Nellore cattle with permanent fistula in the rumen were used as inoculum donors. The semi-automatic in vitro gas production technique was used in two experiments. Quantitative real-time PCR was used to monitor the changes in the rumen microbial community. Key results The diets containing C + U and CS + U decreased (P &amp;lt; 0.05) concentrations of isobutyrate, isovalerate, and valerate after 24 h of incubation, and all diets containing urea decreased (P &amp;lt; 0.05) concentrations of isobutyrate, isovalerate and valerate after 96 h and increased (P &amp;lt; 0.05) acetate:propionate ratio. After 96 h of incubation, the diets containing CS + U and SC + U resulted in a lower (P &amp;lt; 0.05) population of Ruminococcus flavefaciens than the C + U diet, and a lower (P &amp;lt; 0.05) population of Streptococcus bovis than the C + SM diet. Conclusions From our results, a diet containing cassava scraping produces more methane per unit of degraded organic matter, which reduces fermentation efficiency. Diets that contain corn with either soybean meal or urea result in greater degradability with lower gas production rates than diets that contain either cassava scrapings or spineless cactus with urea. Diets containing urea as a total substitution for soybean meal alter the production of short-chain fatty acids and reduce the populations of S. bovis and R. flavefaciens. Implications Use of urea to replace soybean meal in the ruminant diet alters ruminal fermentation and rumen microbial population.

Comparative outcome of patch angioplasty versus balloon angioplasty after surgical thrombectomy of thrombosed arteriovenous hemodialysis graft: 18-month results

Background Repeated interventions to keep the well-functioning dialysis vascular access represent the Achilles heel for hemodialysis patients. Thrombosed permanent dialysis access, either arteriovenous fistula or arteriovenous graft (AVG) remains one of the most common and debatable complications regarding frequency of occurrence and how to manage. Objective Our study aims to evaluate mid-term outcomes of surgical thrombectomy of clotted AVG with adjunctive venous outflow procedures mainly patch angioplasty versus balloon dilatation to restore their function regarding patency as primary endpoint and safety as secondary endpoint. Patients and methods Between May 2016 and April 2019, 96 of 125 patients with first-time thrombosed dialysis AVGs were prospectively evaluated after block randomization for surgical patch angioplasty (group A) versus balloon angioplasty (group B) for venous anastomotic side after surgical thrombectomy in four tertiary referral hospitals in Egypt. Results Over 18-month follow-up period of our enrolled patients, immediate technical success was 100% with regaining graft functionality in 100% of 45 patients in group A patients versus 89.6% (P=0.056) in group B with achieving optimum graft functionality in 100% of technically successful declotting procedures (43 patients) in group B. The primary patency at 6, 9, 12 and 18 months in group A was 66, 63.6, 52.3 and 31.8%, respectively, versus 48.8, 48.8, 37.2 and 18.6%, respectively, in group B. The secondary patency in group A at 6, 9, 12 and 18 months was 86.4, 100, 88.6 and 77.3%, respectively, versus 72.1, 90.7, 79.1 and 69.8%, respectively, that was not statistically significant except 12-month primary patency (P=0.014). Conclusion Our study found no statistically significant difference in 18-month outcomes between patients treated with surgical thrombectomy with patch angioplasty and surgical thrombectomy with balloon angioplasty for thrombosed AVGs regarding regaining functionality and patency, however patients treated with balloon angioplasty required more additional secondary interventions and most of them were to manage graft venous anastomotic site restenosis.

Initial experience with endoscopic ultrasound-guided gallbladder drainage.

IntroductionPatients with acute cholecystitis who are unsuitable for cholecystectomy undergo conservative treatment or percutaneous transhepatic gallbladder drainage. As these two methods are not always successful, further treatment options are needed. One increasingly popular method is endoscopic ultrasound-guided gallbladder drainage (EUSGBD), whereby stents are placed so as to create a permanent fistula connecting the gallbladder to the stomach or the duodenal bulb, thus enabling drainage of its contents to the gastrointestinal tract.AimTo present our early experience with EUSGBD for the treatment of cholecystitis in patients who are not suitable for cholecystectomy.Material and methodsThe procedure was performed in 5 patients with acute cholecystitis. Two patients also had symptoms of biliary obstruction due to pancreatic head cancer. An ultrasound endoscope was used to create a fistula between the gallbladder and the stomach or between the gallbladder and the duodenal bulb, in which a self-expandable metallic stent (SEMS) was placed.ResultsAll procedures were performed with no perioperative complications. In all patients, the clinical symptoms of cholecystitis subsided within 3–15 days. In those patients who also showed symptoms of biliary obstruction, these symptoms subsided within 3–6 days following the procedure.ConclusionsThe EUSGBD seems to be an effective and safe treatment for acute cholecystitis in patients unsuitable for cholecystectomy. It can also be used to treat jaundice caused by obstruction of the common bile duct, when no other methods can be used. The method is particularly promising in cases of concurrent acute cholecystitis and common bile duct obstruction.

The effect of self-care agency on self-perceived burden of patients with permanent bladder fistula

Objective To explore the effect of self-care agency on the self-perceived burden of patients with permanent bladder fistula. Methods From January 2016 to January 2017, the general data questionnaire, the Self-Perceived Burden Scale(SPBS), the Exercise of Self-Care Agency Scale(ESCA) was used to investigate 388 cases of permanent bladder fistula in 2 hospitals in Lanzhou, Baiyin and Dingxi city, and the results were statistically analyzed. Results The total score of SPBS was (36.01±1.34) points, which was in the middle level. The total score of ESCA was (51.05±10.23) points, which was in low level. The total score of SPBS was negatively correlated with the total score of ESCA and each dimension (r=-0.496--0.168, P<0.01 or 0.05). Stratified regression analysis showed that self-care skills, self-responsibility, self-concept and health knowledge level in self-care ability were important influencing factors (P<0.05). Conclusions Nursing staff can improve the self-care ability, reduce the self-perceived burden, and improve the quality of life of patients. Key words: Cystostomy; Self-care agency; Self-perceived burden

Short-term effectiveness of hypospadias repair with free inner prepuce tube

?To explore the short-term effectiveness of hypospadias repairs with free inner prepuce tube. ?Forty-two males with hypospadias were repaired with free inner prepuce tube between May and October 2015. The age ranged from 1 year and 1 month to 28 years and 2 months with a median of 2 years and 9 months. Initial operation for hypospadias was performed in 41 cases and re-operation in 1 case of chordee after 16 months of hypospadias repair. There were 36 cases of hypospadias ( 6 cases of proximal penile type, 1 case of penile scrotal type, 26 cases of scrotal type, and 3 cases of perineal type) and 6 cases of type Ⅳ chordee according to Donnahoo classification criteria. ?The length of reconstructed urethra was 2.0-5.5 cm (mean, 3.6 cm). The patients were followed up 6-10 months (mean, 8 months). Urinary fistulae was noted in 10 patients, which healed spontaneously in 5 cases within 3 months after surgery, and was cured after repair in 5 cases. Urethral stenosis occurred in 4 cases (2 external orifice stricture and 2 distal urethral stricture) and urethral incision was performed. Wound infection was noted in 3 cases, 2 of them needed further surgery for a permanent fistula. Skin ischemic necrosis was found in 3 cases, 1 of them had infection and fistula, and needed further surgical repair. Diverticulum of scrotum developed in 1 case. Ten patients need re-operation, and the success rate was 76.2% (32/42). At 3 months after surgery, the HOSE score ranged from 11 to 16 (mean, 14.7). The maximum urinary flow rate was 1.9-28.4 mL/s (mean, 10.5 mL/s) in 22 cases of outpatient at 3 months after surgery. ?Free inner prepuce tube can survive and play a role of normal neourethra. The short-term effectiveness has shown a relatively high complication rate and suggests this procedure should be carefully applied.

Effect of Supplementing Streptococcus gallolyticus Strain TDGB 406 on Rumen Fermentation and Microbial Profile of Goats Fed on Oak Leaves

An experiment was conducted to study the effect of supplementation of tannin degrading bacteria (Streptococcus gallolyticus strain TDGB 406) on rumen fermentation and microbial profile of goats fed on oak (Quercus semicarpifolia) leaves. Three adult male goats (average body weight 27.5±1.0 kg) fitted with permanent fistula were distributed into three groups (switch over design). The animals of group 1 served as control (C) while animals of group T1 and T2 were given autoclaved and live culture of isolate TDGB 406 (106 cells/ml), respectively @ 5 ml/kg live weight. The animals were fed measured quantity of dry oak leaves as the main roughage source and ad libitum maize hay along with fixed quantity of concentrate mixture. The feeding of live culture of isolate TDGB 406 as probiotic did not show any effect on the rumen fermentation pattern viz. pH, total nitrogen, TCA ppt-N, NPN, lactic acid, total volatile fatty acids production and the activities of carboxymethylcellulase, xylanase, protease and tannase. However, the production of NH3-N was higher (P<0.05) in live culture fed animals as compared to control group. The population of rumen protozoa, total bacteria and fungi were similar in all the three groups, whereas, tannin degrading bacteria population was higher in T2 where the live culture of TDGB 406 was fed. The results of the study indicated that TDGB 406 can modify rumen microbial eco-system when used as probiotic in goats without disturbing the rumen environment.

Single center experience with treatment of spinal dural arteriovenous fistulas.

Spinal dural arteriovenous fistulas (SDAVFs) are rare pathologies with a yearly incidence of 5-10 new cases/million, constituting 60-80% of spinal arteriovenous malformations. Clinical symptoms include progressive paraparesis, paresthesias, bladder, and bowel disturbances. The pathophysiology of SDAVFs is not well elucidated. Microneurosurgery and endovascular techniques are established treatment modalities for permanent fistula occlusion, which are oftentimes accompanied by an amelioration of neurological deficits in the long run. Here, we report our interdisciplinary neurosurgical/neuroradiological management strategy of SDAVFs in 32 patients who were evaluated retrospectively. We focused on clinical presentation, microneurosurgical and interventional technique, early, and late neurological results. Quality of life (QoL) was additionally assessed in 12 patients at last follow-up. We discuss the results against the background of the current literature. Our series and the literature indicate that clinical outcome after treatment of SDAVF is favorable in general. Both neurosurgical and neurointerventional therapies appear to be safe and effective, but short-term neurological deterioration after the intervention constitutes an as-of-yet unsolved problem. Beyond age and preoperative neurological state, presence of comorbidities had a significant influence on neurological outcome in our study sample. Self-assessed physical and mental QoL at long-term follow-up was reduced in quite a number of patients and was associated with a poorer neurological result as well as presence of comorbidities. The patients' perspective in terms of QoL was first investigated in this study, but further research on QoL and psychosocial impairment of SDAVF patients is needed to enable individualized counseling and rehabilitation strategies.

In this issue – July 2015

In this issue – July 2015

Fistulation and Cannulation of the Rumen in Buffaloes: Comparision of Two Methods

Two surgical methods were compared for rumen fistulation and cannulation in 8 buffaloes. A permanent fistula was created in left paralumbar by two-stage surgery. In 4 animals, the muscles were incised along the skin edges in circular fashion and removed and in another 4 animals, the muscles were separated along the muscle fibre (grid). Suturing muscles with skin and rumen wall with muscles prevented postoperative complications. The cannula remained functional for long periods in grid technique.