Skin Fistula Research Articles

A Case of Hypercalcemia Due to Peritoneal Sarcoidosis Presenting as Appendicitis and Recurrent Sterile Intra-abdominal Abscess with Skin Fistula

A Case of Hypercalcemia Due to Peritoneal Sarcoidosis Presenting as Appendicitis and Recurrent Sterile Intra-abdominal Abscess with Skin Fistula

Rare presentation of pilomatrixoma as a fungating breast mass: Case report and literature review

Pilomatrixomas are rare tumors arising from the cellular matrix of hair follicles and typically manifest as subcutaneous nodules. This case report highlights a rarer presentation in a 68-year-old female who presented with a protruding, painful left breast mass. After an initial biopsy revealed a benign pilar cyst with keratin material, the tumor exhibited progressive growth, resulting in skin fistulas and calcified material exuding from the skin. Final surgical pathology confirmed a benign pilomatrixoma. This case underscores the importance of timely diagnosis and surgical treatment of this rare tumor to prevent tumor growth, skin erosion, and secondary infection.

Comparative long-term outcomes of airway resection and functional reconstruction for papillary thyroid cancer

IntroductionThe surgical management of patients diagnosed with papillary thyroid carcinoma (PTC) and tracheal invasion has been a subject of ongoing discussion, particularly regarding the approach to tracheal functional reconstruction. The objective of this study was to examine the surgical technique and prognosis of PTC patients with tracheal invasion. Materials and methodsThis study employed both univariate and multivariate Cox proportional hazard models to determine predictive factors that affect the progression-free survival (PFS) of PTC patients with tracheal invasion. Cox regression analysis was conducted by using R software version 4.3.1. ResultsIn our study, we included 247 patients with T4a PTC. Among them, 146 patients (59.1 %) were classified as Shin I, 57 patients (23.1 %) as Shin II-III, and 44 patients (17.8 %) as Shin IV. Patients in the Shin I group underwent shaving of the tumours in the airway. The preferred surgical methods in the Shin II, III and IV groups were window resection (66.7 %), sleeve resection (34.8 %) and partial tracheal resection and skin fistula (61.8 %), respectively. Multivariate analysis demonstrated that neither tracheal surgery nor reconstruction procedures had an impact on PFS in T4a PTC patients with tracheal invasion. The 5-year DSS rate for patients receiving radioiodine (RAI) therapy was 87.3 % (p = 0.033). ConclusionThis study confirmed that tracheal surgery and reconstruction methods had no impact on PFS in T4a PTC patients with tracheal invasion in different Shin groups. Furthermore, RAI therapy has the potential to increase the survival rate of patients with preoperative distant metastasis of T4a PTC.

Ultrasonography-based staging of inflammatory granulomatous mastitis and estimation of steroid response.

The aim of this study is to present novel diagnostic ultrasonography (USG)-based classification of inflammatory granulomatous mastitis (IGM) and to assess and compare dosage responses of locoregional steroid therapy. From January 2017 through March 2023, total of 230 biopsy-proven IGM patients were reclassified (grades I, II, and III) according to USG-based morphological features. The injection applications were grouped in Group1 (40 mg/mL between years 2017 and 2019) versus Group2 (80 mg/mL between years 2019 and 2023), and effectiveness was analysed for each grade in between groups. The mean age was 31 years old (range: 19-60) with median follow-up period of 7 months. The most common clinical presentation was breast mass accompanying draining skin sinuses of the affected skin and hypoechogenic mass with tubular extensions was the most prevalent feature on USG examination. As per USG-based features, 79 (34.3%) patients were redefined as grade I, 64 (27.8%) as grade II, and 87 (37.8%) as grade III. All patients underwent locoregional steroid injection only. The average number of treatments in the first group was 6 (±3 SD) with an effective dose of 40 mg/mL in the first group, and 4 (±2 SD) with an effective dose of 80 mg/mL in the second group. The generalized linear mixed model was used to investigate effects between groups (P < .05). High-dose steroid treatment was effective in burnout lesions (grades II and III), and it was found to be statistically significant in lowering number of treatments irrespective of grade. This novel classification could be a convenient tool in terms of common language between radiologists and clinicians. In addition, our study is a pioneer in comparing steroid dosage with no relapse in IGM patients.

Management of Hypospadias in Identical Twins at Mali Gavardo Hospital

This is a prospective study of two cases of hypospadias in identical twins with the same location and the same symptomatology at Mali Gavardo Hospital. Hypospadias corresponds to hypoplasia of the tissues forming the ventral surface of the penis responsible for an ectopic abruption of the urethra. Its aetiology is multifactorial, the surgical management is adapted according to the anatomical location.the Mathieu urethroplasty technique was used in both patients, urine drainage was performed with 8fr silicone catheter for 5 days. Post-operative follow-up was marked by a skin fistula in one case on the fourth day with spontaneous closure on day 8. Material Methodology: This was a prospective study of two cases of hypospadias in identical twins at the Mali Gavardo Hospital. The following parameters were studied: age, reasons for consultation, physical examination, complementary examinations, surgical treatment and post-operative follow-up. Conclusion: Hypospadias is a congenital malformation in males, the frequency of which is increasing throughout the world, and should be treated from an early age. In our context, the presence of the same anatomical form and the same location in both twins is still very rare in the literature, hence the need to share our experience with others. The Mathieu technique remains the reference technique for the management of hypospadias.

History of urine diversion techniques

The review article is devoted to the history of the development of urine diversion methods, starting from the very first operations for the imposition of skin fistulas and ending with modern high-tech surgical interventions. The advantages and disadvantages of various methods of urine diversion are described. It is shown that the gold standard today is orthotopic bladder plastic surgery, which allows to achieve good functional results and a high quality of life for patients.

Idiopathic Granulomatous Mastitis or Breast Cancer? A Comparative MRI Study in Patients Presenting with Non-Mass Enhancement.

To compare and determine discriminative magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis (IGM) and breast cancer (BC) that present as non-mass enhancement. This retrospective study includes 68 IGM and 75 BC cases that presented with non-mass enhancement on breast MRI. All patients with a previous history of breast surgery, radiotherapy, or chemotherapy due to BC or a previous history of mastitis were excluded. On MRI images, presence of architectural distortion skin thickening, edema, hyperintense ducts containing protein, dilated fat-containing ducts and axillary adenopathies were noted. Cysts with enhancing walls, lesion size, lesion location, fistulas, distribution, internal enhancement pattern and kinetic features of non-mass enhancement were recorded. Apparent diffusion coefficient (ADC) values were calculated. Pearson chi-square test, Fisher's exact test, independent t test and Mann-Whitney U test were used as needed for statistical analysis and comparison. Multivariate logistic regression model was used to determine the independent predictors. IGM patients were significantly younger than BC patients (p < 0.001). Cysts with thin (p < 0.05) or thick walls (p = 0.001), multiple cystic lesions, (p < 0.001), cystic lesions draining to the skin (p < 0.001), and skin fistulas (p < 0.05) were detected more often in IGM. Central (p < 0.05) and periareolar (p < 0.001) location and focal skin thickening (p < 0.05) were significantly more common in IGM. Architectural distortion (p = 0.001) and diffuse skin thickening (p < 0.05) were associated with BC. Multiple regional distribution was more common in IGM, whereas diffuse distribution and clumped enhancement were more common in BC (p < 0.05). In kinetic analysis, persistent enhancement was more common in IGM, whereas plateau and wash-out types were more common in BC (p < 0.001). Independent predictors for BC were age, diffuse skin thickening and kinetic curve types. There was no significant difference in the diffusion characteristics. Based on these findings, MRI had a sensitivity, specificity and accuracy of 88%, 67.65%, and 78.32%, respectively, in differentiating IGM from BC. In conclusion, for non-mass enhancement, MRI can rule out malignancy with a considerably high sensitivity; however, specificity is still low, as many IGM patients have overlapping findings. Final diagnosis should be complemented with histopathology whenever necessary.

Own Method of Forehead Skin-Sinus Fistula Treatment with Enabling and Maintaining Physiological Drainage in Overgrowing Inflammation of the Sinuses-A Case Report

Surgical treatment of craniofacial region diseases associated with soft tissue and bone loss is always a challenge for medical specialists. The paper reports a case of a 70-year-old patient who presented with a defect in the forehead area that had been dermatologically treated. Following clinical, laboratory and imaging diagnostics, the lesion was classified as skin sinus fistula. The case study analyzes overgrowth of the nasofrontal duct associated with the laryngological endoscopic procedure (restoring the patency of the frontal sinus was performed as the initial part of the treatment.) Maxillofacial surgeons made an attempt to create an acrylic “space maintainer” which can be used either temporarily or as the ultimate option. The manuscript also describes a method of multi-specialized surgical treatment and subsequent esthetic management with the use of an individualized epithesis for soft tissue replacement.

Radical surgical treatment of locally advanced thyroid cancer

The result of radical treatment of locally advanced thyroid cancer with metastases to the regional lymph nodes of the neck on the left, with tissue breakdown and skin fistula formation, is presented. An 84-year-old female patient has severe concomitant pathology, such as ischemic heart disease, widespread atherosclerosis, cardiosclerosis, and permanent atrial fibrillation (tachy form, Grade 2A). A conglomerate of lymph nodes with disintegration in the projection of the external jugular vein and possible profuse bleeding was considered an absolute indication for surgery, which was performed on February 10, 2015. Considering the conglomeration of the lymph nodes of the neck, which displaced the trachea to the right, an endoscopist was called in, who performed tracheal intubation through the nose using a fiberoptic bronchoscope. The surgical treatment included combined thyroidectomy, a Criles operation on the left side, and the removal of the conglomerate of the lymph nodes of the neck as well as the adjacent area of the skin in a single block. The postoperative period was uneventful. On the second day after surgery, the patient was examined by an endocrinologist. The prescribed treatment was L-thyroxine 75 mg once a day in the morning. On the fifth day, the patient was discharged with recovery to be treated in the outpatient clinic by an oncologist and an endocrinologist.

Timing, approach, and treatment strategies for infected pancreatic necrosis: a narrative review

Timing, approach, and treatment strategies for infected pancreatic necrosis: a narrative review

Tetrahedral framework nucleic acid carrying angiogenic peptide prevents bisphosphonate-related osteonecrosis of the jaw by promoting angiogenesis

The significant clinical feature of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the exposure of the necrotic jaw. Other clinical manifestations include jaw pain, swelling, abscess, and skin fistula, which seriously affect the patients’ life, and there is no radical cure. Thus, new methods need to be found to prevent the occurrence of BRONJ. Here, a novel nanoparticle, tFNA-KLT, was successfully synthesized by us, in which the nanoparticle tetrahedral framework nucleic acid (tFNA) was used for carrying angiogenic peptide, KLT, and then further enhanced angiogenesis. TFNA-KLT possessed the same characteristics as tFNA, such as simple synthesis, stable structure, and good biocompatibility. Meanwhile, tFNA enhanced the stability of KLT and carried more KLT to interact with endothelial cells. First, it was confirmed that tFNA-KLT had the superior angiogenic ability to tFNA and KLT both in vitro and in vivo. Then we apply tFNA-KLT to the prevention of BRONJ. The results showed that tFNA-KLT can effectively prevent the occurrence of BRONJ by accelerating angiogenesis. In summary, the prepared novel nanoparticle, tFNA-KLT, was firstly synthesized by us. It was also firstly confirmed by us that tFNA-KLT significantly enhanced angiogenesis and can effectively prevent the occurrence of BRONJ by accelerating angiogenesis, thus providing a new avenue for the prevention of BRONJ and a new choice for therapeutic angiogenesis.

Periorbital infection and fistula after placement of zygomatic implants: a case report and review

Zygomatic implants are a good alternative to severely atrophic maxilla prosthetic treatment, but complications can result from their placement. Skin fistulas are extremely rare complications of zygomatic implants, but it’s management can be challenging. Skin complications can happen when the apex of the zygomatic implant protrudes above the limits of zygomatic bone. To prevent its occurrence, careful planning must be done. The surgeon must control the final position of the implant at the appropriate length carefully. If infection or cutaneous fistula occurs, surgery to cut off the apex of the implant is indicated, either intra- or extra-orally. The aim of this case report was to describe the case of cutaneous fistula after Quad Zygoma treatment of extreme maxillary bone atrophy. A 56-year-old woman developed a left periorbital fistula 4 months after the placement of 4 zygomatic implants. Implant apex was palpable under the skin of zygomatic bone body. We opted for extra-orally cut off the implant tip above the outer cortical of the zygomatic bone. Postoperative course was uneventful and the patient had no more signs and symptoms of infection or fistula.

Hidradenitis suppurativa: bacteriological study in surgical treatment.

Hidradenitis suppurativa (HS) is an inflammatory chronic disease of the hair follicles that presents with different lesions in the apocrine gland-bearing areas of the human body. There are many possible factors for HS. Acne inversa is not primarily considered to be an infectious disease. A variety of Gram-positive and Gram-negative bacteria have been found from the lesions sporadically. To assess the bacteriological profile of HS before surgical treatment. We collected specimens for aerobic microbiological testing from 18 patients before surgical treatment in our hospital. The specimens were obtained from abscesses, directly from skin fistulas, on day 1 of hospitalisation. The most common bacteria in HS lesions were Staphylococcus aureus and Proteus mirabilis. In 4 patients we found multi-drug-resistant bacteria (MLSB, MRSA and A. baumannii). Long-term antibiotic treatment can cause multi-drug resistance in strains collected in HS lesions.

Oncoplastic breast surgery to treat recurrent granulomatous abscess: A new approach.

Introduction and importanceGranulomatous mastitis is a rare chronic and benign inflammatory breast disease with challenging diagnosis and management. No commonly recognized recommendations are established. Despite of medical and surgical approaches, relapse rate remains high.Case presentationA 43-year-old patient with a history of granulomatous mastitis presented recurrent breast abscess associated with skin fistula. She underwent Racquet mammoplasty procedure inspired from oncoplastic techniques. Medical and cosmetic outcomes were satisfactory.Clinical discussionGranulomatous mastitis is challenging to diagnose and can be confused with inflammatory breast malignancies. It's associated with high relapse rate. Management of granulomatous mastitis is complex. Its treatment varies from medical management based on steroid therapy and immunosuppressants to surgical approach. In case of recurrent breast abscess, surgical techniques inspired from oncoplastic breast surgery, can be used to improve cosmetic outcome.ConclusionOncoplastic surgical technic may be considered as an efficient procedure to manage recurrent breast granulomatous abscess.

Catamenial Skin Bleeding

A 37-year-old woman, gravida 3 para 3, presented with a history of 3 cesarean deliveries via midline incisions and abdominal skin bleeding. This bleeding was with her menses and had an associated painful abdominal wall lump (Fig. 1A). Clinical examination showed a midline scar mass with an associated skin fistula that was the source of her bleeding (Fig. 1B). Magnetic resonance imaging revealed a 7-cm abdominal wall lesion with a hyperintense to muscle on both T1- and T2-weighted images (Fig. 2).

A Case Report of Mycetoma and Cranial Osteomyelitis by Nocardia nova

AbstractMycetoma is a chronic, localized, slowly progressive, granulomatous infection of the skin that may progress to subcutaneous tissue, muscle and bone. It is an infrequent manifestation of Nocardia infection that predominantly occurs on the lower extremities.A previously healthy, 17-year-old boy presented to us with a 3-month history of scalp abscesses. On physical examination he had numerous, large left parietal and occipital inflammatory nodules on the scalp covered by alopecic skin and several sinuses discharging a purulent and serosanguinous material. He underwent a CT-scan and an MRI of the skull that revealed signs of cranial osteomyelitis and epidural empyema. Polymerase chain reaction assay of the purulent exudate was performed and identified Nocardia nova. The patient was discharged from the hospital after 8 weeks of antibiotherapy with meropenem and TMP-SMX with clinical, laboratorial and imaging improvement. He completed 12 months of outpatient oral therapy with TMP-SMX, after which cranial CT-scan showed a significant reduction of soft tissue thickening and bone reconstitution, with no relapses after stopping the treatment.The best antibiotic regimen and length of treatment are not established for the management of nocardiosis. This is an unusual and severe presentation of infection by Nocardia nova with extent to the bone and epidural space, with full recovery under standard antibiotic therapy. This case shows that a good outcome may be achieved with prolonged antimicrobial treatment in an immunocompetent patient.

Salvage hepatectomy for local recurrence after particle therapy using proton and carbon ion beams for liver cancer.

AimWith the increased use of particle therapy for liver cancer, local recurrence after particle therapy increased. Salvage hepatectomy is an acceptable treatment option for local recurrence following particle therapy; however, its safety and effectiveness remain unclear. Therefore, this multi‐center study aimed to verify the feasibility and efficacy of salvage hepatectomy and assess clinical issues associated with its application.MethodsWe retrospectively assessed the perioperative outcomes, prognosis, and pathological characteristics of 15 patients who underwent salvage hepatectomy for local recurrence after particle therapy between 2006 and 2019.ResultsHepatocellular carcinoma and metastatic liver tumors were noted in eight and seven patients, respectively. The mean total dose and number of fractions were 66.5 Gy and 12, respectively, and the mean interval between particle therapy and surgery was 30.1 months. Major hepatectomy was performed in seven cases. Moreover, the mortality rate was 0%, and surgical complications of Clavien‐Dindo grade IIIa or higher were observed in four cases (27%)—two bile leakages, one pleural effusion, and one refractory skin fistula. The median overall survival time and 5‐year overall survival rate after salvage hepatectomy were 29.9 months and 43.1%, respectively. Histological examination of the irradiated liver tissue surrounding the tumor showed sinusoidal dilatation, loss of hepatocyte, and fibrosis in most cases.ConclusionSalvage hepatectomy after particle therapy is a feasible therapy; however, the risk of refractory complications associated with particle therapy is relatively high. Therefore, the first‐line treatment for resectable liver cancer should be carefully determined considering second‐line treatment after local recurrence.

A Case of Primary Tuberculosis Mastitis Revealed By a Chronical Skin Fistula

Breast tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic countries. Its frequency is low both in tuberculosis localization (0.06 to 0.1%) as well as in breast disease (0.025 to 4.5%)

Oncology Clinical Treatment between Dentistry and Physician in Relationship with Antiresorptive Drugs

Oncology patients whose are diagnosed with hypercalcemia malignant and related events associated with bone metastases and they are prescribed with antiresorptives such as bisphosphonates, denosumab or antiangiogenics drugs. Those patients could be affected with MRONJ [Medication Related Osteonecrosis of the Jaw] expressed in their different Stages: Stage 0, Stage 1, Stage 2, Stage 3. Most of them attend your dental citation on Stage 3 when MRONJ caused irreversible pain as pathological fractures, anesthesia of the lower dental nerve, bucco-sinus o bucco nasal communication, skin fistulas vaguely in maxilla or jaw. The objective of the authors is developing a clinical oncology case report with a chronical buccal sinusal communication.

Relationship between adverse events associated with lenvatinib treatment for thyroid cancer and patient prognosis.

Tyrosine kinase inhibitors (TKIs) were first approved for treating radioactive iodine-refractory differentiated thyroid cancer (DTC) and anaplastic thyroid cancer (ATC) 5 years ago. Among them, lenvatinib has a high response rate and has become the first-line drug for treating thyroid cancer. Although it has a high response rate, it is also characterized by a high frequency of adverse events (AEs). AEs previously reported in a phase II study occurred after the practical application of TKI therapy. However, the type and frequency of AEs that occurred were significantly different. The present study investigated the type and frequency of AEs in the real-world setting and examined their relationship with prognosis. Between June 2015 and May 2020, 111 patients (79 patients with DTC and 32 patients with ATC) were treated with lenvatinib. An investigation of lenvatinib AEs, including fatal events, revealed that fistula formation or severe tumor regrowth after the discontinuation of treatment was an AE associated with poor prognosis. In total, 11 patients with ATC (34.4%) and 7 patients with DTC (8.9%) developed skin fistula. The mortality rate among these patients was 38.9% (7/18), including three deaths caused by major bleeding and four deaths attributable to mediastinitis or pneumonia. In the DTC group, irreversible regrowth occurred in all 7 patients who required drug withdrawal because of AEs, and all patients died. Conversely, overall survival was longer among patients with DTC and hand-foot syndrome (HFS). Therefore, the present study illustrated that although lenvatinib therapy can result in severe AEs requiring dose reduction or treatment discontinuation, the HFS appearance portends a good prognosis in patients treated with lenvatinib.