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At least 19 recordsLinked to original sources
PubMed1978

Arteriovenous fistulas for long-term dialysis. Factors that influence fistula survival.

We reviewed our total experience with arteriovenous (AV) fistulas for long-term hemodialysis. We are unable to show any significant difference in the survival of AV fistulas based either on the type of material used to create the fistulas or on their location. Complications encountered early in this experience largely were due to technical or judgmental errors. Thrombosis of radiocephalic fistulas resulted from failure to use a vein of adequate caliber. Failure of bovine artery heterograft AV fistulas resulted either from wound infection or from the use of a diseased artery that was incapable of delivering sufficient blood to keep the fistula open. Infection around a heterograft fistula frequently was associated with a lymphocele. The meticulous division, between clips or ligatures, of all tissues deep to the skin prevented lymphocele formation.

Adolescent↗
PubMed1976

[The fistula of the first branchial cleft A critical presentation of its pathogenesis and its clinical and surgical problems. A description of one case combined with a fistula auris congenita (author's transl)].

A case of congenital fistula of the first branchial cleft (Ohr-Hals-Fistel) is presented. Based on the previously published cases the anatomical and clinical aspects of the disease are summed up. Pathogenesis is discussed on the underlying principles of embryological basic research, centering on Hochstetter's "Entwicklungsgeschichte der Ohrmuschel und des äusseren Gehörganges des Menschen" (1948), a publication that is hardly known. Some hypotheses on the genesis of the fistula of the first branchial cleft are criticised and a new hypothesis is developed to the effect that the fistula is caused by a disturbance in the development of the external ear channel. A few critical remarks are added concerning the discussion on the genesis of fistula auris congenita.

Branchial Region↗
PubMedDate not supplied

[Spontaneous right primary iliac arteriovenous fistula and an unrecognized aorto-caval fistula located above an aneurysm].

A patient admitted for treatment of an aorto-iliac aneurism presented himself with swelling of the lower extremities and a low grade bruit over the abdomen continuous throughout systole and diastole. Aortography demonstrated the presence of a suspected ilio-caval fistula. Surgical treatment consisted of closure of the fistula and vascular replacement with an appropriate aorto-bifemoral prosthesis. Large statistics report an incidence of aortocaval fistula up to 4% in association with rupturing aortic aneurisms. The grave clinical signs and aortography confirm the diagnosis. Some of those may obstruct themselves spontaneously only to reopen at the time of operation as in the case reported. The greatest peroperatory problems with closure of those fistulae are pulmonary emboli by air and aneurismal contents. In our first case a temporary caval clip was placed as a part in the management of the lesion.

Aged↗
PubMed1979

[Esophago-tracheal fistula and ano-cutaneous fistula in a newborn (author's transl)].

Esophago-tracheal fistulas are rare malformations in which the frequency of associated defects is not yet well known. This is the reason for the description of a case of oesophago-tracheal fistula and ano-cutaneous fistula in a female newborn. Special attention is also paid to the problem of diagnostic difficulties, which were here resolved by oesophagoscopy accompanied by positive pressure ventilation through a tracheal tube.

Female↗
PubMed1977

External biliary-pancreatic fistulas.

Twenty-seven patients treated for pancreatic and/or biliary-cutaneous fistulas have been reviewed. Four patients died mainly because of cardiopulmonary and septic complications. Spontaneous sealing of the fistula occurred in 81% of the conservatively treated cases (48% of all cases). All the LO fistulas but only 68% of the HO fistulas treated conservatively sealed spontaneously. Eleven patients were treated surgically. There were three deaths and three failures (reappearance of fistula). All the patients who died had been operated on within three months after the appearance of HO fistulas. There was no mortality among the patients with LO fistulas or among patients operated on at a later stage. We have reached the following conclusions: 1. There is a significant difference in prognosis between low output and high output fistulas. 2. In LO fistulas, there is no need for a surgical intervention aimed to close the fistula unless it persists for at least one year. 3. In HO fistulas, if a corrective operation is necessary, it should be withheld for at least three months whenever possible. 4. Roux-en-Y fistulojejunostomy is considered to be the procedure of choice. 5. Infection and premature colsure of the external part of the fistulous tract should be avoided by insertion of drains and repeated surgical drainage, where necessary. 6. High caloric feeding, elemental diet and intravenous hyperalimentation are very important factors that enhance recovery in the surgically and conservatively treated patients.

Adult↗
PubMed1977

[Experiences with bladder-uterus fistulae].

The present summary reports 5 cases of vesicocervical fistula, 9 cases of vesicocervico-vaginal fistula and 1 of vesicocervicocorporeal fistula seen over the last 20 years. When compared with the period between 1941 and 1955 the number of such fistula cases has increased fourfold. All thses fistulas, with just one exception, arose as a consequence of obstetric treatment. Conservative therapie was successful only in one case while all the other fistulas had to been operated upon. The preferred operating technique was that of vaginal metroplasty (Wolkowitsch-Küstner's technique). Hysterectomy or stump exstirpation with cystorraphy were performed in 4 cases. The combined vesicocervico-corporeal fistula required a vaginoabdominal treatment. 14 patients were brought to recovery. Increases in the number of vesicouterine fistulas as observed over recent years are considered to be related to a more concentrated therapy and to a higher frequency of cesarean sections. The vaginal route is all the more justified for fistula operations the nearer the fistula is located to the vagina. Operations of that kind require adequate skill in urinary bladder-ureteral- and uterosurgery.

Abortion, Spontaneous↗
PubMed1977

[Short and long-term results of the treatment of vesicovaginal fistula by the vaginal approach (author's transl)].

Gynecologists prefer the vaginal route for closure of vesicovaginal fistulae. Urologists, however, have some doubts as to the long-term results as far as proper function is concerned. The purpose of this investigation was to discover the limits of the vaginal fistula operations with reference to patients at the Department of Gynecology and Obstetrics, University Erlangen-Nürnberg. From 1962 to 1976, 40 women with vesicovaginal, urethrovaginal and vesicocervicovaginal fistulae were treated. Forty-five operations were necessary. In one patient, surgery in two sessions was planned from the beginning. Besides 4 obstetric fistulae, gynecological operations were the original cause of the fistulae in 34 cases. Two women had actinic fistulae (overdosage of intracavitary radium application). Attempts to close the fistulae here failed utterly. The Latzko technique was used in 27 women. Füth's method, in 7. In the remaining cases various vaginal procedures were chosen, for example, interposition of the bulbocavernosus muscle or interposition of the uterus. Three late complecations with recess formation (in 2 cases with concrements) after the Latzko operation could be treated trans-urethrally. Ten years after a Füth's operation one patient had to undergo vaginal surgery for an urethral diverticulum with concrement. The precedure of choice in the typical post-hysterectomy fistula is the Latzko operation. For fistulae patients who still have a uterus, other vaginal procedures are preferable. No attempt should be made to close a radiogenic fistula--usually following inadequate radiation therapy--by a vaginal operation. Details of our indications are fully dealt with in the discussion.

Female↗
PubMed1978

Coronary artery to pulmonary artery fistulas.

Twelve patients with a total of 14 coronary artery to pulmonary artery fistulas were discovered at the time of diagnostic coronary angiography. Six patients had severe coronary artery disease, five patients had normal coronary arteriography, one patient had insignificant coronary artery disease, and one patient had rheumatic heart disease. Only two patients had characteristic continuous murmurs; one patient had a normal coronary angiogram, and the second patient had severe coronary artery disease. Ten fistulas originated from the left anterior descending artery, three from the right coronary artery, and one from the left circumflex artery. The fistulas were either composed of one large (five fistulas) or one or more small channels (seven fistulas) or poorly defined plexiform channels (two fistulas). Hydrogen studies performed in two patients were negative and dye dilution curves performed in all patients were normal. In only four out of the six patients with severe coronary artery disease, the fistulas originated from a diseased vessel and in each case the origin was proximal to the narrowing. The pathogenesis and functional role of these fistulas is largely unknown.

Adult↗
PubMed1979

[Gastrointestinal haemorrhage due to aorto-intestinal fistula. 3 cases (author's transl)].

Three types of aorto-intestinal fistula may be associated with gastrointestinal bleeding: primary fistulae from an aneurysm, secondary fistulae related to an aorto-prosthetic anastomosis and paraprosthetic fistulae by intraduodenal protrusion of a graft. The prevalence of secondary and paraprosthetic fistulae increases with more widespread vascular surgery. Only if the diagnosis is always borne in mind in a patient with an aneurysm or an aortic prosthesis makes it possible to recognise an aorto-intestinal fistula in time. Upper GI series and endoscopy are more useful in reaching a diagnosis than arteriography but signs must be sought in the third and fourth parts of the duodenum. The lesion may even be missed on surgical exploration, being concealed before separation of the aorta and duodenum. Infection and the underlying general medical condition are factors in the gravity of the operative prognosis. One of our three patients treated surgically was saved by the insertion of an extra-anatomic bypass. The prognosis in paraprosthetic fistulae, the possible precursor stage of a secondary aorto-digestive fistula, is more favourable.

Aged↗
PubMed1978

[Secondary coronary fistulas].

These fistulae are very rare: 8 to 11 p. 100 of all coronary fistulae. Three types are recognised: right coronaro-ventricular, left coronaro-ventricular, and coronao-pulmonary. The two first types are found most frequently in association with a sigmoid atresia on the orifice, and with ventricular hypoplasia in the presence of a functional atrio-ventricular valve. The fistula then serves as a means of ventricular ejection. Of the secondary fistulae, the right coronaro-ventricular type is the most common (73 p. 100). The authors have found 30 cases in the published literature, and add 2 of their own. They have also reviewed the clinical features and the findings on coronary arteriography and post mortem studies on such fistulae. They discuss their etiology, pathogenesis, and physiopathology. Surgical correction involves repairing the fistula in one stage. Fistulae of the left coronaro-ventricular type are exceptions to this rule (9 p. 100), as they are always associated with a rapidly fatal hypoplasia of the left side of the heart. Coronaro-pulmonary fistulae (18 p. 100) are usually found in association with extreme forms of Fallot's tetralogy, and a relatively simple surgical correction can form part of the total correction of the tetralogy.

Coronary Vessel Anomalies↗
PubMed2026

Preoperative intramuscular testosterone and urethrocutaneous fistula formation after primary hypospadias repair.

INTRODUCTION: Preoperative androgen stimulation is widely used before hypospadias repair to increase penile dimensions and optimise surgical conditions. However, its impact on postoperative complications, particularly urethrocutaneous fistula formation, remains controversial. OBJECTIVE: To evaluate the association between preoperative intramuscular testosterone therapy and urethrocutaneous fistula formation in children undergoing primary hypospadias repair. STUDY DESIGN: This was a retrospective comparative analysis of prospectively collected clinical data from 111 boys undergoing primary hypospadias repair at a single tertiary pediatric urology center. Patients were divided into two groups: those who did not receive hormonal therapy (Group 1, n = 55) and those who received intramuscular testosterone enanthate (2 mg/kg administered 5 and 2 weeks before surgery; Group 2, n = 56). Preoperative penile measurements, operative characteristics, and postoperative complications were compared. The primary outcome was urethrocutaneous fistula formation. The mean follow-up duration was 11.9 months (median 7 months). RESULTS: Preoperative testosterone therapy was associated with significant increases in glans diameter and stretched penile length at the time of surgery. The hormone-treated group had a significantly higher proportion of proximal hypospadias (p = 0.001), underwent more complex urethroplasty procedures, and had longer operative times (p = 0.007). Postoperative edema and local inflammatory changes were more frequently observed in the hormone-treated group. Despite these differences, urethrocutaneous fistula occurred in four patients in each group (7.3% vs 7.1%, p = 0.357), with no statistically significant difference between groups. DISCUSSION: Despite greater baseline anatomical severity and operative complexity in the hormone-treated group, preoperative testosterone administration was not associated with an increased risk of urethrocutaneous fistula. These findings suggest that improved tissue bulk and vascularity may offset the potential adverse effects of transient inflammatory changes. CONCLUSION: Selective preoperative intramuscular testosterone therapy was not associated with increased urethrocutaneous fistula risk and may be considered a reasonable adjunct in appropriately selected patients undergoing primary hypospadias repair. CLINICAL/TRANSLATIONAL APPLICABILITY: These findings provide clinical reassurance that preoperative testosterone can be used selectively in patients with smaller penile dimensions or anticipated technical difficulty without increasing fistula risk, thereby supporting shared decision-making in clinical practice.

Humans↗
PubMed1975

The management of high-output intestinal fistulas.

A high-output gastrointestinal fistula is a surgical catastrophe of the first order of magnitude. Previously associated with an extraordinarily high mortality, the advent of parentaeral nutrition has markedly altered the management of these fistulas. Malnutrition and electrolyte imbalance formerly were the causes of death in the majority of patients. At the present time the mortality rate has decreased from approximately 40-60% to 6-20%, depending on the series. a suggested plan of therapy for high-output gastrointestinal fistulas is outlined. Good local care, sump drainage and nutritional support with or without the use of appropriate antibiotics, depending on the circumstances, are the keystones of management. Radiologic definition of the fistula is of primary importance. Certain criteria by which one may predict fistula closure aare outlined. The emphasis in this chapter is on an attempt at spontaneous closure with parenteral nutrition. In the event that this in not achieved, complete exclusion of the fistula from the gastrointestinal tract, either by excision or by total bypass, is mandatory to achieve satisfactory results. Causes of death remain sepsis and peritonitis related to the fistula, but an occasional patient will succumb to massive bleeding. Catheter-related sepsis and complications of hyperalimentation are largely preventable, and steps to prevent such complications are outlined.

Abdominal Muscles↗