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At least 19 recordsLinked to original sources
PubMed1990

[Esophagorespiratory tract fistula treated by primary suture. Apropos of 2 cases of esophago-pleural fistula and 2 cases of esophagobronchial fistula].

We describe two oesophago-pleural fistulas arriving respectively 40 months and 15 years after pneumonectomia, and two oesophago-bronchial fistulas due to perforated oesophageal diverticula. We evaluate diagnostic methods and discuss etiology of these oesophageal fistulas. Pleural fistulas treatment associate thoracic drainage, direct surgical treatment of the fistula with primary suturing of oesophagus. For oesophago-bronchial fistula treatment, we have made pneumonectomia one time and primary bronchial suturing another. In these two cases, oesophagus was only sutured without pleural or muscular flap. Transient alimentary gastrostomy was made. No fistula recidive of postoperative complication occurred. There is no operative mortality.

Adult↗
PubMed1976

Fistula-in-Ano: perineal fistula of intra-abdominal or intrapelvic origin simulating fistula-in-ano--report of seven cases.

Fistulas manifesting in the perianal region but originating in the abdomen often have their true origin not recognized for extended periods. Examples of seven such complex cases are presented and discussed. Removal of the abdominal abnormality is mandatory before any cure can be effected; the perianal portion usually heals without any special local treatment.

Abscess↗
PubMed2001

Comparison of transposed brachiobasilic fistulas to upper arm grafts and brachiocephalic fistulas.

BACKGROUND: Renewed interest in transposed brachiobasilic fistulas has occurred since the release of the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines because it is an alternative method to achieve an upper arm fistula in patients who cannot achieve a functional brachiocephalic fistula. The objective of this study was to compare outcomes among transposed brachiobasilic fistulas, upper arm grafts, and brachiocephalic fistulas. METHODS: A cohort of patients with upper arm accesses was retrospectively identified. Access outcomes were determined from medical records and contact with physicians, dialysis providers, and patients. Primary outcome was thrombosis-free survival. Secondary outcomes were primary failure, time to use, risk of catheter-related bacteremia, need for intervention, incidence of access-related complications, cumulative, and functional patency. Group differences in age, sex, race, diabetes, peripheral vascular disease, and number of previous accesses were adjusted for in the analysis where appropriate. RESULTS: Transposed brachiobasilic fistulas, upper arm grafts, and brachiocephalic fistulas were compared in 59, 82, and 56 patients, respectively. Compared with transposed brachiobasilic fistulas, upper arm grafts were more likely to thrombose with an adjusted relative risk (RR) of 2.6 (95% CI, 1.3 to 5.3) excluding primary failures and 1.6 (95% CI, 1.0 to 2.7) when accounting for the lower risk of primary failure for grafts. Transposed brachiobasilic fistulas also required less intervention (0.7 vs. 2.4 per access-year, P < 0.01) and were less likely to become infected (0 vs. 13%, P < 0.05) than grafts. Mature brachiocephalic fistulas were less likely to fail (RR 0.3, 95% CI, 0.1 to 1.0) and showed a trend for less thrombosis (RR 0.3, 0.1 to 1.1) than mature brachiobasilic fistulas. There was no significant difference in cumulative patency (failure-free survival) among the three types of access if primary failure was included at the median follow-up of 594 days. Transposed brachiobasilic fistulas provided catheter-free access one month sooner than brachiocephalic fistulas and one month later than upper arm grafts. CONCLUSIONS: Transposed brachiobasilic fistulas provide cumulative patency equivalent to upper arm grafts and brachiocephalic fistulas. They are less likely to thrombose and become infected than upper arm grafts. Compared with brachiocephalic fistula, they are more likely to mature but are at increased risk of thrombosis after maturation. Transposed brachiobasilic fistulas should be considered before placing an upper arm graft for patients that cannot achieve a functional brachiocephalic fistula.

Arm↗
PubMed2003

Brachiobasilic arteriovenous fistula: different surgical techniques and their effects on fistula patency and dialysis-related complications.

OBJECTIVE: Easy access to the vascular system is vital in patients with chronic renal failure undergoing long-term hemodialysis. Such patients often require multiple operations, and options for secondary or tertiary access procedures become increasingly limited. Brachiobasilic arteriovenous fistula offers excellent access in such difficult cases and is increasingly preferred over prosthetic grafts. Many surgical techniques have been described to create such fistulas. The purpose of this study was to determine the difference in long-term patency and dialysis-related complications among various techniques. METHODS: Seventy brachiobasilic arteriovenous fistulas were constructed in 70 patients. This was the secondary or tertiary access in 88.6% of patients. The basilic vein was transposed in 30 patients and elevated in 40 patients; twenty veins were elevated with a one-stage technique, and 20 were elevated with a two-stage (delayed elevation) technique. RESULTS: The early failure rate was 5.7% in the entire group. Sixty-six fistulas (94.3%) were successfully used for dialysis. Mean follow-up was 25.8 months (range, 4-36 months). Four fistulas (5.7%) required additional procedures during follow-up, 2 in the transposed vein group and 2 in the elevated vein group. Cumulative secondary patency rate, measured with the Kaplan-Meier survival method, was 86.7%, 90%, and 84.2% at 1 year for the transposed, one-stage, and two-stage elevation procedures, respectively, compared with 82.8%, 70%, and 68.4% at 2 years. The difference was statistically nonsignificant. Forty-two complications developed in 29 (43.9%) fistulas. Thirteen fistulas (19.7%) had more than one complication. Twelve complications in 10 fistulas (35.7%) were recorded in the transposition group, 15 complications in 9 fistulas (47.4%) in the one-stage elevation group, and 15 complications in 10 fistulas (52.6%) in the two-stage elevation group. The total complication rate was higher in the elevated fistulas (71.4% vs 28.6%); the difference was statistically highly significant (P <.001). The most common complication was arm edema (21.2%; n = 14), followed by puncture site-related hematoma (16.7%; n = 11) and thrombosis (16.7%; n = 11). Hematoma was statistically more common (P <.05) in the elevated vein group (26.3% vs 3.6%). The difference in thrombosis between the transposition and elevation groups (23.7% vs 7.1%) was not significant. Hematoma preceded thrombosis in 63.7% (7 of 11) of the fistulas, and it was the major predisposing factor for fistula failure. Transposed vein was easier to manage by dialysis staff. All nurses were satisfied with the transposed veins, but only 53.3% were satisfied with the elevated veins; the difference was statistically highly significant (P <.001). CONCLUSION: Available techniques for creating brachiobasilic arteriovenous fistula are associated with good patency rate, and most related complications can be treated conservatively without loss of the fistula. Among the various procedures, transposition has a lower complication rate and is favored by the dialysis staff dealing with such fistulas.

Adolescent↗
PubMed1995

The Gracz arteriovenous fistula evaluated. Results of the brachiocephalic elbow fistula in haemodialysis angio-access.

OBJECTIVES: To assess fistula patency and complication rates in braciocephalic elbow fistulas of both the Gracz and the side-to-side configuration. DESIGN: Retrospective clinical study. METHODS: Life table patency and complications of 50 Gracz fistulas and 23 side-to-side elbow fistulas created between 1988 and 1993 were reviewed. RESULTS: The cumulative patency for the elbow fistulas was 84% after 1 year and 78% after 3 years. No difference was found between the Gracz fistula and the side-to-side elbow fistula. Stenosis was the most frequent indication for revision and thrombosis was the most frequent cause of fistula failure. CONCLUSION: The elbow fistula has a long patency with few complications and performs as well as wrist fistulas and better than the graft fistulas reported in the literature. The Gracz elbow fistula has results as good as the side-to-side elbow fistula. Graft fistulas should be reserved for tertiary procedures only.

Adolescent↗
PubMed2000

Defective fibroblast growth factor signaling allows for nonbranching growth of the respiratory-derived fistula tract in esophageal atresia with tracheoesophageal fistula.

BACKGROUND/PURPOSE: The fistula tract in esophageal atresia with tracheoesophageal fistula (EA-TEF) appears to arise from a trifurcation of the embryonic lung bud. Subsequently, it does not branch like the other bronchi, which also arise from the lung bud. Previous results have implied that aberrant mesenchymal-epithelial signaling in the developing foregut, possibly involving fibroblast growth factors, may allow for the nonbranching growth of the fistula, and the ultimate development of the fistula tract in TEF. METHODS: Adriamycin injections into pregnant rat dams induced EA-TEF formation in rat embryos. Control and Adriamycin-exposed embryos were harvested on the 13th gestational day, and the developing foregut was isolated with microdissection. mRNA was isolated from the developing fistula tract, embryonic lung, and normal embryonic esophagus. Reverse transcription-polymerase chain reaction (RT-PCR) for the IIIb splice variant of the FGF2R receptor was performed. Foregut specimens also were processed for histologic analysis, and immunofluorescence for FGF1 was performed. RESULTS: FGF2R-IIIb is specifically absent from the developing fistula tract in TEF, whereas it is present in the normal developing lung and esophagus. FGF1 also is uniquely absent from the developing fistula tract, but it is present in the normal lung mesenchyme. CONCLUSIONS: FGF1, FGF7, and FGF10 are critical mesenchymal factors that mediate proliferation and branching morphogenesis by the developing respiratory epithelium. The absence of FGF2R-IIIb, the obligate common receptor for FGF7 and FGF10, from the fistula tract, and the absence of FGF1 in the fistula tract mesenchyme, collectively imply the absence of a specific FGF signaling pathway in the developing fistula tract. This absence of FGF signaling could explain the lack of branching by the developing fistula tract as it grows caudally in the abnormally developing embryo. Downregulation of these components of the FGF signaling pathways may allow for a patterned compensation by the embryo for the proximal foregut atresia in this anomaly. This compensation may then reestablish gastrointestinal continuity as the fistula tract connects to the developing stomach.

Animals↗
PubMed1978

[Evaluation of the fistula test and the positional test in the diagnosis of a fistula of the labyrinth (author's transl)].

111 patients with a chronic otitis media and symptoms of dizziness were investigated. Out of 75 patients, who were operated, a fistula of the labyrinth was suspected in 25 patients due to a positive fistula test or a positive (fistula) positional test. A fistula was found in 15 patients. In those 15 cases both the fistula and the positional (fistula) test were positive in nine cases. In the remaining six cases three had a positive fistula test and three a positive (fistula) positional test. The other 50 patients all with negative fistula reactions one fistula was whereas found by the operation. This would indicate, that a positive fistula test and a positive (fistula) positional test are of value in the preoperative evaluation of patients with chronic otitis media and symptoms of vertigo.

Fistula↗
PubMed1991

Parenteral and enteral nutrition and the enterocutaneous fistula treatment. I. Investigations on fistula output, nutritional status complications.

Prospective evaluation were made of 45 patients with postoperative small bowel fistulas treated with total parenteral nutrition (TPN) and enteral nutrition (EN) between 1971-1988. The administration of TPN in the early treatment of enteric fistulas decreased the mean fistula output significantly (p < 0.05-0.001) and provided an effective tool in the control of high-output fistulas. The electrolyte contents of different fistula secretions were unchanged and the losses through the fistulas depended on the daily output. In patients with high-output fistulas acid-base balance disturbances had to be corrected. When comparing two parenteral nutrition regimens (carbohydrate+amino acids /CH + AA/ versus carbohydrate + amino acids + fat /CH + AA + F/) both facilitated the reduction of fistula secretion (in high-output fistulas. CH + AA = -50.2%; CH + AA + F = -49%). Positive nitrogen balance was achieved in non septic patients after 13 days of treatment. Improvement of serum protein and albumin occurred by the time of fistula healing. In non surviving patients significant decrease in protein synthesis was observed. Out 7 of 75 central venous catheters yielded positive bacterial cultures (9.3%). In 5 patients autopsy proved generalized sepsis. The use of parenteral and enteral nutrition proved to be a powerful method for controlling the enterocutaneous fistulas and maintaining the nutritional integrity of patients.

Adult↗
PubMed2002

The fistula elevation procedure: a valuable technique for maximizing arteriovenous fistula utilization.

Many patients are not considered candidates for radiocephalic fistula (RCF) or brachiocephalic fistula (BCF) creation or have fistulas that do not mature because the cephalic vein is too deep or tortuous to be accessed. Other patients have not been candidates for the basilic vein transposition (BVT) because limited length of adequate caliber vein precludes subcutaneous tunneling of the vein. In an effort to maximize arteriovenous fistula (AVF) utilization, we developed an adjunctive procedure designed to make the deep or tortuous fistula accessible to needle cannulation. The fistula elevation procedure (FEP) involves mobilization of the fistula, approximation of the subcutaneous tissue beneath the fistula, and subcuticular skin closure over the fistula. The procedure enhances the accessibility of the fistula by placing it in a more superficial position. The overlying cicatrix also acts as a guide for dialysis needle insertion. Between June 1998 and January 2001, 45 patients underwent a natural AVF that could not be accessed secondary to venous depth, tortuosity, or length. In each case, a FEP was performed to salvage the fistula. The FEP was performed as an adjunct to a BCF in 20 patients, a RCF in 7 patients, and a BVT in 8 patients. The FEP is a simple procedure that enhances AVF utilization by making the fistula more accessible to dialysis needle cannulation. The procedure is particularly helpful in obese patients who would not traditionally be considered candidates for natural AVF creation.

Adult↗
PubMed1985

Assessment of arteriovenous fistulae from pressure and thermal dilution studies: clinical experience in forearm fistulae.

Knowledge of useful fistula flow (UFF), the maximum blood flow available using twin needles within acceptable pressure limits and without recirculation, is essential for the optimal management of patients receiving maintenance hemodialysis or hemofiltration. A technique for the measurement of UFF employing thermal dilution for the detection of recirculation has been developed. Using this technique, 94 studies were carried out in 69 forearm fistulae. UFF exceeded 400 ml/min in 45 fistulae. In these satisfactory fistulae a normal range was defined for basal intrafistula pressures (60 mmHg being the approximate upper limit of normal). Analysis of arterial and venous line pressure recordings with increasing extracorporeal blood flow and knowledge of the presence or absence of recirculation allowed us to define the functional problem in unsatisfactory fistulae. The functional diagnosis was supported in 16 of 24 fistulae by angiography or surgery or both. In all but two of the remainder, satisfactory UFF was obtained by repositioning the patients' needling sites. Fistulae were divided into different clinical groups. Of 35 fistulae which were thought to be clinically acceptable, 7 were found to be unsatisfactory. In 17 fistulae in patients with poor biochemical control, recirculation was detected in 8. Of 11 fistulae reported to produce poor flows on dialysis, 4 had UFF above 400 ml/min. Of 6 fistulae in patients experiencing needling difficulties, 5 had satisfactory UFF. These studies which take only a few minutes and can be carried out immediately preceding a routine dialysis session not only identify unsatisfactory fistulae, but yield valuable diagnostic information in these cases. This has reduced dependence on angiography and has led to more careful selection of patients for surgery.

Arteriovenous Shunt, Surgical↗
PubMed1978

[Evaluation of the fistula test and the positional test in the diagnosis of a fistula of the labyrinth (author's transl)].

In 111 patients with a chronic otitis media and symptoms of dizziness the positional reactions were examined. Among 75 patients, who underwent operations later on, a fistula of the labyrinth was preoperatively expected in 25 patients according to a positive fistula pressure sign or a pathological fistula positional reaction. A positive fistula positional sign shows a contralateral beating transitory nystagmus in the head hanging position, while after rapid sit up the nystagmus is starting to beat into the ipsilateral direction. A labyrinthine fistula was operatively confirmed in 15 patients out of 25 suspicious cases. In these 15 cases both the fistula and the positional test were positive in 9 cases. 3 had a positive fistula pressure test and 3 a positive fistula positional sign. In 50 patients with negative fistula reactions only one fistula was observed during operation. These data underline the importance of both pressure and positional reactions in the prediction of labyrinthine fistulas.

Adult↗
PubMed2003

Do anal fistulas in Crohn's disease behave differently and defy Goodsall's rule more frequently than fistulas that are cryptoglandular in origin?

OBJECTIVES: The complexity of anal fistulas is different in patients with and without Crohn's disease and in men and women. This may affect the localization of the internal orifice. We compared the characteristics of anal fistulas and the accuracy of Goodsall's rule in predicting the position of the internal orifice in male and female Crohn's and non-Crohn's patients. METHODS: A total of 191 fistula tracks in 182 consecutive patients (110 men and 72 women) were analyzed prospectively. Of the patients, 63 were diagnosed with Crohn's disease. The positions of the orifices were recorded and the accuracy of Goodsall's rule determined. RESULTS: The distribution of fistula subtypes among Crohn's and non-Crohn's patients differed significantly (p = 0.0471). Fistulas with an anterior external opening occurred more frequently in Crohn's patients (p = 0.0350) and in women (p = 0.0030). Fistulas with a posterior external orifice were observed more frequently in non-Crohn's patients (p = 0.0350) and in men (p = 0.0028). Overall, Goodsall's rule performed less well in women compared with men (p = 0.0633). The accuracy of Goodsall's rule overall was not affected by Crohn's disease. In female non-Crohn's patients, the positive predictive value of a posterior external orifice was lower than in men (p = 0.0406). CONCLUSIONS: The distribution of fistula subtypes and the ratio of anterior and posterior external openings among Crohn's and non-Crohn's patients differ significantly. Many fistulas defy Goodsall's rule, particularly in women and when applied to fistulas with anterior external orifices. The popular rule, however, falls equally short in Crohn's and non-Crohn's fistulas.

Adolescent↗
PubMed1989

[Postoperative recurrence of esophago-tracheal fistula. Significance of peroperative catheterization of the fistula with tracheoscopy. Apropos of 10 cases].

Ten children with recurrent tracheo-oesophageal fistula have been treated over 13 years (1976-1988). Five patients were referred from other centers. The original pathology was oesophageal atresia in eight and two patients had a tracheo-oesophageal fistula alone. Barium swallow demonstrated the recurrent fistula in only five of eight cases. In fact, the key examination is tracheoscopy providing that catheterisation of the fistula. The position of the catheter is verified radiologically. The difficulties of surgery in recurrent fistula are linked to the problem of locating the level of the fistula peroperatively. Without catheterisation of the fistula, there were one failure out of three cases (one dead). By contrast, in the seven cases where the fistula was catheterised, a successful outcome was always obtained. The failure of surgery for recurrent tracheo-oesophageal fistula is not linked to a technical problem of closure of the fistulous tract but to failure to localize the fistula adequately.

Adolescent↗