Potential hazards of contrast study diagnosis of esophageal atresia

Delay in the diagnosis of esophageal atresia (EA) is rare. We present a child with EA and distal tracheoesophageal fistula who was diagnosed 9 days from birth after a contrast study performed at the referring hospital. This article aims to highlight the potential hazards of using contrast to diagnose EA.     

Tracheoesophageal fistula secondary to disk battery ingestion: a case report of gastric interposition and tracheal patch

The authors report a child with tracheoesophageal fistula secondary to disk battery ingestion. With respiratory compromise precluding expectant therapy and primary repair not achievable, gastric interposition and tracheal patch repair were undertaken in the acute phase. To the authors' knowledge, this is the first report of primary gastric interposition for traumatic tracheoesophageal fistula and suggest that immediate reconstruction can give an outcome at least as good as other reported approaches.     

Predictive factors for complications after pancreaticoduodenectomy

BACKGROUND: Knowledge of the risk factors for complications following pancreaticoduodenectomy (PD) is sparse and there is not a consensus regarding the criteria to define the complications. The objective of this study was to determine the predictive risk factors for this surgery using the international study group definition. PATIENTS AND METHODS: Between October 1999 and September 2005, data from 295 consecutive patients who underwent a PD in the Eastern Hepatobiliary Surgery Hospital were recorded prospectively. Medical records and specific charts from surgical procedures, histopathology reports, and intensive care units were continually scrutinized. Multivariable logistic regression analyses were used to estimate relative risks and their 95% confidence intervals. RESULTS: Among 295 patients undergoing PD, 103 (34.9%) experienced at least one complication. Operations by low-volume surgeons (<50 PD surgeries across their lifetime) were followed by more abdominal complications (odds ratio [OR] 45.2). End-to-end pancreaticojejunostomy (PJ) resulted in more complications than end-to-side PJ (OR 2.7). Diabetes mellitus, increased estimated blood loss, and soft gland texture significantly increased the risks of abdominal complications. Systemic morbidity (OR 9.9) was the only independent predictive factor for mortality. CONCLUSION: High-volume surgeons and end-to-side PJ greatly reduce the risk of abdominal complications in patients undergoing PD. The higher abdominal complications rate in patients with soft gland texture was similar to those found in previous reports. Moreover, PD should be performed with considerable attention in patients with diabetes mellitus.     

开颅术后硬脑膜动-静脉瘘合并静脉窦血栓形成的临床和影像学分析

目的：探讨硬脑膜动-静脉瘘（DAVF）合并静脉窦血栓形成的临床和影像学特点。方法：回顾本例患者的临床表现和影像学特点及介入治疗经过,并结合复习国外相关文献报道。结果：开颅术后DAVF合并静咏窦血栓形成的报道很少,临床表现复杂多样,血管造影（DSA）均有相应改变。DSA介入治疗疗效显著。结论：DSA检查对确诊和治疗该病尤为关键。     

经眼上静脉途径栓塞海绵窦区硬脑膜动静脉瘘

目的 探讨经眼上静脉途径栓塞治疗海绵窦区硬脑膜动静脉瘘的临床效果. 方法 对27例海绵窦区硬脑膜动静脉瘘患者行经眼上静脉途径栓塞治疗,通过脑血管造影及临床随访来评价临床疗效. 结果 术后即刻造影示瘘口完全闭塞15例,瘘口处血流速度明显减慢12例.11例患者术后眼球水肿一过性加重.随访3月～4年,临床症状消失17例,症状明显缓解10例. 结论 经眼上静脉途径栓塞治疗海绵窦区硬脑膜动静脉瘘对部分患者是一种有效的治疗方法 .     

扩张置管术治疗难治性食管狭窄和瘘的研究

目的总结难治性食管狭窄和瘘的种类,探讨难治性食管狭窄和瘘的扩张置管方法、临床应用价值和治疗中应注意的问题。方法选择常规扩张置管比较困难,技术要求较高,常规支架治疗效果不好,反复需要扩张置管或过去认为不宜扩张置管治疗者作为研究对象,共73例。对狭窄病例在内镜或X线下应用气囊扩张器或Sa-vary-Gilliard扩张器扩张治疗,然后置入记忆合金支架。结果 73例患者中有70例一次顺利置入支架,3例因情况复杂第二次置管成功,共放置支架94个。53例食管狭窄患者支架置入术后狭窄处直径由4.0±1.3mm增至18.3±1.2mm（P〈0.01）。吞咽困难由2.63±0.42改善为0.91±0.83级（P〈0.01）;20例食管瘘患者均成功置入支架,食管瘘全部闭合,患者吞咽困难及呛咳症状消失,恢复经口进食,控制了严重感染,病人一般情况明显改善。术后并发症：穿孔0例,出血2例,因扩张引起,内镜止血后出血停止。胸痛67例,用药一周后逐渐缓解。结论据难治性食管狭窄和瘘特点,采取不同的扩张置管方法,可取得较好的临床疗效。     

经阴道彩色多普勒超声在子宫动静脉瘘诊断中的应用

目的:探讨经阴道彩色多普勒超声在子宫动静脉瘘诊断中的应用.方法:对32例患者进行经阴道彩色多普勒超声检查,记录病灶声像图改变及血流频谱特点.结果:二维黑白超声显示病灶为多条带状无回声区;经阴道彩色多普勒表现为极丰富的动、静脉血流信号,部分交错重叠,且部分动、静脉相通,此为动静脉瘘的特征性改变:PSV:18.4-73.4...     

Chylous fistula after axillary lymph node dissection: incidence, management, and possible cause

Introduction

Chylous fistula is a known complication in procedures such as neck dissection and aneurysm surgery. However chyle leak that develops after axillary dissection is a rare phenomenon. In this study we have evaluated the incidence, possible cause, and management of chylous fistula that develops after radical breast cancer surgeries.

Material and Methods

Chylous fistula developed in 6 of 1863 patients who underwent axillary dissection. Their records were analyzed in terms of clinical profile and management. A review of the literature regarding the thoracic duct anatomy at its termination was carried out and a hypothesis about the possible cause of chylous leak was suggested.

Results

All 6 patients had procedures on the left side and had varied clinical stages and profiles. The chyle discharge was detected intraoperatively during the primary surgical procedure in 2 patients. The other 4 patients presented with chyle in their drains postoperatively. One patient did not respond to conservative management and underwent reexploration to seal the leak. Injury to the thoracic duct or its aberrant branches is apparently not the cause of chylous fistula in the axilla. The injury to the left subclavian duct or its tributary, which drains aberrantly into the thoracic duct through a valveless junction has been hypothesized to be the source of chyle in the axilla.

Conclusion

Chylous fistula is very unusual after axillary dissection. Most of the chyle leaks in the axilla are manageable through conservative methods; surgical intervention is required rarely in special situations. Injury to the left subclavian duct or its tributary is the possible cause.     

被膜金属支架在气道瘘治疗中的应用研究

背景与目的气道瘘包括食管气管瘘、支气管胸膜瘘和气管纵隔瘘,临床治疗较为棘手。本文旨在探讨被膜金属支架封堵气道瘘的疗效和安全性。方法回顾性分析32例食管气管瘘、5例支气管胸膜瘘和1例气管纵隔瘘患者在气管镜和/或X线透视下放置被膜金属支架。原发病为食管肿瘤26例,肺癌11例,甲状腺癌1例。结果 38例患者共有46个瘘口,口径0.5cm-7.0cm。放置Z型气管被膜金属支架40枚(其中Y形24枚,L形8枚和I形8枚)。食管放置被膜金属支架24枚。46个瘘口封堵疗效:治愈2例(4.3%),临床完全缓解28例(60.9%),部分缓解11例(23.9%),无效5例(10.9%),有效率为89.1%,中位生存时间为5个月。结论被膜金属支架能有效封堵食管气管瘘、支气管胸膜瘘和气管纵隔瘘。应首选气管支架封堵ERF,无效的患者可同时放置食管支架。分叉型气管支架尤其适于隆突周围瘘口。     

颌面部血管瘤合并动静脉畸形：病例报告及文献复习

血管瘤和血管畸形虽是婴幼儿的常见病,但血管瘤能否与动静脉畸形合并发生却一直存在争议。作者报告1例颌面部巨大、多发性血管瘤伴动静脉畸形的新生儿病例,经α-干扰素皮下注射治疗,血管瘤基本消退,而动静脉畸形依然存在。该病例报告证实,血管瘤可与动静脉畸形并存发生,且干扰素治疗重症血管瘤具有显著疗效。