Postlaminectomy arteriovenous fistula masked by stenosis of the inferior vena cava

Discovery of a postlumbosacral discectomy fistula between the right iliac artery and vein was obscured by an associated severe stricture of the infrarenal inferior vena cava in a 49-year-old man. During venous stenting for treatment of peripheral edema, the fistula was suspected because of faint pulsatile right iliac vein flow and increased O₂ saturation of the venous blood. The suspicion was confirmed on subsequent iliac arteriography. Surgical closure of the fistula with arterial interposition grafting was then performed. The patient improved substantially.     

Percutaneous transcatheter occlusion of coronary artery fistulas using detachable balloons

Three pediatric patients underwent successful transcatheter coronary artery fistula occlusion using the Debrun system. This latex balloon system offers several advantages over other occlusion systems. First, the balloon delivery and release is controlled. Second, “test occlusions” can be performed that allow simultaneous balloon inflation, coronary cineangiography, and electrocardiographic monitoring. Third, because the balloons are flow-directed, they are easily positioned in properly chosen locations. Finally, the balloons can be constructed to suit the size of the fistula. In this study, two patients received only one balloon; in the other patient two balloons were placed in the same fistula. All fistulas drained into either the right atrium or ventricle and were successfully occluded. After a follow-up period of up to 3 years, no local or systemic reactions to the balloons were recognized. We conclude that detachable balloon occlusion of coronary artery fistulas is a safe, effective alternative to surgical ligation in selected pediatric patients.     

Diagnostic lessons learnt from a series of enterovesical fistulae

Objective An enterovesical fistula (EVF) is an uncommon condition requiring careful and sometimes extensive preoperative investigation. Our experience over a 10‐year period has been reviewed with emphasis on the diagnostic investigations performed. Patients and method Forty‐two patients (30 male) have been studied. Presenting symptoms, diagnostic investigations, and subsequent treatment have been reviewed. Results The site of the fistulae were; 37 colonic, 2 rectal, and 3 ileal. The commonest presenting symptoms were; pneumaturia 75%, faecaluria 63% and urinary tract infections 57%. The positivity rate of the investigations performed were; cystoscopy 89%, urine cytology 86%, barium enema 65%, computerized tomography (CT) scanning 55%, IVP 35%, and cystography 27.5%. The causes of the fistula were; diverticular disease 71%, carcinoma 20%, Crohn's disease 7%, and radiotherapy 2%. Conclusions We recommend cystoscopy and urine cytology for faecal material as the first‐line investigations in all patients with a suspected enterovesical fistulae. CT scanning and barium enema should not be first line investigations but may be performed subsequently to help determine the aetiology and planning of surgery.     

Evaluation of an aortic stent graft for use in surgery on esophageal cancer involving the thoracic aorta

Objective: The purpose of this experimental study was to investigate whether aortic stent grafting can be applied to the treatment of an esophageal cancer involving the thoracic aorta. Methods: The canine thoracic aorta was partially resected without aorta being clamped after emplacement of an endovascular stent graft. Study I; The aortic whole layer of 1 cm in length and 1/4 of the circumference was resected and was covered by a free fascia patch of the abdominal rectal muscle immediately after stent graft placement. Study II; The aortic adventitia and the outer half of the media of the same size was resected on day 3, 7,14, 21, and on day 28, after the stent graft placement. The resected portion was covered by the free fascia patch in half experimental dogs, and was uncovered in the others. Study III; The aortic adventitia and the outer half of the media of 1 cm in length and 1/2 of the circumference was resected and was uncovered on day 7 after stent graft placement. Histological examinations were performed on day 28 and at one year after aortic resection. Results: The aortic wall could be resected in all cases with no complication, except in resection of 1/2 the circumference where the aorta had become narrow. There was no difference in healing of the resected portion of the aorta between with and without fascia covering. Conclusion: An aortic endovascular stent graft could be applied to surgery for an esophageal cancer involving the aorta.     

直肠癌全直肠系膜切除术后直肠阴道瘘原因与防治

本文通过分析近5年来我院18例女性直肠癌全直肠系膜切除术后直肠阴道痿的临床资料。发现直肠阴道痿多发生于中低位直肠癌行全直肠系膜切除保肛手术的患者。痿的发生与肿瘤的位置、肿瘤的分期、肿瘤距肛门口的距离．以及手术技巧、手术难度、引流方法有关。而与是否进行预防性造口，以及是否采用腹腔镜手术无关。预防上强调应重视术中直肠前壁的锐性分离、结肠直肠吻合以及术后盆腔的负压引流。治疗上应首先进行保守治疗，即肠内营养，阴道冲洗。早期配合肠外营养、及全身或局部抗炎治疗，大部分直肠阴道痿通过保守治疗可以治愈。保守治疗无效时考虑结肠或回肠末端造口。若长期不愈应考虑吻合口肿瘤复发的可能。     

Amebic abscess of the liver manifested by “hemoptysis”: US,CT, and MRI findings

Ultrasonographic (US), computed tomographic (CT), and magnetic resonance imaging (MRI) findings of a patient suffering from an amebic abscess of the liver complicated by a bronchohepatic fistula are presented. Subsequent to US, CT provided the specific diagnosis. Multiplanar MRI was valuable to directly visualize the secondary diaphragmatic rupture and the bronchohepatic fistula.     

HEREDITARY HEMORRHAGIC TELANGIECTASIA WITH MALIGNANT LYMPHOMA An Autopsy Case

A 60-year-old Japanese woman was diagnosed at autopsy as having had hereditary hemorrhagic telangiectasia (HHT) associated with systemic hemangiomas. In her repoduction period, premenstrual epistaxis frequently occurred. At the age of 60, the patient died of malignant lymphoma. At autopsy, multiple telangiectatic spots were noted on the face, limbs and trunk. The paraaortic lymph nodes, which were enlarged and irregularly conglomerated, were histologically diagnosed as malignant lymphoma of the diffuse large cell type. Submucosal telangiectatic lesions were found in the gastrointestinal system from the oral cavity to the rectum. Cavernous hemangiomas were present in various visceral organs including the liver, spleen, small and large intestines, rectum, appendix, uterus, and jejunal and colonic mesenteries. There was an arteriovenous fistula in the left lung. Examination of her family pedigree showed that the patient had an autosomal dominant trait of inheritance. The pathogenesis of the systemic visceral hemangiomas observed in this patient was considered to be similar to that of hamartoma.     

彩超及多排CT在诊断颈动脉海绵窦瘘中的应用

目的探讨B超及多排螺旋CT血管造影(CTA)在诊断颈动脉海绵窦瘘中的应用价值。方法分析23例颈动脉海绵窦瘘病例。对受检者行B型超声及颅脑CTA检查,采用容积再现(VR)、最大密度投影(MIP)、多平面重建(MPR)技术处理图像。结果超声可发现增粗的眼上静脉与脉搏同步搏动,并能检测血流频谱,CT检查发现23例均海绵窦扩大.动脉期眼上静脉显影并扩张,8例动脉期大脑中静脉显影并扩张。其中一例同时合并左侧大脑中动脉动脉瘤。结论B型超声及多排螺旋CT血管造影对诊断颈内动脉海绵窦瘘有重要的应用价值。     

Expanding the phenotypic spectrum of Mabry Syndrome with novel PIGO gene variants associated with hyperphosphatasia,intractable epilepsy,and complex gastrointestinal and urogenital malformations

Mabry syndrome is a glycophosphatidylinositol (GPI) deficiency characterized by intellectual disability, distinctive facial features, intractable seizures, and hyperphosphatasia. We expand the phenotypic spectrum of inherited GPI deficiencies with novel bi-allelic phosphatidylinositol glycan anchor biosynthesis class O (PIGO) variants in a neonate who presented with intractable epilepsy and complex gastrointestinal and urogenital malformations.