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Post-traumatic carotid-jugular fistula is a rare condition. We report a case to understand the mechanism through doppler ultrasound and angioscanner data. The patient is a 22-year-old woman who was the victim of a stabbing attack to the neck. The clinical examination revealed a latero-cervical swelling associated with a thrill. The doppler ultrasound showed an abnormal jugulo-carotid communication and aneurysm making arteriovenous fistula suspicious and confirmed by angioscanner. [ABSTRACT FROM AUTHOR]

Introduction. Considered by many authors a vestigial structure, the appendix is a small dimensions organ with mostly unknown functions. Acute appendicitis is the most common condition of the ileocecal appendix, having multifaceted clinical manifestations, often masquerading as various unrelated syndromes, but causing increased morbidity, especially when diagnosed late. Although the disease could manifest at any age, there is a progressive increase of its incidence from birth, with a maximum between 10 to 40 years. Case presentation. We report the case of an 84 years-old female patient, who presented with significant abdominal pain in the lower quadrants, mainly in the right iliac fossa and in whom the CT examination was suggestive of a utero-appendicular fistula, a very rare complication in daily practice and even more seldomly encountered in the elderly. Conclusions. Acute appendicitis remains a condition for which surgery is still the optimum treatment, especially in the case of an elderly patient having a radiologically suspected fistula with the uterus that could easily lead to septic gynecological complications and possibly progression to multiple organ failure.

Carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus. It is most commonly due to congenital arteriovenous malformations but it can also be caused by a trauma. It is a rare disease which can give rise to visual and life-threatening consequences. We here report the case of a young female patient aged 34 years who had been victim of road accident with craniofacial and lower limb trauma two years before her admission. Left exophthalmos with slowly progressive evolution occurred one year after road accident without other associated signs, revealing left carotid-cavernous fistula. What is peculiar about this case is the relatively long delay between the trauma, the onset of exophthalmos and the diagnosis of posttraumatic carotid-cavernous fistula. [ABSTRACT FROM AUTHOR]

Cholocystocolonic fistulas (CCFs) represent a rare medical entity. Previous inflammatory processes in the abdomen, especially in the gallbladder and surgeries are all related to their appearance. There are not typical findings concerning the clinical image and the therapeutic approach varies between patients. Herein, we present a case of a 46-year-old patient, with a history of perforated duodenal ulcer, suffering from abdominal pain and diarrheas. A computed tomography (CT) demonstrated air inside the biliary system. A laparotomy was conducted to the patient and no complications have occurred. In addition, a review of literature regarding the clinical presentation and the therapeutic options for this disease is discussed in this manuscript in relation to our patient.

Introduction: the treatment of large biliocystic fistulas is not unanimous among authors in the absence of consensus or a high level of evidence. There is a controversy over the use of a radical approach which allows the fistula to be sutured in a healthy area or conservative treatment that poses repair issues. The purpose of this study is to compare different conservative techniques to treat large biliocystic fistulas. Methods: we conducted a retrospective study of 54 patients with large fistulas in the Department of General Surgery at the Habib Bourguiba University Hospital in Sfax over a period of 9 years (2010 - 2018). Results: fourty-four patients were enrolled in the study. Abdominal ultrasound suggested opening of the bile ducts in 18 cases (47.4%) while computed tomography (CT) scan suggested opening in 28 patients (68.3%). The treatment of fistulas was based on DITFO (internal trans-fistulary drainage) in 18 cases (33.3%), cystobiliary disconnection (PERDROMO) in 11 cases (20.4%) and bipolar drainage in 25 cases. Specific surgical morbidity rate was 31.5% and it was dominated by postoperative biliary fistula in 18.5% of cases. DITFO technique was associated with shorter hospital stay (p=0.028) and lower morbidity rates (22.2%) with no statistically significant difference. Conclusion: DITFO technique is the gold standard technique in the treatment of biliocystic fistula because it is associated with lower morbidity rates and the shortest hospital stay. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of complex perianal fistulas in Crohn's disease remains a challenge especially after the failure of Infliximab., Aim: Update on the different therapeutic alternatives for anal fistula in Crohn's disease after failure of Infliximab., Methods: A research in the medical literature on PubMed and Google Scholar was carried out. We included cohort studies, reviews and randomized double-blinded therapeutic trials. Case reports and fundamental research studies have been excluded., Results: Anti-TNF therapy, notably Infliximab remain the therapeutic option of choice. Since Infliximab efficacy has been estimated at 60%, with a significant loss-of response rate, new therapeutic strategies have been evaluated and may offer new opportunities for the management of anal fistulas: for example, Ustekinumab could be effective after failure of anti-TNF therapy, although further studies are required. Recent guidelines suggest that injection of mesenchymal stem cells is an effective and safe treatment for complex fistulas. Other surgical options have been proposed, such as endorectal advancement flap, fibrin glue injection, anal fistula plug and ligation of the intersphincteric fistula tract, but all with limited and debatable efficacy. Given the failure rate of all these options, new strategies are currently being evaluated., Conclusion: Anal fistulas in Crohn's disease are a real therapeutic challenge. New medical and surgical therapies are currently being evaluated, with promising results.

Ano-rectale malformations (ARM) are a spectrum of heterogeneous abnormalities in the development of the rectal canal. Its incidence is usually low and it is a little higher in some developing countries. Boys are more affected than girls and rectobulbar fistula associated with atresia of the anal canal is the most frequent disorder among them. We report the case of a 10-months old infant of male sex, whose mother lived in a mining area and had been complaining of fecaluria since the birth of her child. Physical examination showed fingerprint 1 cm below the intersection of the median raphe and the bi-ischiatic line. Paraclinical examinations showed no other associated malformation. Patient's management was based on anorectoplasty through abdominal and perineal approach with lower abdominoperineal reconstruction. In the post-operative period, the patient received antibiotic treatment and intravenous analgesia as well as dilations, which continued after discharge 2 weeks after surgery. No complications were observed and outcome was favorable. [ABSTRACT FROM AUTHOR]

This study aims to analyze the epidemiological, clinical, therapeutic and anatomopathologic features of urogenital fistulas. We conducted a retrospective study of patients with urogenital fistulas admitted to the department of general surgery and gynecology and obstetrics between January 1, 2014 and December 30, 2015, including the first 5 fistula repair campaigns organized by the Fistula Mali project. Urogenital fistulas account for 19.53% of all urologic disorder treated during our daily practice. The median age at first marriage was 16.57 years. The majority of our patients (96.70%) was illiterate and self-employed, coming from rural areas (85.36%). Obstructed labour was the dominant etiology, with 91.50% of stillborn children. The patients were primiparous women (43.33%) and, among them, 53.60% received no prenatal care. The divorce rate associated with the disease was 7.30%. Most patients underwent simple fistulorraphy, of whom 121 underwent lower fistulorraphy, 26 upper fistulorraphy and 3 mixed fistulorraphy. Outcomes were satisfactory in 65.33% patients and poor in 34.66% of patients. Patients with type I and type V obstetric fistulas had the highest healing rate compared to patients with type IV fistulas. Urogenital fistulas are a real public health problem. Treatment is mainly based on surgery and prognosis is compromised by the narrowness of the surgical field, the complexity of the lesions and the condition of the surrounding tissue. The focus must be on the implementation of women’s socio economic development programs and on emergency obstetric care access. The research and discussion should continue to facilitate the development of a standard classification. [ABSTRACT FROM AUTHOR]

Résumé: Les lésions ano-périnéales (LAP) de la maladie de Crohn (MC) sont fréquentes et constituent un défi tant diagnostique que thérapeutique. Elles peuvent être liées directement à la MC : lésions primaires (ulcérations et pseudo-marisques) exclusivement liées au processus inflammatoire de la maladie et lésions secondaires (fistule, abcès, sténose) dont l'évolution est au moins partiellement indépendante. Mais le clinicien peut être confronté à d'autres lésions : infectieuses (mycose, herpès, condylomes...), inflammatoires (psoriasis, maladie de Verneuil...), tumorales (néoplasie intra-épithéliale, carcinome épidermoïde, adénocarcinome), dermatologiques (dermite de macération, eczéma...) ou proctologiques communes (hémorroïdes, fissure anale...). Les prélèvements à visée histologique par biopsie cutanée au punch sont indispensables devant toute lésion chronique inhabituelle ne répondant pas aux thérapeutiques usuelles (dermocorticoïdes, antifongiques imidazolés, antibiotiques). Anoperineal lesions in patients with Crohn's disease (APLOC) are frequent and remain a diagnosis and therapeutic challenge. APLOC can be directly related to Crohn's disease: primary lesions (ulcerations and skin tags) reflect the inflammatory activity of the disease ; and secondary lesions (fistula, abscess, stricture) are also influenced by infectious processes. Physicians should be aware of various other lesions: infectious (mycosis, herpes, condyloma...), inflammatory (psoriasis, Verneuil's disease...), tumoral, dermatologic (maceration dermatitis, eczema...), haemorrhoids, and common anal fissure. Skin biopsy are required for atypical chronic lesion that does not respond to usual treatments (topical corticosteroids, imidazole antifungals, antibiotics). [ABSTRACT FROM AUTHOR]

The first publication in 1960 on maintenance hemodialysis was followed in 1963 by some reports on dialysis in the home. The introduction of proportioning pumps and concentrated electrolyte solutions led to developing single-patient machines and safety devices that made home hemodialysis possible. It was demonstrated in 1964 that home hemodialysis can be done overnight, unattended. This led to a steady rise in the number of patients treated at home. The percentage in France was ≈20% by the end of the seventies, out of a total of ≈ 6 000. The decline began when Public Health authorities authorized a program of ‘’limited – care’’ units. A loophole in the regulations led to a massive transfer of patients to these units and a rapid decline of home HD. The revival can be dated to 2012 with the development of disposable dialysate bags that make low flow daily home HD feasible. Efficacy and tolerability are such that the total number of patients treated at home rose from 307 in 2014 to 374 in 2016, owing to those on daily hemodialysis - an increase from 55 in 2014 to 374 in 2016 and 448 by the end of 2018. Currently, ≈46 000 patients are hemodialyzed in France. The % of those treated at home is very low but the trend is to a steady increase.

Vescicouterine fistula (VUF) is a rare lesion accounting for only 4% of all urogenital fistulas. It is most often secondary to cesarean section and forms a connection between the bladder and the uterus. We report the case of a young patient with VUF secondary to cesarean section. This study aims to investigate the clinical and therapeutic features of this disorder. [ABSTRACT FROM AUTHOR]

œso-tracheal fistulas are a pathological condition characterized by an abnormal communication between the tracheal tree and the esophagus. We here report a clinical case of œso-tracheal fistula due to the ingestion of a foreign body in order to highlight its etiopathogenesis, to evaluate our therapeutic approach and to do a literature review. The study involved a 15 year old patient admitted with dysphagia evolving over the last two months following the ingestion of a foreign body (a piece of bone). œsophagoscopy under general anesthesia allowed extraction of the foreign body. Post-operative EGD transit objectified fistular orifice at the C7 level. The absence of fistular orifice was recorded 30 days after endoscopy during his follow-up EGD transit. Medical treatment is a therapeutic alternative for oeso-tracheal fistula and must be based on well-defined criteria. [ABSTRACT FROM AUTHOR]

A 21-year-old woman with no history of tuberculosis was admitted to the emergency room with an acute abdominal accompanied by fever. She underwent an emergency abdominal operation surgery and histological studies revealed a peritoneal and appendicular ovarian tuberculosis. The patient received antibacillar (Rifampicine, Isoniazid, Pyrazinamide). Two months later, she was readmitted with fever and a general physical deterioration while being on antituberculosis medications. Chest X-Ray and CT scan revealed a miliary tuberculosis with pleural and peritoneal effusion and lymphadenopathy above and below the diaphragm. HIV serology was negative. This peritoneal collection had caused a fistula on the abdominal wall with two sinus tracts in the midline. The bacteriological examination of the purulent material revealed a Mycobacterium tuberculosis with a high resistance to all anti-bacillar drugs except Etambuthol and Pyrazinamide. The patient was treated by etionamide, pyrazinamide, spiramycin and etambutole, with favorable outcome.

Perianal fistula frequently occur in Crohn disease (CD), are challenging to treat and must be considered in a multimodal management (gastroenterologist, proctologist, radiologist, surgeon). TNF-α is more expressed in the serum and in the fistula tract in CD patients than in control patients. TNF-α 1 receptor is also highly expressed in the fistula tract. Safety and efficacy of local Anti TNF α therapy has been evaluated in five retrospectives uncontrolled studies between 2001 and 2012 (infliximab n=4 and adalimumab n=1). Remission rate (define as complete cessation of symptoms) were 36 to 75%. A large majority of patient had active luminal disease and did not receive IV anti-TNF-α infusion during the procedure. No severe adverse effects were reported and tolerance was excellent. Today, local injection of anti-TNF is currently out of practice and needs to be evaluated in a controlled study. [ABSTRACT FROM AUTHOR]

Anastomotic fistula is the the most feared complication following colorectal surgery and continues to be a diagnostic and therapeutic problem. This study aimed to determine the prevalence and the features of diagnostic and therapeutic treatment of colonic fistula after colectomy. We conducted a retrospective descriptive study of the cases of colonic fistula following colectomy over a period of 7 years from January 2007 to December 2013. Out of 170 patients undergoing colectomy in our Department 17 patients had colonic fistula, corresponding to a rate of 10%. The average age at the time of the first treatment was 45.1 years (ranging from 20 to 78 years). There was a prevalence of male patients (n=13), with a sex ratio of 3.3. Colorectal tumor pathologies (n=9) and volvulus of the pelvic colon (n=7) were the main indications for colectomy. The first treatment was performed as an emergency in 13 patients. The mean time of occurrence of the fistula was 10.8 days. 10 patients had colocutaneous fistula and 7 patients had postoperative stercoral peritonitis. Eleven patients had anemia (average hemoglobin level 9.1 g/dl) and 8 patients had leukocytosis (average level 15100 leucocytes/mm3). Ultrasound, performed in 6 patients, was normal in 1 patient and showed intraperitoneal effusion in 5 patients, while CT scan without digestive opacification was performed in 2 patients but helped to establish a diagnosis only in 1 patient. Nine patients received only medical treatment. This was based on antibiotic coverage, hyperproteic diet and a well-fitting colostomy bag around the fistula. The fistula closed spontaneously within an average of 15 days. Revision surgery was performed in 8 patients within an average of 4.8 days. It was indicated in the presence of peritonitis due to anastomotic fistula (7 patients) and of persistent colocutaneous fistula despite medical treatment (1 patient). Surgical treatment was based on gastrointestinal ostomy in 6 cases. Seven patients had at least one complication related to colonic fistula (2 fistula recurrences, 3 weepings and 2 eviscerations). The average length of stay in hospital was 55.2 days (with 15-168 day interval). Two deaths were recorded after septic shock. Accessibility of therapeutic means such as parenteral nutrition and percutaneous drainage would allow us to reduce a lengthy hospital stay and also high costs of care. [ABSTRACT FROM AUTHOR]

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Copyright of Colon & Rectum is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Scrotales fistulas are rare and often represent secondary lesions of tuberculosis. Mucinous adenocarcinomas are tumors containing at least 50% of extracellular mucus. They occur most commonly in the rectosigmoid; scrotal location is rare. We report the case of a 54-year old patient, with no particular past medical history, with secondary mucinous adenocarcinoma of the scrotum revealed by scrotal fistulas. The patient had suffered from recurrent scrotal fistulas for two years, with no other associated signs. Clinical examination showed multiple scrotal fistulas with discharge of thick pus. Rectal examination was normal. Urological examinations (IVU, UCRM, cystoscopy, ...) were normal, the assessment of infectious diseases as well as the detection of BK virus in urine and sputum were negative. Biopsy of sample of scrotal tissue was in favor of moderately differentiated mucinous adenocarcinoma. Immunohistochemical examination was in favor of primary colorectal cancer. Patient's evolution was marked by the occurrence of complex anal fistulas, which appeared on MRI as active, supplying several pelvic peritoneal collections resulting in fleshy buds. There is no consensus on the therapeutic approach due to the rarity of this cancer. Surgical resection is the treatment of choice for this disease. Preoperative chemotherapy and radiation therapy are recommended for this type of cancer, but their role is not well established. The patient underwent primary neoadjuvant chemotherapy and radiation therapy, before abdominoperineal excision. [ABSTRACT FROM AUTHOR]

Résumé: Les fistules coronaro-camérales sont des malformations souvent congénitales, rarement acquises ; la complication de cette anomalie d’un pseudo-anévrysme ventriculaire est exceptionnelle. Nous rapportons un nouveau cas de fistule coronaro-camérale acquise, survenue chez un patient ayant bénéficié d’un pontage aorto-coronaire et devenu symptomatique d’angor d’effort une année après la chirurgie. Sur le coroscanner, la fistule paraît communiquer la première diagonale à un pseudo-anévrysme du ventricule gauche. Une embolisation de la fistule et un comblement du pseudo-anévrysme par un neurocoil ont été réalisés avec succès. Le contrôle clinique et angiographique, réalisé après trois mois, a montré une disparition de la symptomatologie et l’absence de reperméabilisation de la fistule. [ABSTRACT FROM AUTHOR]

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Un foyer septique périphérique peut être le mode de révélation d’une fistule aortodigestive chez un patient porteur d’une prothèse endovasculaire aortique. Nous avons pris en charge un patient de 69 ans pour un abcès de la face antérolatérale de la jambe gauche. Le patient avait bénéficié quatre années auparavant d’un pontage prothétique aortobifémoral secondaire à la cure d’un anévrisme de l’aorte abdominale. Le bilan initial de recherche de fistule aortodigestive justifié par la présence de germes anaérobies retrouvés lors du parage et de la mise à plat de l’abcès, était resté négatif. Le traitement de l’abcès associait un parage et une mise à plat, un pansement à pression négative et une couverture de la perte de substance cutanée par un substitut dermique et une greffe dermoépidermique. Quelques mois plus tard, devant un retard de cicatrisation inexpliqué et l’apparition de signes généraux, un nouveau bilan a permis de mettre en évidence une fistule aortodigestive. De plus, les prélèvements locaux au niveau de la plaie et les hémocultures retrouvaient tous deux de nombreuses colonies d’Escherichia Coli. Le changement de la prothèse aortobifémorale et la cure de la fistule aortodigestive ont permis la cicatrisation complète de la perte de substance cutanée de la jambe. Les fistules aortodigestives sont des complications des prothèses endovasculaires aortiques au pronostic très défavorable. De diagnostic difficile, leur suspicion clinique doit engager un bilan paraclinique complet. Toutes les plaies septiques chez un patient porteur d’une prothèse vasculaire doivent faire évoquer le diagnostic de fistule aortodigestive. [ABSTRACT FROM AUTHOR]

Copyright of Journal Africain D'Hépato-Gastroentérologie is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The authors report the first case of gas embolism arising during an upper gastrointestinal endoscopy to a patient carrier of a biliary drain placed by radiological way. The hypothesis of a biliary-vascular fistula with abnormal connection between the biliary tree and the hepatic vascular system and finally an arteriovenous intrapulmonary shunt was retained to explain the physiopathology. The immediate stop of the endoscopic procedure and the implementation of symptomatic treatment allowed a favorable neurological outcome without sequelas. The realization of an upper gastrointestinal endoscopy to a patient carrier of a biliary drain has to lead the anaesthesiologists and the gastroenterologists to take care given the incurred risk of gas embolism. [Copyright &y& Elsevier]

Abstract: Introduction: Exophthalmia can be associated with several disorders. Although unusual, a carotid-cavernous fistula should be ruled out systematically as it may be associated with severe complications. Case reports: We report three cases associated with both types of carotid-cavernous fistula that highlight the clinical presentation and diagnostic process. Conclusion: A carotid-cavernous fistula should be systematically ruled out in patients with a uni- or bilateral exophthalmia. Careful examination with auscultation of the ocular globe contributes greatly to the diagnosis that may be confirmed by MRI or arteriography. [Copyright &y& Elsevier]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objectives: To evaluate efficacy and functional results (sexual activity) of vaginal flap for rectovaginal fistula in Crohn''s disease. Patients and methods: From May 2004 to March 2008, we proposed a vaginal flap in patients who had a rectovaginal fistula in Crohn''s disease and for which rectal flap was technically impossible. Monitoring included a clinical examination at 1 month and every 3 months for 1 year, Perianal Disease Activity Index for sexual activity evaluation. Every year and in April 2009 the nursing team during a telephone interview filled a standardized questionnaire. Results: We treated 5 patients. At 6 months, 4 of 5 patients were healed. At 7 months, 1 patient presented a new flare up of CD with reopening of the fistula. The other 3 patients were still healed at a median follow-up of 30.66 months (15 to 59). One patient presented dyspareunia during 3 months. Discussion and conclusion: Vaginal flap is an effective technique that entails neither prolonged dyspareunia nor fecal incontinence. Stoma is not systematic. [Copyright &y& Elsevier]

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Abstract: Introduction: Hypertrophic osteoarthropathy (HOA) located to lower extremities may be the initial manifestation of an infected aortic graft. Case reports: We report two patients with HOA secondary to aortobifemoral vascular prosthesis infection and aortoenteric fistula. As reported in the literature, initial manifestations included fever, painful swelling of limbs, joint pain, clubbing and in one case intestinal bleeding. These symptoms preceded frank episodes of septicaemia due to a wide variety of bacteria (microbial enteric flora). Bone scan was an appropriate tool for confirming the diagnosis of HOA. Abdominal computed tomography, and PET-scan were useful for detecting vascular infection. Aortoenteric fistula remained difficult to identify. Conclusions: Mechanisms involved in the pathogenesis of HOA associated with infected graft are poorly understood, but vascular endothelial growth factor (VEGF) could play a major role. The mortality of infected aortic grafts remains high, but knowledge of this association could lead to early diagnosis and accurate treatment. [Copyright &y& Elsevier]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Tuberculosis is an endemic public health problem in developing countries and can be a source of diagnostic problems, particularly in the case of rare locations such as calvaria. The purpose of this report was to discuss the epidemiologic, pathogenic, diagnostic, and therapeutic aspects of this disorder. We report two cases of cranial vault tuberculosis. The first occurred in a 17-year-old male who presented with a lingering scalp infection lasting six months with a right frontal-temporal fistula. Clinical examination did not reveal abnormalities. The CT scan showed a right frontal extradural empyema with osteitis of the frontal bone. The empyema and infected bone were removed, which was followed by antibacillar drug treatment. The second case was a 2-year-old boy who presented with right frontal swelling with purulent fistula. The CT scan showed a lytic lesion of the frontal bone. Improvement was noted after removal of the lesion and antibacillar chemotherapy. Calvaria is a rare location of tuberculosis. It is frequently revealed by chronic infection of the scalp and cranial vault. Antibacillar chemotherapy is the basis of treatment. [ABSTRACT FROM AUTHOR]

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Summary: Congenital isolated tracheo-oesophageal fistulae without oesophageal atresia account for about 4 % of tracheo-oesophageal malformations. Its diagnosis is difficult in some cases and the prognosis is better. We report two cases of two infants, aged 3 months and 7 months, who presented from birth, after each feeding, respiratory symptoms in type of coughing, cyanosis and permanent bronchial obstruction associated with abdominal distension. Lung auscultation revealed diffuse rales snoring. The chest showed atelectasis. Trache-oesophageal fistula was demonstrated by gastroscopy in one case and by barium meal in the other. The treatment was surgery, and postoperative follow-up was simple in one case and marked by a wound dehiscence in the other. The aim is to discuss the different investigations for diagnosis and various therapeutic approaches. Trache-oesophageal fistula is the result of incomplete development of the tracheo-oesophageal septum during embryogenesis. The diagnosis should be considered in respiratory symptoms occurring especially during power off the neonatal period. If the clinical findings are suspect of this anomaly, further investigations must be confirmed before the therapeutic decision. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Posttraumatic arteriovenous fistulas are not a rare event in military facilities during periods of armed conflicts, but are seldom seen in the civilian health care system. Patients and method: We report our approach to the management of 26 cases of posttraumatic limb arteriovenous fistulas colligated from 1996 to 2006. Results: The main cause of our posttraumatic arteriovenous fistulas is the penetrating traumatism. Arteriography was the mostly used imaging exploration. The treatment was surgical for 24 patients. One case of thrombosis was reported. Conclusion: Our series of posttraumatic fistulas is characterized by a particularly high rate of penetrating trauma, in which case intervention is the rule. Our study shows that, in our experience, surgical treatment is still a safe and efficient therapeutic attitude. [Copyright &y& Elsevier]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Background: The treatment of Inflammatory bowel disease comes from many years of esperience, clinical trials and mistakes. Discussion: In patients with active Crohn disease steroids are considerated the first choice, but recently, the introduction of anti-TNF alfa agents (infliximab and adalimumab) has changed the protocols. Anti-TNF are also used for closing fistula after surgical curettage. An efficently preventive treatment of Crohn disease still has not been found but hight dose of oral salicylates, azatioprine or 6-MP and antibiotics might be useful. In severe attacks of ulcerative colitis, high dose iv treatment of steroids are required for a few days. Later on, a further treatment with anti-TNF might delay the need of surgery. In patients with mild to moderate attacks of ulcerative colitis, topical treatment is preferred, it consists of enemas, suppositories or foams containing 5-aminosalycilic acid, traditional steroids, topical active steroids. Topical treatment can be associated with oral steroids or oral salicylates. Oral salicylates or azatioprine are used for prevention of relaps. [Copyright &y& Elsevier]

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Copyright of Andrologie (11662654) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Intestinal fistula is a rare complication in necrotizing enterocolitis (NEC) and is typically associated with a colonic stricture. We report the case of a preterm infant with severe NEC, who developed an ileocolic fistula followed by the appearance of a colonic stricture after surgical treatment. This report shows how complex the outcome of NEC can be: a contrast enema should be done in NEC when the clinical or biological outcome is not favorable, in order not to delay the diagnosis of intestinal fistula. [Copyright &y& Elsevier]

Abstract: Although initial prognosis of oesophageal atresia is nowadays excellent with more than 95% of survival, the long-term complications are frequent. A gastro-oesophageal reflux is found in 26 to 75% of the cases, responsible for peptic oesophagitis, anastomotic stenosis and Barrett''s oesophagus, risk factor of adenocarcinoma of the oesophagus. A dysphagia is frequently observed on these patients, sometimes several years after the surgery, observed in almost 45% of five-year-old children. Growth retardation is found in nearly a third of these children. Respiratory symptoms are particularly frequent, especially in the first years, associating tracheomalacia facilitating the bronchopulmonary infectious episodes (found in about 30% of 5-year-old children). Esotracheal fistula recurrence is very rare. A deformation of the rib cage is reported in 20%, and a scoliosis in 10% of the patients. However, the quality of life of these patients in the adulthood is good, and influenced by the existence of associated malformations. Even if the current prognosis of oesophageal atresia is good altogether, the frequency of the complications (digestive, respiratory, nutritional, orthopaedic) far from the initial intervention, and the necessity of a surveillance of the secondary oesophageal damages, justifies a systematic and multidisciplinary follow-up until adulthood. [Copyright &y& Elsevier]

Copyright of Andrologie (11662654) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Urachal diseases are infrequent. Congenital affections include cysts, fistula, diverticulum, external sinus, and alternating drainage sinus. Ultrasonography and fistulography are useful for the diagnosis. Treatment of malformations is rarely conservative; it consists in urachal resection. Urachal tumours are frequently malignant and adenocarcinomas are the main histological form. CT scanning is useful for staging. Treatment of urachal carcinomas consists in urachal, umbilicus and bladder removal. Prognosis is poor. [Copyright &y& Elsevier]

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Protection of urinary anastomoses using a ureteral sound is a frequent option in urology but such use in a systematic manner remains debated in renal transplantation. Some consider that systematic insertion of a double J sound decreases the incidence of ureteral complications (fistula and stenosis). Others who prefer a selective use in some situations with a related risk consider that the implementation of a double J sound cannot compensate a technical defect. It is even responsible for specific complications (infections, incrustations, haemorrhages); it increases implantation costs and is useless in more than 90% of the cases. This article analyses the risks related to systematic implementation of a double J sound in Lich-Gregoir ureterovesical anastomoses for renal transplantation, together with the related costs and the infectious risk. The benefits in terms of prevention of ureteral complications are evaluated. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate risks and benefits of laparoscopic surgery of deep endometriosis, especially with bowel involvement with the aim of improve the inform consent of patients and choice of adequate management. Patients and methods: Observational continuous study on 118 patients suffering from deep endometriosis (48 with bowel endometriosis) treated by laparoscopic surgery. Results: 95.6% of the patients improved their symptoms (93.7% for dyspareunia). Upon the 29 infertile patients, 21 (72%) got pregnant, including 14 (66%) spontaneously. During operative time, 3 laparotomies occurred, two of them for haemorrhage. During postoperative time, 4 major complications (2 rectal fistulas and 2 ureteral necrosis) and minor complications occurred. Discussion and conclusions: Those data confirm the efficiency of laparoscopic treatment of deep endometriosis especially for pain relief and fertility. Nevertheless, few but severe complications may occur. Therefore, it is imperative to deliver clear, loyal and appropriate information before to proceed to such a treatment. [Copyright &y& Elsevier]

Abstract: Objective. – To determine predictive factors of bronchial fistula following pneumonectomy. Patients and methods. – In 14 years (1989–2003), we collect 58 cases of bronchial fistula following 725 consecutive pneumonectomy in the service of thoracic surgery of the Sainte Marguerite Hospital in Marseilles. There were 53 cases (91.4%) of cancers and 5 cases (8.6%) of various pathology. The average age of the patients was of 61±10 years (range 24 to 80 years). The sex ratio M/F was 8.7. The software of regression SPSS (version11.5) was used to identify the factors risk of a bronchial fistula after a univariate and multivariate analysis. Results. – The prevalence of the bronchial fistula after a pneumonectomy was 8%.The preoperative factors which increased to a significant degree the incidence of the bronchial dent to the univariate analysis were the chronic smoking (P <0.001), the existence of COPD (P =0.001) and of a previous thoracic surgery (P =0.01). Operational data like a right- side pulmonary resection (P <0.001), the type of bronchial stup carried out (P =0.03) as and an extended pneumonectomy to the auricule (P =0.03) were significant risk factors. With the logistic regression the significant risk factors were the chronic smoking (P =0.002), the existence of COPD (P =0.003), a previous pulmonary surgery (P =0.03) and the right - side of the pneumonectomy (P <0.001). The indication of the pneumonectomy was retained neither by the univariate analysis, nor by the logistic regression significant risk factors. Conclusion. – The predictive factors of a bronchial fistula after a pneumonectomy are dominated by respiratory co-morbidities. To prevent this complication, we insist on the stop of the tobacco, a better respiratory preparation and the acquisition of a protocol adapted of the bronchial stub after a pneumonectomy particulary on the right side. [Copyright &y& Elsevier]

Abstract: Gastrojejunocolic fistulae, ultimate complication of anastomotic peptic ulceration, are presently uncommon. We report two recent cases of postoperative gastrojejunocolic fistulas (after duodenal ulcer surgery and total duodenopancreatectomy), which were complicated at time of diagnosis (acute peritonitis and liver cirrhosis) and required a two-stage treatment. [Copyright &y& Elsevier]

Abstract: We describe a rare case of fistula between the Wirsung duct and the right psoas muscle. The initial clinical presentation was localised in the thigh and successful treatment was achieved by exclusive mini-invasive techniques. [Copyright &y& Elsevier]

Abstract: On connection with four cases of arterio-uro-enteric fistula in three patients and after a review of the literature, the authors propose to make light on this extremely rare complication describing aetiologies factors and the diagnostic means and therapeutics. Two patients had had a pelvic exenteration with respectively Bricker and Kock pouch. The third patient had had an anterior resection in blok with the right deferent duct and right seminal gland. All three received high doses of radiotherapy. These fistulas had appeared by abundant haemorrhages. The surgical operation in urgency had made it possible to treat these fistulas with success in two patients. The other patient had deceased of cataclysmic haemorrhage. [Copyright &y& Elsevier]

Radiation therapy is commonly used to treat pelvic or retroperitoneal cancers but has some impact on genito-urinary system: short-term side effects are frequent with usually a completed regression. However, the incidence of major complications is about 12% and is probably underestimated due to a long delay between radiation therapy and diagnosis of some adverse events such as ureteral strictures or fistula. Clinical follow-up must absolutely include an early diagnosis and treatment of radiation therapy complications such as renal dysfunction, ureteral stricture, ureteral fistula, chronic bladder injury, bladder fistula, urethal stricture, infertility or erectile dysfunction. [Copyright &y& Elsevier]