The effect of Eck and reverse Eck fistula in dogs with experimental diabetes mellitus

1. 1. Dogs with alloxan diabetes were subjected to Eck fistula. This procedure produced a marked increase in the amount of insulin necessary to control glycosuria. When the dogs were fasted, glycosuria disappeared, blood sugars fell toward normal, and the need for insulin was eliminated. 2. 2. Reverse Eck fistula was created in dogs with alloxan diabetes, and resulted in minor increases of doubtful significance in daily insulin requirement. When fasted, the blood sugar of these animals remained elevated and glycosuria continued. 3. 3. Nondiabetic dogs with Eck fistula all died of meat intoxication. Dogs with Eck fistula plus diabetes had no evidence of meat intoxication and in general were in better health than dogs with Eck fistula alone. 4. 4. Possible mechanisms of the role of Eck fistula in the alteration of the diabetic state are discussed. © 1959

A large, single pulmonary arteriovenous fistula presenting hours after birth

This article reports a case of a single, large pulmonary artery to left atrial fistula presenting within hours of birth. Symptomatic fistulas of this type are exceptionally rare in the neonatal period. The images of the fistula obtained during echocardiography and cardiac catheterisation is included. This case highlights the importance of intra-operative echocardigraphic guidance during surgical ligation of fistulas of this type.peer-reviewe

Colovesicular Fistula

A fistula is an atypical connection between two epithelial surfaces, in the case of an enterovesical fistula between the urinary and gastrointestinal systems. These may be the result of a number of causes including: 1. Congenital abnormalities 2. Inflammatory diseases of the bowel (such as diverticulitis and Crohn’s Disease) 3. Cancer 4. Infection 5. Trauma 6. Iatrogenic (such as a post-operative complication) [3] A colovesical fistula (colovesicular fistula), an abnormal connection between the bladder and colon, is a known complication of diverticular disease, occurring in around 2%-22% of patients suffering from diverticulosis. These fistulae tend to occur three times more often in males than in females. The difference in occurrence is thought to be related to the fact that in females there is the uterus which may prevent the colon and bladder from coming into contact with each other. In fact in females other types of fistulae, such as vesicovaginal and enterovaginal, occur more frequently than colovesical fistulae. [2] Aim: This article highlights the importance of the early identification and management of colovesical fistulae, which although uncommon complications of diverticulitis, can be very uncomfortable for the patient and if not treated early, can lead to high morbidity.peer-reviewe

Autologous haemodialysis access in Malta

Chronic kidney disease is a worldwide problem which is rapidly increasing. In the United States the incidence and prevalence of end stage renal disease has doubled in the last ten years and is expected to continue rising in the future.In Malta the high prevalence of diabetes and the ageing population has similarly resulted in a significant increase in patients requiring haemodialysis over the last decade. Despite advances in dialysis and transplantation, prognosis has not improved worldwidepeer-reviewe

Coronary artery fistulae : 4 cases repaired surgically

Coronary artery fistulae involve a communication between a coronary artery and a heart chamber or part of the pulmonary circulation. Most are asymptomatic and discovered incidentally, whilst larger ones may cause coronary steal syndrome. Fistulae may produce continuous murmurs and are diagnosed at echocardiography or angiography. Treatment is by percutaneous coil embolisation or open surgery. This article reviews four cases treated with surgical closure. All patients were asymptomatic and diagnosed incidentally at angiography. One case involved a failed attempt at percutaneous coil embolization requiring immediate open surgery. The other three cases required other operative procedures and the fistulae were oversutured during the same procedure.peer-reviewe

Operative strategy for fistula-in-ano without division of the anal sphincter

We would like to thank Mr ER MacDonald for his contribution in data collection during the early years of the study. The material in this paper was presented as a poster at the annual meeting of the American Society of Colon and Rectal Surgeons held in Vancouver, Canada, May 2011.Peer reviewedPublisher PD

A systematic review of infected descending thoracic aortic grafts and endografts

Objective: The objective of this study was to collect and critically analyze the current evidence on the modalities and results of treatment of descending thoracic aortic surgical graft (SG) and endograft (EG) infection, which represents a rare but dramatic complication after both surgical and endovascular aortic repair. Methods: A comprehensive electronic health database search (PubMed/MEDLINE, Scopus, Google Scholar, and the Cochrane Library) identified all articles that were published up to October 2017 reporting on thoracic aortic SG or EG infection. Observational studies, multicenter reports, single-center series and case reports, case-control studies, and guidelines were considered eligible if reporting specific results of treatment of descending thoracic aortic SG or EG infection. Comparisons of patients presenting with SG or EG infection and between invasive and conservative treatment were performed. Odds ratio (OR) meta-analyses were run when comparative data were available. Results: Forty-three studies reporting on 233 patients with infected SG (49) or EG (184) were included. Four were multicenter studies including 107 patients, all with EG infection, associated with a fistula in 91% of cases, with a reported overall survival at 2 years of 16% to 39%. The remaining 39 single-center studies included 49 patients with SG infection and 77 with EG infection. Association with aortoesophageal fistula was significantly more common with EG (60% vs 31%; P = .01). In addition, time interval from index procedure to infection was significantly shorter with EG (17 +/- 21 months vs 32 +/- 61 months; P = .03). Meta-analysis showed a trend of increased 1-year mortality in patients with SG infection compared with EG infection (pooled OR, 3.6; 95% confidence interval, 0.9-14.7; P = .073). Surgical management with infected graft explantation was associated with a trend toward lower 1-year mortality compared with graft preservation (pooled OR, 0.3; 95% confidence interval, 0.1-1.0; P = .056). Conclusions: Thoracic aortic EG infection is likely to occur more frequently in association with aortoesophageal fistulas and in a shorter time compared with SG infection. Survival is poor in both groups, especially in patients with SG infection. Surgical treatment with graft explantation seems to be the preferable choice in fit patients

Workup and conservative management of ileal conduit-vaginal fistulas: review of literature.

Ileal conduit-vaginal fistulas are a rare but challenging complication of urinary diversion. Here we identify risk factors and summarize the workup and conservative management strategies for this complication. We present two cases of elderly women with remote history of cancer who presented with persistent urinary leakage from the vagina several years after ileal conduit creation. Fistulas may be identified using dye or imaging with a loopogram and looposcopy. Correction of obstruction such as stomal stenosis or urinary diversion should be pursued to relieve pressure off the conduit. Minimally invasive management such as fulguration can result temporary relief; however, the recurrence rate is high

Angioarchitectural evolution of clival dural arteriovenous fistulas in two patients.

Dural arteriovenous fistulas (dAVFs) may present in a variety of ways, including as carotid-cavernous sinus fistulas. The ophthalmologic sequelae of carotid-cavernous sinus fistulas are known and recognizable, but less commonly seen is the rare clival fistula. Clival dAVFs may have a variety of potential anatomical configurations but are defined by the involvement of the venous plexus just overlying the bony clivus. Here we present two cases of clival dAVFs that most likely evolved from carotid-cavernous sinus fistulas