1/20. mycobacterium xenopi infection of a 50-year-old oil plombage complicated by bronchopleural and pleurocutaneous fistulas.We report the rare combination of simultaneous bronchopleural and pleurocutaneous fistulas 50 years after oil plombage, together with infection of both the plombage and the contralateral lung with mycobacterium xenopi. Our case documents imaging patterns of complex fistula formation and subsequent infection resulting from oil plombage. Our case also emphasizes the infectious potential of mycobacterium xenopi.- - - - - - - - - - ranking = 1keywords = cutaneous fistula (Clic here for more details about this article) |
2/20. The first histological demonstration of pancreatic oxidative stress in human acute pancreatitis.Necrotizing acute pancreatitis is associated with an inflammatory explosion involving numerous pro-inflammatory mediator cascades and oxidative stress. Acinar oxygen free radical production aggravates pancreatic tissue damage, and promotes cellular adhesion molecule upregulation resulting in leukocyte adherence and activation. The cerium capture oxygen free radical histochemistry combined with reflectance confocal laser scanning microscopy allows the "in situ" histological demonstration of oxygen free radical formation in live tissues. Here we present a case report, where oxidative stress is demonstrated on a histological level for the first time in human acute pancreatitis. A 44-year-old male patient suffering from acute exacerbation of his chronic pancreatitis developed a pancreato-pleural fistula with amylase-rich left pleural exudate causing respiratory compromise. Subsequent to an urgent thoracic decompression a distal pancreatectomy and splenectomy was performed with the closure of abdomino-thoracic fistula. The postoperative course was uneventful, except for a transient pancreatico-cutaneous fistula, which healed after conservative treatment. To carry out cerium capture oxygen free radical histochemistry the resected pancreas specimen was readily perfused with cerium-chloride solution through the arteries on the resection surface. frozen sections were cut, E-, p-selectin, ICAM and VCAM were labeled by immunofluorescence. The tumor-free margin of an identically treated pancreas carcinoma specimen served as a control. Intrapancreatic oxidative stress and cellular adhesion molecule expression were detected by confocal laser scanning microscopy. Numerous pancreatic acini and neighboring capillaries showed oxygen free radical-derived cerium-perhy-droxide depositions corresponding to strong local oxidative stress. Acinar cytoplasmic reflectance signals suggested xanthine-oxidase as a source of oxygen free radicals. These areas presented considerably increased endothelial p-selectin expression with adherent, oxygen free radical-producing polymorphonuclear leukocytes displaying pericellular cerium-reflectance. Modest ICAM upregulation was noted, e-selectin and VCAM expression was negligible. The control pancreas specimen showed minimal oxidative stress with weak, focal p-selectin expression. The development of deleterious pancreatic oxidative stress was based on indirect evidence in human acute pancreatitis. To the best of our knowledge this is the first report demonstrating persistent intrapancreatic oxidative stress histologically in human acute pancreatitis. We have noted p-selectin overexpression with a preponderance in the areas of acinar oxidative stress.- - - - - - - - - - ranking = 0.2keywords = cutaneous fistula (Clic here for more details about this article) |
3/20. Management of postpneumonectomy bronchopleural-cutaneous fistula with a single free flap.A variety of local flaps have been described for chest wall and bronchopleural fistula reconstruction. When local options cannot be used because of previous surgery, trauma, radiation, or body habitus, free flaps become an acceptable option. The authors report a case of persistent bronchopleural-cutaneous fistula treated with a free latissimus dorsi musculocutaneous flap that obliterated the right chest cavity, closed the site of empyema drainage, and aided healing of a bronchopleural fistula. Surgical technique including anastomosis to the innominate vein is described.- - - - - - - - - - ranking = 1keywords = cutaneous fistula (Clic here for more details about this article) |
4/20. An unusual case of pneumorrhachis following resection of lung carcinoma.We report an unusual case of a patient with a bronchopleural-subcutaneous fistula that occurred 3 years following a lobectomy and en bloc chest wall resection for carcinoma. Following a sudden resolution of subcutaneous emphysema, an epidural air collection developed. Spontaneous pneumorrhachis is a previously unreported late complication after surgical or radiation therapy for lung carcinoma.- - - - - - - - - - ranking = 0.2keywords = cutaneous fistula (Clic here for more details about this article) |
5/20. Bronchopleural cutaneous fistula due to eikenella corrodens.OBJECTIVE: The aim of this paper is to review the subject and to report on and discuss a case of bronchopleural cutaneous fistula due to eikenella corrodens. DESCRIPTION: A 16-year-old girl was brought to our hospital with fever and blood-tinged sputum 2 weeks prior to her admission. She suffered from neurologic sequelae of herpetic encephalitis and had been bed-ridden since 5 years of age. A longitudinal paraspinal soft mass had been noted in the previous week by her mother. She had been given oral feeding despite frequent choking for the past few years. On palpation, the mass can be squeezed to follow the least resistance of subcutaneous space longitudinally extending to the lower thoracic region. Chest computed tomography scan revealed right lower lobe necrotizing pneumonitis and a pleuro-cutaneous fistula leading to the subcutaneous air locules. A protracted course of antibiotics was prescribed and subcutaneous air trapping decreased in size over 8 weeks. COMMENTS: eikenella corrodens has increasingly been implicated as a potential causative pathogen in pleuropulmonary infections. Pleuro-cutaneous fistula and abscess formation complicating empyema and necrotizing pneumonitis due to E. corrodens infection have not been reported. A bulging thoracic subcutaneous lesion waxes and wanes with respiration suggest the possibility of a pleruo-cutaneous fistula. Treatment of Eikenella empyema using antibiotics without surgical decortication requires a prolonged course of antibiotic therapy.- - - - - - - - - - ranking = 1.6keywords = cutaneous fistula (Clic here for more details about this article) |
6/20. Pleural aspergillosis with bronchopleurocutaneous fistula and costal bone destruction: a case report.A 65-year-old man who, when young, had had tuberculosis treated by therapeutic pneumothorax, consulted his family physician for a constitutional syndrome and dyspnea. At this time radiologic studies showed left pleural effusion with bilateral calcified plaques, an infiltrate in the upper left lobe, and a picture compatible with aspergilloma, all suggesting semi-invasive aspergillosis. The patient failed to show up for his followup visit, so no therapy could be started or further diagnostic tests ordered. One month later he was admitted to this hospital for a bronchopleural fistula (empyema necessitatis) with subsequent spontaneous hydropneumothorax and costal bone involvement. The patient underwent surgery because of his rapid worsening condition. biopsy examination revealed a large pleural aspergilloma. Despite immediate antifungal therapy, the patient died. We believe this to be the first report of pleural aspergillus with a bronchopleurocutaneous fistula and costal bone destruction.- - - - - - - - - - ranking = 1keywords = cutaneous fistula (Clic here for more details about this article) |
7/20. The maintenance of total ventilatory requirements through a chronic bronchopleural cutaneous fistula.In patient with a chronic post-tuberculous bronchopleural cutaneous fistula (BPCF), minute ventilation, dead space, flow rates, arterial blood gas tensions, and oxygen consumption were measured during mouth breathing and after 30 min of steady-state breathing solely through the BPCF. Despite a 390-ml (18%) decrease in dead space when breathing took place through the BPCF, there were no significant changes in minute ventilation or respiratory rate. BPCF breathing was also associated with an increase in airways resistance as reflected by a 300-ml (35%) decrease in the FEV1 and a 16% decrease in the FEV1/FVC ratio. The increased resistance resulted in a 20 ml/min (18%) increase in oxygen consumption. Arterial blood gas tensions remained constant. We conclude that although ventilatory efficiency was not improved, this patient was able to satisfy his total minute ventilatory requirements, for the 30-min period, solely through BPCF breathing.- - - - - - - - - - ranking = 1keywords = cutaneous fistula (Clic here for more details about this article) |
8/20. Oesophago-pleuro-cutaneous fistula.We describe a case of oesophago-pleuro-cutaneous fistula occurring as a complication of tuberculous pyopneumothorax in a young adult.- - - - - - - - - - ranking = 1keywords = cutaneous fistula (Clic here for more details about this article) |
9/20. Percutaneous use of fiberoptic bronchoscope to investigate bronchopleurocutaneous fistula.The fiberoptic bronchoscope was used percutaneously to visualize the track of a bronchopleurocutaneous fistula and to obtain tissue and microbiologic specimens for examination. The bronchoscopy turned out to be a very simple procedure and patient discomfort was minimal. The findings aided in the successful management of this patient.- - - - - - - - - - ranking = 1keywords = cutaneous fistula (Clic here for more details about this article) |
10/20. Esophago-pleuro-cutaneous fistula. A case report.In a sixty-three year old Japanese man with a history of long standing pulmonary tuberculosis, an unusual esophago-cutaneous fistula developed. The possibility of esophago-pleuro-cutaneous fistula was considered, because there was an old tuberculosis causing lung abscess of hilar lymph node adenopathy and which facilitated development of an extensive fistulous tract. The patient was effectively treated by palliative surgical procedure. This may be the first report of a benign esophago-pleuro-cutaneous fistula.- - - - - - - - - - ranking = 1.4keywords = cutaneous fistula (Clic here for more details about this article) |
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