1/103. Midfacial complications of prolonged cocaine snorting. Acute and chronic ingestion of cocaine predisposes the abuser to a wide range of local and systemic complications. This article describes the case of a 38-year-old man whose chronic cocaine snorting resulted in the erosion of the midfacial anatomy and recurrent sinus infections. Previously published case reports specific to this problem are presented, as are the oral, systemic and behavioural effects of cocaine abuse. ( info) |
2/103. Cholelithoptysis and pleural empyema. We report a case of delayed cholelithoptysis and pleural empyema caused by gallstone spillage at the time of laparoscopic cholecystecomy. An occult subphrenic abscess developed, and the patient became symptomatic only after trans-diaphragmatic penetration occurred. This resulted in expectoration of bile, gallstones, and pus. Spontaneous decompression of the empyema occurred because of a peritoneo-pleuro-bronchial fistula. This is the first case of such managed nonoperatively and provides support for the importance of intraoperative retrieval of spilled gallstones at the time of laparoscopic cholecystectomy. ( info) |
3/103. Complications resulting from treatment of severe posterior epistaxis. Recent advances in nasal endoscopy and arterial embolization have improved the treatment of severe posterior epistaxis. This report reviews the therapeutic options, including a case of epistaxis that did not respond to nasal packing but was successfully controlled with superselective arterial embolization. The discussion includes an outline of potential complications of epistaxis treatment, including a case of nasal septal perforation. ( info) |
4/103. Surgical management of acquired laryngopharyngeal fistulae. Pathological communication between the food and air passages in the neck region due to malignant disease is known. However, such a pathology arising as a result of a non malignant process is relatively uncommon, and only a handful of reports exists in the literature. The authors describe and discuss the management of two patients with laryngopharyngeal fistula of nonmalignant etiology. ( info) |
5/103. An unusual iatrogenic cause of right coronary air embolism. A 62-year-old woman undergoing redo mitral valve replacement was noted to have persistent intracardiac air following standard deairing procedures. Transesophageal echocardiography (TEE) identified air bubbles entering the left atrium from the right superior pulmonary vein. Exploration of the pleural cavity revealed a fistula between the pulmonary parenchyma and the right superior pulmonary vein caused by the atriotomy closure suture transfixing the edge of the lung, which was repaired with immediate disappearance of the air emboli. This demonstrates that transesophageal echocardiography is an invaluable aid to ensuring complete deairing after open heart procedures. ( info) |
6/103. Communicating bronchopulmonary pancreatic foregut malformation. Bronchopulmonary foregut malformations include intralobar and extralobar pulmonary sequestrations, bronchogenic cysts, and communicating bronchopulmonary foregut malformations (CBPFM). These malformations, formes frustes, originate as developmental abnormalities of ventral foregut budding of the tracheobronchial tree or the gastrointestinal tract. The communication's patency with the parent viscus determines if a contained malformation occurs, or if an abnormal communication persists as a CBPFM. This case demonstrates a unique example of a CBPFM in which the main pancreatic duct communicated with pulmonary parenchyma through a retroperitoneal fistula. ( info) |
| Tracheocutaneous fistula is seen frequently in decannulated children and respiratory complications associated with primary surgical closure can be potentially fatal. cough is a precipitating factor for an air leak and we report two cases in which this occurred. A tracheotomy was performed on a 5-month-old girl for mechanical ventilation. Decannulation was successful at the first attempt. One year later, she presented with a persistent tracheo-cutaneous fistula. After surgical closure without drainage, she developed subcutaneous emphysema during a coughing episode. sutures were removed. A 9-month-old boy presented with oxygen-dependence after lung disease and a tracheotomy was performed for respiratory support. Decannulation was successful at the first attempt 6 months later. He developed a pneumomediastinum after surgical closure of a tracheo-cutaneous fistula. sutures were removed but replacement of a tracheotomy tube was required. In both cases the wounds were allowed to heal by secondary intention. ( info) |
8/103. Aortopulmonary fistula. BACKGROUND: Aortopulmonary fistula is an uncommon but usually fatal condition if not treated surgically. The most frequent cause is erosion of a false aneurysm of the descending thoracic aorta into the left lung. methods: review of charts of all patients who had had resection of a thoracic aortic aneurysm at the MidAmerica heart Institute (1971 to 1997) revealed three cases in which the presentation was hemoptysis resulting from an aortopulmonary fistula. The clinical features and course of each patient are summarized in this report. RESULTS: The three patients with hemoptysis due to an aortopulmonary fistula had emergency surgical intervention with no major complication. CONCLUSIONS: Any patient who has an otherwise unexplained hemoptysis and a history of a previous thoracic aortic surgical procedure or is known to have a thoracic aortic aneurysm should have appropriate clinical evaluation to exclude the presence of an aortopulmonary fistula. If an aortopulmonary fistula cannot be excluded, emergency operation should be done. ( info) |
9/103. Pancreaticopleural fistula: diagnosis with magnetic resonance pancreatography. Pancreaticopleural fistula secondary to chronic pancreatitis is a rare cause of recurrent pleural effusion. The demonstration of the fistula with endoscopic retrograde pancreatography and CT is invasive or limited. We report in two patients the use of magnetic resonance pancreatography as a noninvasive alternative to endoscopic retrograde pancreatography for the diagnosis of pancreaticopleural fistula. ( info) |
10/103. Anaesthetic management for a left pneumonectomy in a child with bronchopleural fistula. The anaesthetic management of a left pneumonectomy in a 18-month-old girl with a bronchopleural fistula is described. An ordinary tracheal tube was slit at the bevel to ensure upper lobe ventilation on right endobronchial intubation. A combination of a bronchial blocker, endobronchial intubation with a slit tube, and nerve blocks for these manoeuvres was used. pain relief by a thoracic epidural block ensured good physiotherapy and a comfortable postoperative period. ( info) |