Cases reported "Fistula"

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1/11. Pneumoencephalomeningitis secondary to infected lumbar arthrodesis with a fistula: a case report.

    pneumocephalus associated with spinal problems is very rare. association with encephalomeningitis secondary to a fistula after an infected elective lumbar spine fusion has not been previously reported. The authors report a case in which the clinical onset of pneumoencephalomeningitis occurred after an airplane flight. CT-scan and lumbar puncture were used to make diagnosis; the treatment was based on parenteral antibiotics. The symptoms and signs of infection and neurological deficit resolved but the fistula remained. diagnosis in such cases must be based upon CT-scan and lumbar puncture. Treatment should consist of systemic antibiotic therapy. Surgical management of infection and fistula is desirable, should the status of the patient allow such a treatment. In any case, as airplane flights in such cases may predispose to pneumocephalus, patients with an infected CSF fistula should avoid airplane flights until the problem is solved.
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2/11. intracranial hypotension and recurrent pleural effusion after snow-boarding injury: a manifestation of cerebrospinal fluid-pleural fistula.

    BACKGROUND DATA: intracranial hypotension causing postural headaches has been described after occult and postsurgical cerebrospinal fluid (CSF) leaks and rarely isolated lumbar punctures. The occurrence of a CSF-pleural communication is much rarer, and a high level of suspicion aids in prompt recognition. PURPOSE: Early detection and anatomic delineation of the site of CSF-pleural fistula allows prompt intervention, results in resolution of symptoms and prevents the complication of meningitis. STUDY DESIGN: A case of intracranial hypotension with postural headaches is described after spinal surgery, with demonstration on computed tomography (CT) myelography of a rare CSF-pleural fistula. methods: The clinical presentation, postoperative intervention and imaging as well as laboratory data are presented. RESULTS: Chest X-ray showed recurrent pleural effusion after placement of chest tube, and serial head CT studies revealed decreasing ventricular size with development of severe headaches. Myelogram and CT postmyelogram demonstrate the CSF-pleural communication, allowing appropriate surgical repair. CONCLUSION: Severe headaches with a recurrent pleural effusion after thoracic spinal surgery may indicate presence of a CSF-pleural fistula, an unusual complication of thoracic spinal surgery.
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3/11. Case report: cerebrospinal fluid fistula--a rare complication of myelography.

    A case of a cerebrospinal fluid fistula developing following a lumbar puncture done for myelography is described. Radiographic documentation was obtained by a sinogram using an oily contrast medium. The exact aetiology of the fistula was undetermined, however, the large calibre of the spinal needle used for lumbar puncture as well as the patient's decubitus ulcer in the early post-myelography state may have had a role to play. The presence of a low grade infection also remains a possibility as the needle used was of an autoclaved, reusable type.
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4/11. Recurrent bacterial meningitis. Secondary to malformation of the inner ear.

    A 5-year-old girl with congenital sensorial deafness experienced four episodes of bacterial meningitis in a 13-month period. On the fourth episode, an extensive search for the cause of recurrent meningitis was conducted. Complete immunologic studies, humoral, cellular, and phagocytic, yielded negative results. Precise otological examination, i.e., skull roentgenograms, an inner ear target CT scan, and puncture of the eardrum, was attempted, which disclosed the inner ear malformation (Mondini's anomaly) and a cerebrospinal fluid (CSF) fistula. CSF discharge from the oval window was repaired surgically. Extensive otologic evaluation should be conducted in patients with recurrent bacterial meningitis.
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5/11. Hypertrophic scarring of tracheoesophageal fistula causing vocal failure.

    There are many known complications of tracheoesophageal puncture for voice restoration. A patient developed hypertrophic scarring with subsequent vocal failure, an as yet unreported complication.
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6/11. Spinal cerebrospinal fluid leak demonstrated by radioisotopic cisternography.

    Many conditions are known to cause a cerebrospinal fluid (CSF) fistula; one of them is lumbar puncture for contrast myelography. Reported here is the case of a man who underwent contrast myelography at the L2-L3 level and who presented with postural headaches and lumbalgia with radiation to the legs three weeks after the procedure. Tc-99m albumin isotopic cisternography at the L5-S1 level was performed and clearly depicted a functional CSF leak through the dura at the L2-L3 level and CSF suffusion along several rachidian roots. Scinticisternography may thus be used to localize accurately a CSF leak.
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7/11. Pulmonary venous-bronchial fistula following left atrial pressure line insertion: iatrogenic cause of air embolism following cardiac surgery.

    A 65-year-old patient sustained massive air embolism after the needle used for left atrial pressure line insertion punctured the posterior wall of the superior pulmonary vein, entering the middle lobe bronchus and causing a pulmonary venous-bronchus fistula. This is an apparently heretofore unrecognized potential cause of massive air embolism following cardiac surgery.
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8/11. Caudal epidural blood patch for the treatment of a paediatric subarachnoid-cutaneous fistula.

    This clinical report describes the performance of an epidural blood patch in a four-year-old child with acute lymphocytic leukaemia, who developed a subarachnoid-cutaneous fistula from repeated lumbar punctures for chemotherapy. The epidural blood patch was performed using an #18-gauge epidural catheter threaded through a #16-gauge intravenous catheter via the caudal approach. This approach was successful in a child whose lumbar epidural anatomy was distorted due to a collection of subcutaneous cerebrospinal fluid making identification of the epidural space by the usual lumbar approach very difficult. This report demonstrates an alternative technique for the performance of an epidural blood patch.
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9/11. Post-laminectomy cerebrospinal fluid fistula treated with epidural blood patch.

    OBJECTIVES AND SUMMARY OF BACKGROUND DATA. cerebrospinal fluid fistula after spinal surgery is associated with a definite risk of meningitis or discitis, and as a result, early active intervention usually is recommended. methods AND RESULTS. This report describes the successful use of an epidural blood patch after a more conventional intervention--namely, surgical re-exploration--had failed to control a postoperative cerebrospinal fluid leak. CONCLUSIONS. The techniques involved in performing a blood patch after spinal surgery may well differ from those usually recommended in the management of spinal headache resulting from other causes of dural puncture.
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10/11. Atrioventricular fistula: an unusual complication of endomyocardial biopsy in a heart transplant recipient.

    Endomyocardial biopsy remains the primary method for diagnosis of cardiac allograft rejection. Generally, endomyocardial biopsy is considered a relatively safe procedure in heart transplant recipients. Complications that have been reported are related to catheter insertion and include carotid arterial puncture, prolonged bleeding, vasovagal reaction, ventricular tachyarrhythmias, and transient conduction abnormalities. Serious complications such as right ventricular perforation with cardiac tamponade may also occur. Most complications are usually without significant long-term sequelae. This report describes an unusual case of atrioventricular fistula between the right atrium and left ventricle that occurred during a routine endomyocardial biopsy in a heart transplant recipient. Sudden hemodynamic compromise developed in this patient soon after heart biopsy associated with hemodynamic picture of high-output heart failure. Right heart catheterization, including oximetry, peripheral venous contrast echocardiography, color flow Doppler studies, and transesophageal echocardiography confirmed the diagnosis of fistulous communication between the right atrium and left ventricle, most likely through the membranous interventricular septum. Conservative medical management resulted in striking clinical improvement within 48 hours commensurate with spontaneous closure of the right atrium-to-left ventricle fistula documented by hemodynamic and echocardiographic studies.
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