11/1471. Transient pseudo-hypoaldosteronism following resection of the ileum: normal level of lymphocytic aldosterone receptors outside the acute phase.Pseudo-hypoaldosteronism (PHA) is due to mineralocorticoid resistance and manifests as hyponatremia and hyperkalemia with increased plasma aldosterone levels. It may be familial or secondary to abnormal renal sodium handling. We report the case of a 54-year-old woman with multifocal cancer of the colon, who developed PHA after subtotal colectomy, ileal resection and jejunostomy. She was treated with 6 g of salt daily to prevent dehydration, which she stopped herself because of reduced fecal losses. One month later she was admitted with signs of acute adrenal failure, i.e. fatigue, severe nausea, blood pressure of 80/60 mmHg, extracellular dehydration, hyponatremia (118 mmol/l); hyperkalemia (7.6 mmol/l), increased blood urea nitrogen (BUN) (200 mg/dl) and creatininemia (2.5 mg/dl), and decreased plasma bicarbonates level (HCO3-: 16 mmol/l; N: 27-30). However, the plasma cortisol was high (66 microg/100 ml at 10:00 h; N: 8-15) and the ACTH was normal (13 pg/ml, N: 10-60); there was a marked increase in plasma renin activity (>37 ng/ml/h; N supine <3), active renin (869 pg/ml; N supine: 1.120), aldosterone (>2000 pg/ml; N supine <150) and plasma AVP (20 pmol/l; N: 0.5-2.5). The plasma ANH level was 38 pmol/l (N supine: 5-25). A urinary steroidogram resulted in highly elevated tetrahydrocortisol (THF: 13.3 mg/24h; N: 1.4 /-0.8) with no increase in tetrahydrocortisone (THE: 3.16 mg/24h; N: 2.7 /-2.0) excretion, and with low THE/THF (0.24; N: 1.87 /-0.36) and alpha THF/THF (0.35; N: 0.92 /-0.42) ratios. The number of mineralocorticoid receptors in mononuclear leukocytes was in the lower normal range for age, while the number of glucocorticoid receptors was reduced. Small-bowel resection in ileostomized patients causes excessive fecal sodium losses and results in chronic sodium depletion with contraction of the plasma volume and severe secondary hyperaldosteronism. Nevertheless, this hyperaldosteronism may be associated with hyponatremia and hyperkalemia suggesting PHA related to the major importance of the colon for the absorption of sodium. In conclusion, this case report emphasizes 1) the possibility of a syndrome of acquired PHA with severe hyperkalemia after resection of the ileum and colon responding to oral salt supplementation; 2) the major increase in AVP and the small increase in ANH; 3) the strong increase in urinary THF with low THE/THF and alpha THF/THF ratios; 4) the normal number of lymphocytic mineralocorticoid receptors outside the acute episode.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
12/1471. Aortobronchial fistula after coarctation repair and blunt chest trauma.A 34-year-old man had development of an aortobronchial fistula 17 years after patch aortoplasty for correction of aortic coarctation and 5 years after blunt chest trauma, an unusual combination of predisposing factors. The clinical presentation, characterized by dysphonia and recurrent hemoptysis, and the surgical findings suggested the posttraumatic origin of the fistula, which was successfully managed by aortic resection and graft interposition under simple aortic cross-clamping, associated with partial pulmonary lobectomy. When hemoptysis occurs in a patient with a history of an aortic thoracic procedure, the presence of an aortobronchial fistula should be suspected. early diagnosis offers the only possibility of recovery through a lifesaving surgical procedure.- - - - - - - - - - ranking = 64.513774769927keywords = fistula (Clic here for more details about this article) |
13/1471. Bronchial-atrial fistula after lung transplant resulting in fatal air embolism.We describe a rare case of fatal air embolism in a patient in whom a left atrial-bronchial fistula developed 1 month after single lung transplant. The cause was a combination of mediastinal infection and bronchial necrosis.- - - - - - - - - - ranking = 46.081267692805keywords = fistula (Clic here for more details about this article) |
14/1471. Management of prostatic fistulas.Prostatic fistulas communicating with the rectum or perineal skin are unusual complications of a prostatic operation, pelvic trauma, prostatic abscess or other iatrogenic injury. A third of these fistulas may close spontaneously with proper urinary drainage and avoidance of fecal soilage. The many operative procedures described for the repair of these fistulas indicate that no ideal method of repair can be applied to every case. Operative management should be mandated by the size, location and duration of the fistula as well as by the surgeon's experience with the various anatomic approaches.- - - - - - - - - - ranking = 74.230028308489keywords = fistula, urinary (Clic here for more details about this article) |
15/1471. Therapeutic embolization for unusual latrogenic complications related to coronary revascularization.Percutaneous therapeutic embolization may be an effective strategy to manage distal coronary perforations or inadvertent iatrogenic coronary arteriovenous fistula complicating revascularization procedures. We present two cases in which embolization techniques were used to manage these patients and avoid the need for surgical intervention.- - - - - - - - - - ranking = 9.2162535385611keywords = fistula (Clic here for more details about this article) |
16/1471. Disseminated herpes simplex virus infection in a renal transplant patient as possible cause of repeated urinary extravasations.Disseminated herpes simplex virus type 2 (HSV-2) infections are infrequent in patients receiving organ transplants, but usually have a poor outcome. We describe the case of a renal transplant patient who developed a disseminated HSV-2 infection with repeated urinary extravasations. The diagnosis was carried out using a multiplex polymerase chain reaction nested assay and it suggested HSV-2 as a possible cause of repeated urinary fistulas.- - - - - - - - - - ranking = 34.267029795624keywords = urinary fistula, fistula, urinary (Clic here for more details about this article) |
17/1471. External pancreatic fistula: a recent advance in management.The management of six consecutive recent cases of external pancreatic fistula is reported in which the use of total parenteral nutrition resulted in rapid closure of the fistula. The fistulae closed from 11 to 28 days after the commencement of total parenteral nutrition, with an average of 19 days. Surgical intervention to close the fistula was not required in any of the cases.- - - - - - - - - - ranking = 73.730028308489keywords = fistula (Clic here for more details about this article) |
18/1471. Striae and acne following cardiac surgery in a child.We report a 13-year-old girl with extensive striae and an acneiform eruption following surgery for complex congenital heart disease. These findings were associated with elevated serum and urinary cortisol levels with loss of diurnal rhythm. The resolution of the eruption and the fading of her striae coincided in time with normalization of her blood parameters on day 72 postoperatively. We conclude that the cause of steroid excess in our patient was stress induced by the cardiac surgery and a complicated and protracted postoperative course. To our knowledge, this is the first report in the English language literature of skin changes due to endogenous hypercortisolaemia caused by intense physical and emotional stress.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
19/1471. Management of ureteric obstruction in the solitary kidney by a segmental suspended ureteric prosthesis.Ureteric obstruction of a single kidney, secondary to an aorto-iliac bypass graft, was treated with a suspended segmentary ureteric prosthesis. No urinary stasis was observed during 1 year and the urodynamic implication are discussed.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
20/1471. Postparotidectomy fistula: a different treatment for an old problem.There is little consensus on the optimal management of postparotidectomy salivary fistulas. Timely treatment is important since fistulas may result in wound dehiscence and infection. Management options include pressure dressings, total parotidectomy, tympanic neurectomy, graft interpositioning, surgical closure of the tract, radiation therapy, and pharmacotherapy. Unfortunately, many therapies require weeks to months for resolution and possess additional risks. The affected patient often suffers social embarrassment from the drainage. Through our work with neurologically impaired children with sialorrhea, we have had success with using glycopyrrolate, an anticholinergic frequently used to decrease salivary secretions. We present a case of a patient with a postparotidectomy fistula which was successfully treated with glycopyrrolate and pressure dressings. The rationale and potential use of glycopyrrolate for the treatment of a salivary fistula are the focus of this presentation.- - - - - - - - - - ranking = 73.730028308489keywords = fistula (Clic here for more details about this article) |
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