Recording of unexpectedly high frequency vibrations of blood vessel walls in experimental arteriovenous fistulae of rabbits using a laser vibrometer

Because arteriovenous fistulae are associated with a palpable thrill and an audible murmur, the vibrational activity of the blood vessel walls about experimental arteriovenous fistulae in rabbits was investigated using, for the first time, a high-resolution laser vibrometer. Frequencies of mural vibrations up to 2200 Hz were recorded at different sites about the fistulae. The relationship of this vibratory activity of blood vessel walls to physiological and pathological conditions warrants further investigation.     

Hereditary hemorrhagic telangiectasia or Rendu-Osler-Weber syndrome in the same family

The authors present the case of three patients from the same family in whom hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber syndrome was diagnosed. The disease is rare and occurs with multiple telangiectases of the skin and mucosa, and pulmonary arteriovenous fistulae. The clinical status of our patients included multiple telangiectases of the skin and mucosa, recurrent epistaxis, exertion dyspnea and cyanosis. Polycythemia and hypoxemia were observed in the blood. The clinical status and conventional radiological examination of the thoracic region, with the suspicion of arteriovenous (A-V) fistulae, pointed to HHT. A-V fistulae were confirmed by pulmonary angiography. The pulmonary A-V fistulae were operated in all three patients and diagnosis was confirmed by histopathological examination of the operated samples. Clinical improvement was observed after the operation and cyanosis, dyspnea, hypoxemia and polycythemia disappeared.     

Pedicled Greater Omentum Graft: A New Technique to Repair Recurrent Urinary Fistulae After Kidney Transplantation

Urinary fistula is the most frequent urologic complication within the first month after kidney transplantation, which often leads to graft loss and mortality. Open surgery is the most popular approach for the treatment of these fistulae; however, it is associated with high failure rates. Here, we present a new technique of pedicled greater omentum graft to repair recurrent urinary fistulae after kidney transplantation. We used this technique in the repair of recurrent urinary fistulae in 13 post-kidney transplant patients. All operations were successful at the first attempt, and there was no fistula recurrence. Further, no complications associated with the technique have been observed during the follow-up (1–7 years). In conclusion, the use of pedicled greater omentum graft for the repair of recurrent urinary fistulae after kidney transplantation is both effective and safe.     

Predicting the course of a congenital hemangioma.

We report a series of 10 congenital hemangiomas which have been followed by serial examinations with the Doppler apparatus, to determine persistence of and increase in A--V fistulae, or a decrease in same. We believe the data on the A--V fistulae correlate inversely with the likelihood of spontaneous regression and involution.     

THE EFFECT OF INTESTINAL RESECTION ON THIRY-VELLA FISTULAE OF JEJUNAL AND ILEAL ORIGIN IN THE RAT: EVIDENCE FOR A SYSTEMIC CONTROL MECHANISM OF CELL RENEWAL

Local and systemic control mechanisms have been postulated to explain the maintenance of steady state cell renewal in intestinal epithelium. Permanent alterations of cell renewal resulting in a new steady state imply alterations in control. Intestinal resection appears to cause such alterations resulting in hyper-plasia of the residual intestine. To test the hypothesis of a systemic control, the effect of 60% mid-intestinal resection on Thiry-Vella fistulae of both jejunal and ileal origin was observed in rats. Results showed that hypoplasia occurred in fistulae without resection of the remaining intestine in continuity. Cell counts of crypt and villus columns and tritiated thymidine uptake in isolated whole crypts were reduced. Scanning electron microscopy showed marked hypoplastic alterations in villi. However, when 60% of the intestine in continuity was resected, hyperplasia occurred not only in the residual intestine but in the fistulae of both jejunal and ileal origin. Cell counts of villus and crypt columns were increased along with increased tritiated thymidine uptake per crypt. Neutral cc-glucosidase and non-specific esterase activities did not change as a result of resection but the activities of both enzymes were greater in ileal fistulae than in ileum in situ. Observations on the different resection response of the jejunal versus ileal fistulae lead to a distinction between inherent and induced differences within the small intestine. This study suggests a systemic control of cell renewal. A possible mechanism involving intestinal vascular physiology is discussed.     

Bilateral coronary fistulae to pulmonic valve in presence of severe three-vessel coronary artery disease

A 62-year-old man was admitted to the coronary care unit due to anginal pain and palpitations--coronary angiography revealed three-vessel coronary artery disease. The unexpected finding was the presence of coronary to pulmonary artery fistulae bilaterally, from both the proximal RCA and the proximal LAD. Right heart catheterization revealed normal right ventricular and pulmonary artery pressure and absence of hemodynamically significant left to right shunt. The patient underwent a triple coronary bypass including the closure of bilateral fistulae, which were draining into the left sinus of the pulmonary valve. One month after the operation he was in good health and had no complaints. Bilateral coronary artery fistulae is a rare anomaly diagnosed in 0.002-0.0013% of adult coronary angiograms. (Int J Cardiovasc Intervent 1999; 2: 249-251).     

Intraoral cheek fistulae: a refined technique

Taste reactivity testing (TRT), which entails infusing a solution into the oral cavity of subjects, is used across a wide range of studies. For laboratories inexperienced in the conventional technique of implanting cheek fistulae, the surgery can be problematic for both the subjects and the experimenter. We have proposed a refined method for fistulae implantation that is less invasive, thereby reducing the pain and distress of the animals. Using this refined technique, we were able to replicate the findings of previous TRT studies, namely that a high dose of lithium chloride produces an increase in aversive and a decrease in ingestive orofacial and somatic responses. Using indices of health, we demonstrate that unlike animals with the conventional method of fistulae implantation, subjects that receive the refined technique regain their pre-surgery body weights rapidly and show no physical signs of discomfort. Additional advantages of the refined technique are discussed.     

Vacuum Effects over the Closing of Enterocutaneous Fistulae: A Mathematical Modeling Approach

Enterocutaneous fistulae are pathological communications between the intestinal lumen and the abdominal skin. Under surgery the mortality of this pathology is very high, therefore a vacuum applying system has been carried previously on attempting to close these fistulae. The objective of this article is the understanding of how these treatments might work through deterministic mathematical modelling. Four models are here proposed based on several assumptions involving: the conservation of the flow in the fistula, a low enough Reynolds number justifying a laminar flow, the use of Poiseuille law to model the movement of the fistulous liquid, as well as phenomenological equations including the fistula tissue and intermediate chamber compressibility. Interestingly, the four models show fistulae closing behaviour during experimental time (t<60 sec). To compare the models, both, simulations and pressure measurements, carried out on the vacuum connected to the patients, are performed. Time course of pressure are then simulated (from each model) and fitted to the experimental data. The model which best describes actual measurements shows exponential pumping flux kinetics. Applying this model, numerical relationship between the fistula compressibility and closure time is presented. The models here developed would contribute to clarify the treatment mechanism and, eventually, improve the fistulae treatment.     

Congenital coronary artery-cardiac chamber fistulae: Report of two cases

Two cases of coronary arteriovenous fistulae are reported. In the first case, the right coronary artery (RCA) drained into the right ventricular outflow tract, and the distal RCA filled through a branch of the left anterior descending coronary artery. In the second case, the RCA drained into the right atrium and filled through a branch of the left circumflex artery. The fistulae were closed with subcoronary mattress sutures that preserved the continuity of the native circulation.     

Acetorphan, an enkephalinase inhibitor, decreases gastric secretion in cats

Acetorphan is an inhibitor of "enkephalinase" (EC 3.4.24.11) which has been shown to reduce in vivo and in vitro the degradation of enkephalins and other peptides. The effects of acetorphan on gastric secretion were studied in cats fitted with gastric fistulae and Heidenhain pouches. Acetorphan inhibited by 40-60% the acid secretion from the gastric fistulae after stimulation by submaximal doses of pentagastrin, histamine and 2 deoxy-D-glucose. These inhibitions were reduced or suppressed by naloxone. The meal-stimulated secretion from the fistulae was not changed after acetorphan. Acetorphan slightly and progressively reduced the pentagastrin-stimulated acid output from the Heidenhain pouches, and this effect was naloxone resistant. No change was found in the secretion from Heidenhain pouches under histamine stimulation, while meal-induced secretion of the pouches was increased by acetorphan, and this increase was not prevented by naloxone. Endogenous opioids probably exert an inhibitory regulatory control upon the gastric secretion of cats. In addition, non-opioid factors may be involved in the effect of acetorphan on meal-stimulated secretion.     

Effect of prednisolone on the inhibition of basal gastric secretion in laboratory rats induced by fats or blockade of H2-receptors

Experiments on rats with gastric fistulae for the first time have shown that glucocorticosteroid prednisolone causes weakening of the fat and H2-receptor inhibition of basal gastric secretion.     

Treatments for the amelioration of persistent factors in complex anal fistula

Biotechnology Letters - Anal fistulae are abnormal hollow connections between the wall of the anal canal and the perianal skin around the anus that have remained a burden on the medical sector for...     

Role of free-tissue transfer in the treatment of recalcitrant palatal fistulae among patients with cleft palates

Recurrent palatal fistulae present a particularly vexing problem for patients with cleft lips and palates and their surgeons. When primary closure fails, conventional wisdom and the standard of care suggest local flap techniques for defect closure. For the large majority of patients, this approach is successful. There is, however, a small subset of patients who undergo multiple surgical procedures in unsuccessful attempts to close recalcitrant fistulae, particularly at the anterior, densely scarred, hard palate. In this setting, repair calls for the introduction of well-vascularized pliable tissue to close the defect and to avoid hampering further palatal growth. Local muscle flaps and oral axial pattern flaps have been advocated and used successfully. However, those approaches have their own drawbacks, such as multiple surgical interventions, patient compliance, and intraoral scarring. In an effort to avoid the problems associated with local flaps, distant microvascular tissue transfers were investigated. During a 6-year period, six free-tissue transfers were performed as a primary means of treating recalcitrant palatal fistulae. Three dorsalis pedis flaps and three osseous angular scapular flaps were used. The conditions of all patients improved, with five patients achieving complete long-term closure of the palatal defect. This experience indicates that modern microvascular techniques have reached a level of success commensurate with that of other flap techniques; therefore, it is concluded that free-tissue transfer should be considered as a primary means of addressing these difficult cleft problems.     

Participation of the beta-adrenergic receptor in the enteroruminal reflex and enteroenteric reflex

In sheep with chronic fistulae of the small intestine and rumen the participation of the beta-adrenergic receptor was investigated in the enteroruminal reflex and enteroenteric reflex using the method of pharmacological analysis. The movements of the segments of the digestive tract with fistulae were recorded by the balloon method. A solution of hydrochloric acid administered into the ileum caused a reflex stimulation of its motor activity and inhibited the movements of the rumen. Intravenous administration of propranolol before instillation of the acid into the intestine abolished or reduced greatly the reflex inhibition of the movements of the rumen and in the small intestine it enhanced significantly the studied reflex reaction. Thus stimulation of the beta-adrenergic receptor plays an important role in the reflex stimulation of the motor activity of the rumen, and stimulation of the motor activity of the small intestine in the enteroenteric reflex is limited by the effects derived from this receptor.     

Dialyzable leukocyte extract (transfer factor) in the treatment of superinfected fistulating tuberculosis of the bone

The effect of the addition of dialyzable leukocyte extract (DLE) (transfer factor) to tuberculostatic drugs in the treatment of superinfected fistulating tuberculosis of bones and joints was evaluated in a controlled study. Eleven patients whose disease had persisted for a mean of 20 ± 4.8 years and had proved to be resistant to antibiotics and tuberculostatic drugs were treated with an additional combined tuberculostatic drug regimen consisting of isoniazide, ethambutol, and rifampin for a control period of 2 years; after this therapy had failed as judged by the persistence of the superinfected fistulae and of the symptoms, DLE was added to the regimen. The result of this therapeutic approach was evaluated after another 2 years. Through this therapy, a closure of the fistulae was achieved in 9 out of the 11 patients (P < 0.001) with a concomitant decrease of symptoms. DLE may prove beneficial in the treatment of patients with superinfected fistulating tuberculous osteomyelitis.     

Novel treatments for complications after bariatric surgery

Bariatric surgery has been considered one of best treatments for obesity. As every surgical procedure—and any medical intervention, it is not exempt of complications, among which leaks, strictures, acute hemorrhages and fistulae highlight. Leaks are more common in the gastro-jejunal anastomosis (GJA) in the case of Roux-en-y Gastric Bypass (RYGB), while in Sleeve Gastrectomy (LSG) they locate in the stapler line. Stenosis can be seen in the gastro-jejunostomy in the RYGB and in the gastric tube in case of the LSG. For each of these complications, many innovative solutions have been developed, including new surgical devices. In spite of promising good results, evidence regarding utility and safeness of these technologies is still scarce. Self-expandable endoscopic stents have been used to treat leaks, with an overall success rate of 80–90 % and a migration rate of 15–35 %. The bear trap-like over-the-scope (Ovesco) clips have been used to treat GI hemorrhages, leaks and even fistulae, with a 70–80 % success rate, although more endoscopic sessions may be needed. Overstitch, an endosurgical suture devices, have been used to treat leaks, fistulae and perforations. Overall, technical success achievement approaches to 90 %, while clinical success ranges from 80 to 90 %, except for leaks closure, where a lower success rate has been observed. Despite of all of these advances, early diagnosis and treatment remains the main strategy to achieve success. In summary, novel therapies for complication management can be very useful, though further studies with larger series are still needed in order to confirm their efficacy and safeness.     

Experience with Three Brescia–Cimino Shunts

Bresica–Cimino shunts inserted to facilitate intermittent dialysis may markedly increase the circulatory load on the heart. Three patients in whom there was evidence of overload are described. Thorough investigation of the cardiac output should be made in patients with fistulae of this kind, which should be closed as soon as practicable after transplantation.     

Modified human umbilical vein graft arteriovenous fistulae as a source of angioaccess in maintenance hemodialysis

Forty-six modified human umbilical vein graft arteriovenous fistulae were used for maintenance hemodialysis in 45 patients with chronic renal failure. Complications were encountered in 15 of the 46 grafts after one to 24 months. In only one case did a graft become infected. The results show a significantly lower complication rate than for any other graft material.     

The importance of the lysophosphatidylcholine and choline moiety of bile phosphatidylcholine in lymphatic transport of fat

A luminal supply of biliary phosphatidylcholine is important in the translocation of absorbed fat into lymph and in the amount and composition of phosphatidylcholine concurrently synthesized. This study was undertaken to determine whether the effect was due to absorbed lysophosphatidylcholine, to a specific (1-palmitoyl) biliary lysophosphatidylcholine or to extra choline supplied by lysophosphatidylcholine. Rats with bile fistulae and thoracic duct lymph fistulae were given test meals of oleic acid and monoolein (molar ratio 2 : 1) infused duodenally for 8 h. Addition of choline chloride to the test meal increased lymphatic output of triglyceride and phospholipid but not to values found previously in rats with supplements of bile phosphatidylcholine or with bile ducts intact. Addition of dioleoyl phosphatidylcholine increased triglyceride and phospholipid output to values found in rats with intact bile ducts. Since dioleoyl phosphatidylcholine was as efficient as biliary phosphatidylcholine it was concluded that a luminal supply of 1-palmitoyl lysophosphatidylcholine was not essential. It seemed likely from the smaller effect of supplemented choline and from the fatty acid composition of lymph phosphatidylcholine that the essential requirement was a supply of absorbed lysophosphatidylcholine for rapid reacylation to phosphatidylcholine.