No abstract available.
Drug Therapy* ; Fistula*

Esophagorespiratory fistulas resulting from Mycobacterium tuberculosis infection are rare. Whereas most esophagorespiratory fistulas are absolute indication for direct surgical closure, this may not be necessary in the case of those of tuberculous origin. If diagnosed early, the infection and the complicating fistula could be treated effectively with anti- tuberculous chemotherapy without the need for surgical intervention. Despite the sugges- tion of a trend away from direct surgical closure in recent years, it seems that anti tuberculous chemotherapy may not result in healing of the fistula in all patients. So we report a case of tuberculous esophagorespiratory fistula that has severe aspiration pneumorua and effectively treated with implantation of silicone-covered self-expandable metal stent and antituberculous chemotherapy.
Drug Therapy ; Fistula* ; Humans ; Mycobacterium tuberculosis ; Silicones* ; Stents* ; Tracheoesophageal Fistula

Tracheoesophageal fistula (TEF) in adult patients is an uncommon complication in leukemia. We present here on a case of TEF in a 46-year-old woman with ALL. The patient was asymptomatic and TEF is resulted from aspergillus bronchitis during the chemotherapy for acute lymphoblastic leukemia (ALL).
Adult ; Aspergillosis* ; Aspergillus ; Bronchitis ; Drug Therapy ; Female ; Fistula ; Humans ; Leukemia ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Trachea ; Tracheoesophageal Fistula*

In Crohn's disease, neurologic complications such as cerebrovascular accident, headache, peripheral neuropathy have been reported sporadically. The pathogenesis of these neurologic complications is still unknown and controversial. We experienced a 22-year-old man, with Crohn's disease accompanied by optic neuritis. Loss of visual acuity was developed during the worsening course of enterocutaneous fistula. After high dose steroid treatment, his visual acuity and neurologic symptoms improved immediately.
Adult ; Crohn Disease/*complications/drug therapy/pathology ; Humans ; Intestinal Fistula/complications ; Male ; Optic Neuritis/*complications/diagnosis

Esophagopericardial fistala is a rare and usually life threatening complication of both benign and malignant esophageal disease. A case of pyopneumopericarduim in 45 year-old female is reported. Streptocoeeus viridana in pas celtore was isolated from pericardial pus. The disorder resulted from eaqyhagoyericardial fistula which probably developed as a complication of esophageal diverticnlum. The diagnasis of the fistula was established preoperatively on the basis of chest X-ray, esophagogram and. endoeeopic findings. The treatment was thoracotorny with drainage of pericardium, diverticulectomy and antimicrobial chemotherapy. The patieat improved postoperatively.
Drainage ; Drug Therapy ; Esophageal Diseases ; Female ; Fistula* ; Humans ; Middle Aged ; Pericardium ; Suppuration ; Thorax

Uterine cervical cancer is the most common malignancy in Korean women. In spite of recent development of early diagnostic and therapeutic modalities, about 40% of treated patient will develop relapse. So more aggressive local treatment such as more extensive surgery and higher radiation dose and administration of systemic chemotherapy will promote the curability but treatment related complications cannot be avoidable. We used 22 cases of early cervical cancer, treated with surgery and post-operative radiotherapy, clinical data of these patients were analyzed to determine relationship between clinical parameters and final outcome. Three out of 22 cases revealed relapse and one patient showed rectovaginal fistula and another patient showed small bowel obstruction and the other patient showed rectal obstruction. Two out of three recurrence were stage IIa and the other one case was stage Ib adenocarcinoma with lymphovascular involvement. Nineteen out of 22 cases were followed without remarkable side effect or treatment related complication or sequelae. We concluded that out treatment policy was safe and effective to eradicate high risk postoperative cervical cancer with acceptable side effects or complication.
Adenocarcinoma ; Drug Therapy ; Female ; Humans ; Radiotherapy* ; Rectovaginal Fistula ; Recurrence ; Uterine Cervical Neoplasms*

Esophageal cancers are highly malignant neoplasms. Prognosis of esophageal cancer treated by external irradiation alone is rather poor because of local recurrence and distant metastasis. Recently intracavitary irradiation has been used as a boost therapy after external irradiation to obtain better local control. One case of esophageal cancer has been treated by high dose rate remote-controlled after loading unit as boost therapy after external irradiation. The result was excellent in short term follow up esophagogram but esophageal bleeding and esophagotracheal fistula were noted in further follow up examination after inappropriate posttreatment management including insufficient chemotherapy due to poor general condition. We reviewed possible causes of esophageal bleeding and esophagotracheal fistula after external irradiation and high dose rate ICR.
Drug Therapy ; Esophageal Neoplasms* ; Follow-Up Studies ; Hemorrhage ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Tracheoesophageal Fistula

Differential diagnosis between tuberculous epididymitis and nonspecific chronic epididymitis is one of the most difficult problem in the field of urology. The definitive diagnosis of tuberculous epididymitis is often made by pathological examination of the epididymectomy or orchiectomy specimen. However, the preferred approach to treatment of tuberculous epididymitis is primarily antituberculous chemotherapy and we believe that as a primary measure, surgical procedure is avoidable with careful clinical work-up. A clinical comparative investigation was undertaken on 20 cases of tuberculous epididymitis and 13 cases of nonspecific chronic epididymitis, diagnosed by histopathologic examination during recent 6 year period. Tuberculous epididymitis occurred most frequently in men aged 21-30 years (80%), whereas nonspecific chronic epididymitis occurred frequently in men aged above 31 years (69.2%). Tuberculous epididymitis and nonspecific chronic epididymitis Were present clinically as painless scrotal mass in 70%, 53.8%, painful scrotal mass in 30%, 46.2%, and voiding symptoms in 15%, 7.7% respectively. Scrotal swelling were present in 30% of tuberculous epididymitis, but only in 7.7% of nonspecific epididymitis. Irregularity of mass were noted in 65% of tuberculous epididymitis, and in 23.1% of nonspecific epididymitis. Scrotal fistula were present only in 5% of tuberculous epididymitis. Of the patients with tuberculous epididymitis, 20% had a history of tuberculosis, and 46.1% of the patients with nonspecific chronic epididymitis had a history of acute epididymitis. In tuberculous epididymitis, clinical findings of concurrent infection with tuberculosis were found in kidney, prostate, vas, lung, and testis in order of frequency. Past history of tuberculosis or acute epididymitis and clinical findings of concurrent tuberculous lesions were helpful for clinical diagnosis, in 70% of the patients with tuberculous epididymitis and 46.2 % of the patients with nonspecific chronic epididymitis.
Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Epididymitis* ; Fistula ; Humans ; Kidney ; Lung ; Male ; Orchiectomy ; Prostate ; Testis ; Tuberculosis ; Urology

PURPOSE: Choledochoduodenal fistula (CDF) is an extremely rare condition even in the most populous nations. However, diagnostic tools are inadequate for the young surgeon to be made aware of such a rare condition before surgery. Hence, basic understanding of the epidemiology, etiology, and management for this unusual but discoverable condition are necessary and essential. METHODS: The exclusive case reports of CDF, which were published from 1983 to 2014 concerning mainland Chinese people, were performed to review the epidemiology, etiology, and management. RESULTS: A total of 728 cases were incorporated into this review among 48 papers. More than half of the CDF cases were female (416) with an average age of 57.3 years. CDF was usually caused by cholelithiasis (573 of 728). Epigastric pain (589 of 728) and cholangitis (395 of 728) were the most common symptoms of CDF. CDF was usually detected and confirmed by endoscopic retrograde cholangiopancreatography (ERCP) (475 of 728) in Mainland China. The fistulas larger than 1 cm (82 of 654) were recommended for surgical biliary reconstruction. Fistulas between 0.5 cm and 1.0 cm (467 of 654) which were followed frequently by cholangitis attacks also required surgery; the rest were recommended to have stone removal and/or the application of an effective biliary drainage. Fistulas less than 0.5 cm (105 of 654) were usually received conservative therapy. CONCLUSION: CDF should be considered in differential diagnosis of recurrent epigastric pain and cholangitis. A possible ERCP should be arranged to investigate carefully. Depending on the size of fistula and clinical presentation, different programs for CDF are indicated, ranging from drug therapy to choledochojejunostomy.
Asian Continental Ancestry Group ; Biliary Fistula ; China* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledochostomy ; Cholelithiasis ; Diagnosis* ; Diagnosis, Differential ; Disease Management ; Drainage ; Drug Therapy ; Epidemiology* ; Female ; Fistula* ; Humans

PURPOSE: Interferon gamma release assays (QuantiFERON-TB Gold in Tube test [QFT-GIT]); Cellestis Limited, Victoria, Australia) have been studied for diagnosing pulmonary tuberculosis (TB) or latent TB but there have been no reports on the usefulness of this assay in diagnosing tuberculous anal fistula in actual clinical practices. In this study, we evaluated its diagnostic usefulness in patients with suspected tuberculous anal fistula. METHODS: We conducted a retrospective analysis of 119 patients with suspected tuberculous anorectal fistula from May 2007 to May 2009. Diagnosis of tuberculous fistula was concluded by identification of acid-fast bacilli, typical caseating granuloma and successful clinical response to anti-TB chemotherapy. All patients underwent the QFT-GIT and all patients diagnosed with tuberculous anal fistula were analyzed. RESULTS: Of the 119 patients with suspected TB fistula, 51 (43%) patients were classified as having TB fistula, including 31 with confirmed tuberculosis and 20 with probable tuberculosis, and other 68 (57%) were classified as not having tuberculosis. Among the 51 patients with TB fistula, Chronic caseating granuloma, acid-fast bacilli stain, and successful clinical response to anti-TB treatment were positive in 27 (52.9%), 4 (7.8%), and 20 (39.2%), respectively. Of the 51 with TB fistula, 44 had positive QFT-GIT results and 7 had negative results. The sensitivity and specificity of the assay were 86% and 85%, and positive predictive value (PPV) and negative predictive value (NPV) were 81% and 89%, respectively. CONCLUSION: QFT-GIT is a simple, sensitive, and specific method for the diagnosis of clinically highly suspected TB fistula.
Diagnosis* ; Drug Therapy ; Fistula* ; Granuloma ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests* ; Rectal Fistula ; Retrospective Studies ; Sensitivity and Specificity ; Tuberculosis ; Tuberculosis, Pulmonary ; Victoria