Postpneumonectomy empyema with or without fistula is a serious complication. Management includes drainage, antibiotherapy, debridement closure of the bronchopleural fistula when present, and obliteration of the residual pleural space. Excellent results can be obtained in most patients using the Clagett procedure and its modification. A detailed description of each step ...

A 44 year old man who had a 5-year history of recurrent duodenal ulcer with a choledochoduodenal fistula is reported. He showed bulbar stricture and was successfully treated with an truncal vagotomy and distal gastrectomy by Billroth II method, leaving the fistula intact. Choledochoduodenal fistula is an uncommon complication of ...

The use of self-expanding prostheses in the management of malignant oesophageal strictures has become well established. The majority of benign peptic oesophageal strictures can be successfully managed using endoscopic or fluoroscopically guided balloon oesophageal dilatation combined with long-term drug therapy, particularly using proton pumper inhibitors. Although endoscopic oesophageal dilatation can ...

Stem-cuttings of Wedelia chinensis (Osbeck.) Merr. Were treated with different concentrations of IBA and GA. The results indicate that 100 ppm IBA treatment greatly enhances root production and quick establishment of the stem-cuttings.

Cerebrospinal fluid fistulae present a common management problem for the surgeon managing craniofacial trauma. Controversies exist concerning various aspects of treatment. These controversial management issues include cerebrospinal fluid drainage, antibiotic prophylaxis, timing of surgical intervention, and techniques of repair. Although most cerebrospinal fluid fistulae cease spontaneously, some fistulae persist, resulting ...

Some secondary metabolites of herbs and certain products of traditional systems of medicine as possible sources of anti-AIDS drug potentials are presented and discussed.

This report describes a benign tracheogastric fistula that developed 2 years after pharyngoesophagectomy, right radical neck dissection, and pharyngogastric anastomosis for recurrent peristomal squamous cell carcinoma. The fistula most likely developed as the result of inflammatory disease of the trachea, stomach, or both. We discuss the common complications of pharyngogastric ...

The cystohepatic ducts represent accessory bile ducts of variable size which frequently travel within the gallbladder fossa or in the posterior wall of the gallbladder. These ducts can be injured during laparoscopic cholecystectomy and can result in bile collections if transected. Successful treatment by operative means or radiologically guided percutaneous ...

The management of traumatic biliary fistulas is controversial. New ideas in nonsurgical treatment have recently evolved, in part because of the rapid advancement of laporoscopic surgery. Three major concepts are important in managing biliary fistulas: diagnosis, drainage, and decompression. These concepts were applied to a trauma patient, then reviewed in ...

A technique whereby a long intestinal tube piggy-backed on the colonoscope was placed in the cecum for decompression of the large bowel in Ogilvie's syndrome is described. This technique eliminates the need for fluoroscopy as a KUB can easily confirm the placement of the tube. Although the tube can be ...

Techniques for intrathoracal stapler anastomosis under thoracoscopic control were studied and developed in an experimental program. Since this procedure is possible from two directions, both directions were evaluated. Two different techniques, a transoral and a transhiatal, resulted. For the transoral technique the stapler is inserted from above. The anvil, which ...

Recent publications dealing with pancreatic pseudocysts, pancreatic ascites, and pancreatic fistulas are reviewed. Terminology relevant to pancreatic pseudocysts and other complications of acute pancreatitis is clarified. The natural history of pseudocysts is examined. Newer management strategies for these complications of pancreatic inflammatory disease are discussed, including percutaneous drainage of pseudocysts ...

Peptic oesophageal stricture develops in approximately 10-15% of patients with inadequately treated reflux oesophagitis and poses a difficult clinical problem. The management of reflux oesophagitis has been revolutionised by improvements in medical management, endoscopic and balloon techniques of oesophageal dilatation. The major advance has been the development of inhibitors of ...

A questionnaire on ECT, tapping attitudes, opinions and usage, was mailed to all medical members of the Indian Psychiatric Society whose addresses were known; 263 (28.8%) responded. This paper, the second in a series that presents the results of the survey, describes the practical administration of ECT. Specific issues discussed ...

Management of a pharyngocutaneous (PC) fistula following laryngopharyngectomy with or without neck dissection is a difficult problem, particularly in cases where repair cannot be accomplished in a reasonable period of time. Use of a silicone septal button is described in the temporary management of selected PC fistulas (i.e., fistula size ...

Colonic polyps commonly occur in all age groups and are of varied significance depending on the type of polyp and the symptoms manifested. There is some debate in the medical literature regarding the appropriate clinical management of polyps and the follow-up of patients after polypectomy. This discussion addresses the significance ...

Balloon dilation of gastrointestinal strictures using a radiologic, endoscopic or combined approach is a safe, effective means of managing an ever-increasing variety of stricturing processes. At present the ability to dilate strictures in the gastrointestinal tract is limited mainly by access. Balloon dilation is now well established in the management ...

The herbal vendors are the mobile tribal medicinement seen on the busy streets of many Indian cities selling crude medicinal plants and their products. They prescribe herbal treatment for several diseases, a skill they inherited from their forefathers through several generations of experience. They claim to have specific herbal remedies ...

Management of acute gastrointestinal bleeding follows a logical sequence of steps. The first priority is to assess the magnitude of blood loss and resuscitate the patient. The patient history and nasogastric aspiration can help localize the source of bleeding to the upper tract or lower tract. Treatment of suspected upper ...

Traumatic and iatrogenic urethral strictures present serious management difficulties. Classically their repair has been done through transpubic or perineal approaches. We have investigated the endoscopic route. In this study, 6 patients with dense posterior urethral strictures were managed endoscopically. The results of this "cut to the light" technique compare favorably ...

The anaesthetic management is described, of a patient with malignant tracheo-oesophageal fistula undergoing palliative oesophageal bypass. The oesophagus was divided and closed at its upper end and replaced with a segment of colon. The fistula remained in situ and fundoplication was performed to allow drainage of the oesophageal remnant but ...

Capnography is a useful tool in differentiating tracheal from esophageal intubation. It may be an especially useful tool in emergency airway management by rescue squads or in the emergency department. However, in clinical practice the question has arisen as to whether prior ingestion of carbonated beverages can generate false-positive capnographic ...

Angiolipomas are benign vascular fatty neoplasms, usually found in the subcutis of the trunk. Gastric angiolipomas have not been described. We report a gastric angiolipoma causing chronic gastrointestinal bleeding that did not respond to electrocoagulation and required surgical resection. Its classic endoscopic appearance is described. It may be managed endoscopically, ...

The etiology of anorectal abscess and fistula-in-ano is discussed. The anatomy, which is vital to the understanding and treatment of the above, is reviewed, with two of the more common classifications of fistula-in-ano presented. The different methods of treating each are discussed, and some of the common complications of the ...

We report a new technique for the management of the complications of vesicorectal fistulas. The patient we present had a fistula and severe skin excoriation. The fistula was caused by carcinoma of the prostate that had been treated by radiation therapy. The fistula was patched with a rectal prosthesis similar ...

Thorough understanding of the pathophysiology of anal fissures and fistulas is essential for the physician treating these conditions. An acute fissure often heals in a month with conservative management; long-standing disease is relieved by lateral internal sphincterotomy. An acute fistulous abscess must be drained by unroofing the abscess rather than ...

Most biliary cutaneous fistulas are side fistulas that communicate with the main biliary ductal system. As long as distal obstruction is not present, nearly all fistulas will close spontaneously. The present case of an end biliary fistula due to transection of an aberrant bile duct during cholecystectomy and its successful ...

The clinical presentation and management of 24 patients treated for colovesical fistula were reviewed. It is concluded that an aggressive investigative approach in the management of patients with suspected colovesical fistula is rewarding. Cystoscopy and barium enema appear to be the most useful investigative tools. Once found the fistulae should ...

Experiences with seven cases of gallbladder perforation managed in Kingston, Jamaica, at the District of Columbia General Hospital, and other Howard University affiliated hospitals are presented. The results of a review of 197 consecutive biliary operations at DC General Hospital for occurrence of this entity are presented.Gallbladder perforation is a ...

The combined procedure by antegrade introduction of the guidewire and retrograde placement of ureteral stents was successfully performed for the conservative management of postoperative ureteral fistulas in two patients. Superselector guidewire and ureteral bougie catheter are of use to facilitate difficult stent placement for severe narrowing accompanied with the dehiscent ...

Complex anal fistulas challenge the judgment and operative skills of the surgeon in effecting a cure without compromise of anorectal function. This chapter outlines the classification, pathogenesis, methods of investigation and alternatives of management of a variety of complex fistulas. Also reviewed are the advantages and disadvantages of both traditional ...

A technique for construction of a functional loop colostomy is described for the management of colonic injuries in which complete fecal diversion is not required. The colostomy and mucous fistula are converted into a functional loop colostomy at the initial procedure and exteriorized through a single stoma. Subsequent colostomy closure ...

The principal radionuclide procedures involved in the evaluation of esophageal disorders that are amenable to surgery are illustrated and briefly described. The role of the radionuclide esophagogram (RE) in the diagnosis and management of achalasia, oculopharyngeal muscular dystrophy and its complications, tracheoesophageal fistulae, pharyngeal and esophageal diverticulae, gastric transposition, and ...

Bronchoesophageal fistula and megaesophagus were diagnosed in a dog. Within 2 days after surgical correction of the bronchoesophageal fistula, peristalsis in the thoracic portion of the esophagus returned to normal and the esophagus resumed its normal size. The cause of the fistula was attributed to damage from a foreign body. ...

It is not uncommon following reduction mammoplasty that the nipple-areola vasularity becomes compromised. If simple maneuvers do not restore circulation, then a free nipple graft becomes mandatory to minimize morbidity. Occasionally, nipple congestion that recurs as the areola is inset might best be managed by delayed closure. The advantages of ...

The preperitoneal approach to groin hernia is applicable particularly for the operative management of incarcerated and strangulated inguinal or femoral hernias. This technique allows excellent exposure to reduce and, when necessary, to resect the hernia contents through a single incision. Both inguinal and femoral hernial defects can be repaired easily ...

An elderly woman with a history of cholelithiasis was seen for right upper quadrant pain and jaundice. During her evaluation, she was found to have extensive choledocholithiasis and a cholecystoduodenal fistula. Successful management was accomplished with cholecystectomy, removal of the common bile duct stones, and by creating a choledochoduodenostomy where ...

A 67-year-old man with upper esophageal dysphagia thought to be caused by a large Zenker's diverticulum was found to have esophageal web at the time of diverticulectomy and cricopharyngeal myotomy. The web was divided by sharp dissection. Untreated, this thin web would almost certainly have resulted in dysphagia postoperatively. The ...

Sclerotherapy is currently used to treat acute variceal bleeds and also in the long-term management after a variceal bleed. The technical variants and results of sclerotherapy in both settings are reviewed and compared with alternative surgical treatment options. Sclerotherapy has become an accepted therapy for acute variceal bleeding. In Cape ...

A case of vomiting-induced perforation of the lower esophagus proximal to a chronic peptic stricture is described. The patient had a remarkably benign course and conservative management resulted in complete cure. Criteria for nonoperative management of esophageal perforation are outlined. Esophageal injury due to retained pills, we believe, contributed to ...

A patient who developed a fistula secondary to Marlex mesh in the nipple valve of a continent ileostomy is reported. Etiology and management of fistula following continent ileostomy are discussed. Fistula formation should be recognized as a potential hazard of the use of prosthetic material to stabilize the nipple valve ...

The aetiology, pathological anatomy and management of the vesicovaginal fistula are reviewed. Closure of the vaginal route is preferred by most gynaecological surgeons and is suitable for low-lying fistulas. A suprapubic approach is more suitable for high or tethered fistulas and is favoured by urological surgeons. The importance of meticulous ...

Most colonic polyps can be removed colonoscopically from all reaches of the colon, provided that one is experienced with endoscopic morphology and snare electrosurgical techniques. Virtually all pedunculated polyps and the majority of benign sessile polyps can be excised colonoscopically, certain of the larger benign sessile polyps and all malignant ...

Nineteen cases of congenital colon atresia are presented with two deaths resulting in a mortality rate of 10.5%. The authors conclude that operative management of atresias proximal to the splenic flexure should include resection of the dilated proximal colon with primary ileotransverse colostomy or ileosigmoidostomy. Atresias distal to the splenic ...

A technique to facilitate the retrieval of a microneedle following knot tying is described. A small foam block is mounted on the non-dominant-hand forceps, where the needle can be easily stored and relocated during microsurgical procedures.

This report reviews our experience with six patients with post-pneumonectomy empyema and bronchopleural fistula over a ten-year period (1969-1978) at the University College Hospital, Ibadan. The most common indications for pneumonectomy in this environment are TB-destroyed lung and suppurative diseases of the lung complicated by massive hemoptysis. Five of the ...

In a 15-month period, at the University College Hospital, Ibadan, 44 cases of obstructed hernia were treated by emergency operation. More than 94 percent were inguinal, but femoral hernia was not common. The ratio of females to males was 1:6.4, and more than 68 percent of hernias occurred on the ...

Effective sump drainage of high enterocutaneous fistulae, together with alimentary rest and total parenteral nutrition, is now an integral part of the modern management of patients with this condition. The low tissue reactivity of the plastic and polymer materials currently used in most drainage tubes appears however, to be counterproductive ...

The principles enunciated by Adam Politzer concerning the management of fistula of the lateral semicircular canal are as true today as they were during his time, in spite of the advances made in otologic surgery during the past 25 years or more. If a fistula of the lateral semicircular canal ...

We have briefly presented our concepts of the investigation and management of lower intestinal bleeding. Such bleeding was divided into massive and nonmassive colonic hemorrhage, and the differences in the investigative techniques were discussed for each of these circumstances. An algorithm of our diagnostic and management protocol for massive large ...