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A case of 57-year-old woman with hepatic artery pseudoaneurysm associated with fistula into the biliary tract following laparoscopic cholecystectomy. Because of mechanical barrier presence, constricted the blood vessel leading blood into the aneurysm, endovascular embolization with histoacrylate glu was used as a treatment. The use of histoacrylate glu is an effective alternative in hepatic artery pseudoaneurysms treatment, which allowed to get haemostasis by endovascular embolization, especially in cases when it is impossible to use standardly applied microcoils.

We reviewed 573 patients who underwent total laryngectomy between 1989-1999 in the Otolaryngological Clinic of CM UMK. Pharyngocutaneous fistulae occurred in 65 cases (11.3%). In 16 patients who were preoperatively irradiated, the fistulae occurred in 7 cases (43.7%). In the non-radiotherapy group of 557 persons, in 58 cases (10.4%) after total laryngectomy, the wound healing was disturbed and a pharyngocutaneous fistula was observed. The authors reviewed the Polish and the foreign literature concerning the influence of preoperative radiotherapy on wound healing after surgical treatment of larynx carcinomas.

Pneumocephalus in hydrocephalic shunted patients is very rare. So far only 46 cases have been described in the literature. A case of pneumocephalus in a patient with shunted hydrocephalus, and the diagnostic and therapeutic problems were described. A 38-year-old woman suffered from a subacute headache, dizziness and bradyphrenia. Eight years ago, the ventriculo-atrial shunt was implanted due to idiopathic hydrocephalus, and the shunt was changed 2 months before the present admission (ventriculo-peritoneal valve). CT and MRI revealed pneumocephalus, but neither clinical nor radiological symptoms of the CSF fistula were found. After temporary ligation of a distal catheter, the anterior fossa and a sellar area were directly repaired via right fronto-temporal craniotomy, with a good outcome. In the case of pneumocephalus in hydrocephalic shunted patients, the direct closure of the skull base fistula via craniotomy combined with restoration of the proper shunt function is usually the most effective treatment. If the site of the fistula can not be established, dural cranioplasty in the most likely site of the fistula is recommended.

Case Presentation: 26 y.o woman 3 weeks after cesarean section complained of urine leakage from vagina. Urography revealed uretero-uterine fistula. Surgery was performed--3 dexon sutures attaching strictured ureter to the uterine were localized and then cut off. Distally obliterated ureter was separated out of adjacent tissues. The strictured part of ureter was then incised on the length of ca 8 cm, pig tail catheter was induced and human dura mater allograft was put on and sewed in into the strictured segment. In the long term follow-up the woman gave birth to two more children in the vaginal delivery without any complications. Urographies revealed no fistula, no stricture recurrency and normal urine passage.

A case of vesicouterine fistula diagnosed in 40-year old woman who underwent cesarean section 18 years earlier was presented. The clinical features, etiologic factors, diagnostic procedures and treatment modalities were discussed in relation to the case and others reported in the literature. The gift of contrast by catheter to bladder allowed to visualize the fistula.

The case of iatrogenic trachea injury during endotracheal intubation is reported in this article. The case concerns a 36 years old woman, with diagnosed DIC resulting from postpartum complications. Injury of the brachiocephalic trunk and the tracheoarterial fistula were found during autopsy. The authors considered the time and the mechanism of both injuries.

Our observations of 14 women with vesico-uterine fistulas as a result of caesarean section complications were presented. The patients were treated between 1965-1999 in urology clinic in Lublin. The case were diagnosed on the basis of medical history, radiological investigations and cystoscopy. In 3 cases hysterectomy was performed, in the rest of cases uterus was preserved and after the first operation complete recovery was observed.

Labyrinthine fistulas (l.f.) are reported to be diagnosed in 3-12.9% of the chronic otitis media patients. Their most frequent location is the lateral semicircular canal. The other locations include posterior semicircular canal, superior s.c. and vestibular window. Surgical removal of the cholesteatoma matrix brings a high risk of the complete hearing loss in the operated ear. Preoperative diagnosis of the l.f. is not always possible. Authors present the analysis of the group of 18 patients with l.f. treated at the Otosurgery Department, Medical University of Lodz. In all patients the radical modified surgery has been performed. Postoperative results are strictly correlated to the l.f location and size. As a conclusion authors present an algorithm of the l.f. surgical treatment based on their experience.

The main reasons of fistula dysfunction are stenosis and thrombosis. There are two kinds of thrombosis: acute and chronic. Acute thrombosis is total fistula occlusion while chronic occlusion is partial venous occlusion with collateral veins, which lead to impair fistula's function. 450 dialysis fistulas were referred to US (ultrasound) examination. Among 392 patients with fistula dysfunction, 71 presented chronic venous occlusion in hemodialysis shunt. 35 patients were qualified to endovascular recanalization. The mean length of the occluded segment was 3-35 cm (subclavian vein 2-4 cm). 38 patients underwent angiography (35 before endovascular treatment). Technique of recanalization included antegrade venous puncture, insertion guidewire (0.021'), catheter (5 Fr), balloon catheter (5-8 mm) and in 2 cases stent placement. Colour Doppler allowed to diagnose 34 (97%) cases of chronic venous occlusion in hemodialysis shunt. Decrease of mean flow volume in brachial artery--709 +/- 395 ml/min. (50-1500 ml/min) was statistically significant (p = 0.0015). Normal mean flow volume was 1242 +/- 641 ml/min. 20 of 35 recanalization procedures were performed successfully. The main reason of failure was perforation or false channel. Mean primary patency was 75% after 3 months. Mean cumulative was 85% (10/12) after 6 months. Chronic venous occlusion is often present in hemodialysis shunt and reduces flow volume. Percutaneous recanalization results aren't magnificent but there is only kind treatment for many patients with fistula failure.

A case of 25 years lasting semi-invasive (necrotic) aspergillosis is presented. Aspergilloma in the probably post-tuberculous cavity was the first sign of the disease. Then, in the course of disease, two broncho-pleural fistulas, bronchiectases and cirrhosis of the lung were observed. Effective antifungal treatment with itraconazole was followed by pneumonectomy of the affected lung.

The authors presented own results concerning complications in wound healing after total laryngectomies. 59 total laryngectomies and 4 pharyngo-laryngectomies were performed. In 18 cases local and systemic complications were observed. Pharyngo-cutaneous fistulas developed in 15 patients. Therapeutic management was successful in all cases.

The case of the extensive laryngeal cancer recurrence after radiotherapy was described. The authors were discussed treatment surgery it with reconstruction of the tissue defect. The skin defect was reconstructed with the pectoralis mayor myocutaneous island flap, the pharyngeal secondary fistula was reconstructed with the Trapezius myocutaneous flap.

The case of vesico-uterine fistula after second Cesarean section is presented. The diagnosis was based on history data, urine examination, histerosalpingography and cystoscopy. Transvesical fistulectomy with good results was performed 6 month after Cesarean section.

The aim of the paper is to present the surgical methods applied in a 76 year old patient treated for carcinoma of the larynx. As an effect of the carried out total laryngectomy, extensive pharyngeal fistula occurred. The fistula was closed with myocutaneous flap which was pedunculated on double reversed pectoral major muscle. Due to lymphatic metastases surgical dissection of lymphatic system of the left side of the neck was performed 2 years after laryngectomy. During this operation the left common cervical artery was removed (Goretex graft). Next-cobaltotherapy was applied. After following 2 years the skin necrosis just over the flap occurred. It was caused by shirt collar pressure. Because of the major bleeding common cervical artery was oligated. During this procedure the frontal wall of the oesophagus was damaged and again pharyngeal fistula appeared. Attempts at closing it with flaps pedunculated on pectoral major muscle and trapezius muscle did not succeed. Finally fistula was closed with cylindric flap from the abdomen connected with the cutaneous flap from surrounding fistula tissues. Following recognition of this illness the patient had undergo nine consecutive, extensive operations. Ten years after diagnosis he is still alive and leads a life appropriate to his age.

Several hundreds of thousands of operations on the lumbosacral spine are carried out annually for decompression of nerve roots and disc removal. It is the opinion that serious intraoperative complications developed in 2.5 to 13.7% of cases. In the few literature reports cases have been described of dural sac rupture, injury to large retroperitoneal vessels, intestinal perforation and complete severing of ureters.

Three cases are presented of a rare complication of abdominal aorta aneurysm, that is its rupture into the gastrointestinal tract. In two cases the aneurysm ruptured into the duodenum, and in one case into small intestine. The authors call attention to the variety of symptomatology and diagnostic difficulties with the primary aorto-intestinal fistula. This is true especially of cases in which the rupture is the first and not infrequently the only symptom of the aneurysm. The rupture of the abdominal aorta aneurysm into the gastrointestinal tract is still fraught with a very high mortality; out of three patients with primary aorto-intestinal fistula only one was saved.

The case of vesico-uterine fistula after cesarean section was described. Ultrasound technique was used to confirm the diagnosis because of noncharacteristic urography and absence of typical changes in urine analysis. Surgical intervention with good result was performed 3 month after cesarean section.

The authors presented 2 cases of massive bleeding from brachiocephalic artery as a late complication after tracheotomy. In both deadly cases the artery wall was secondary damaged by the tracheal tube. The pathomechanism of this complication origin and significance of its acquaintance was discussed.

The authors of the article describe the case of a child surgically treated for inborn anomaly of the first branchial cleft. Basing upon this example, they discuss the difficulties that the surgeon may encounter during the operative treatment. Concluding, they present the characteristic features of this type of developmental anomaly.

The authors described a case of endometriosis of the urinary bladder and periodically active uterovesical fistula, following Cesarean section. Clinical symptoms of endometriosis dominated and were the reason for the patient's visiting the physician. Clinical diagnosis was made by cystoscopy during menstruation. Surgical resection of the focus of endometriosis of the bladder and uterus during menstruation led to permanent recovery.

Three cases of the bladder-uterine fistulas treated within the last three years (1982-1984) have been presented. All patients underwent cesarean sections (two patients once, and the third - thrice). The patients were treated surgically. Each one has undergone hysterectomy, and the opening of the fistula into the bladder has been operated by incision of the bladder in two cases and through extracystic approach in one case. Mechanism of development, symptoms, various types, diagnosis, and therapy of the bladder-uterine fistulas have been discussed.

The purpose of this study was assessment of the results of surgical treatment of children with developmental anomalies derived from the first and second branchial clefts and thyroglossal duct. Normal and abnormal development of branchial arches and clefts, pharyngeal pouches and thyroglossal duct, as well as the anatomy nd topography of the resulting developmental anomalies are discussed. The observed developmental anomalies are classified into: cysts, cysts with sinuses developing as a result of inflammatory processes, puncture, incision, operation, dermal sinuses draining externally, dermal sinuses with external and internal orifices, the latter in the groove of the palatine tonsil or foramen caecum of the tongue, dermal sinus with external orifice and dermal fistula. Methods of diagnostic investigations and surgical treatment are described. The cysts derived from the first and second branchial arches were treated surgically by a transverse incision running across the peak of the bulging cyst. Removal of the cyst was started by dissection of the anterior and lateral surfaces of the wall, and then the posterior wall was dissected free from the deep structures in the neck. In cases of cysts with fistulae or dermal sinuses the operation was preceded by injection of 1% methylene blue into its external orifice. In this way it was possible to stain the walls of the cyst or sinus and to mark its end. The operation was started with elliptical excision of the external orifice of the lesion. In cases of dermal sinuses derived from the first branchial clefts an additional incision was made along the posteroinferior border of attachment of the auricule to the skull. In operations of dermal sinuses derived from the second branchial cleft after dissection of the wall at a distance of several centimeters a second incision was made transversely for easier dissection of the sinus wall lying in deeper parts of the neck. Removal of the cysts and sinuses derived from the thyroglossal duct required always resection of the middle part of the body of the hyoid bone. Upward elevation of the cut hyoid bone body visualized the upper part of the thyroglossal duct up to its end in the lingual foramen caecum, and made possible removal of this part. The cut hyoid bone body was left divided. In the years 1953-1976 56 children were treated surgically for these developmental anomalies. The material comprised 33 girls and 23 boys. Three groups of patients were isolated. Most children were operated upon between the 5th and the 9th year of life at the age of 12 years.(ABSTRACT TRUNCATED AT 400 WORDS)