Fistulae

Matthew, T.L., Spotnitz, W.D., Daniel, T.M. and Kion, I.L., Closure of small bronchopleural fistulas using fibrin sealant through the flexible fiberoptic bronchoscope. Chest, 94, 77S (1988). 

Cushny has compared the action of d- and Z-hyoscyamines with that of atropine, and of d-homatropine with that of dZ-homatropine in antagonising the action of pilocarpine, and finds that the order of activity of the first three is in the ratio 1 40 20, and of the second two in the ratio 4 2-5. He drew attention also to the important influence of the acyl radical in the tropeines, which exercises the maximum effect when it is a hydroxyalkyl aromatic residue and is laevorotatory and in illustration of this point gives the following table of relative activities on the basis of capacity to antagnonise pilocarpine in the salivary fistula dog —... 

Fistel, /. fistula falsetto, -holz, n. = Fiset-holz. -kassie,/. purging cassia, cassia fistula, fistulds, a. fistular, fistulous. 

Liquids inserted into body cavities, such as fistulas... 

Sodium is administered for hyponatremia (low blood sodium). Examples of causes of hyponatremia are excessive diaphoresis, severe vomiting or diarrhea, excessive diuresis, and draining intestinal fistulas. 

Hassan, E. A. A1 Assaf, S. Phillips, G.O.. Williams, P.A. (2005). Studies on Acacia gums Part III molecular weight characteristics of Acacia seyal var. seyal and Acacia seyal var fistula. Food Hydrocolloids, Vol. 19, No. 4, (July 2005), pp. 669-677, ISSN 0268-005X. 

Fecal impaction, ischemic bowel, pancreatic insufficiency, and intestinal fistulae... 

Small bowel resection, severe diarrhea, intractable vomiting, bowel obstruction, and fistulas ° Critically ill patients with nonfunctioning GI tract... 

Gastrointestinal losses (e.g., diarrhea, fistula, ileostomy, uretero sigmoido stomy)... 

Transmural disease may result in penetration or fistula formation... 

Furthermore, the inflammation may be transmural, penetrating to the muscularis or serosal layers of the GI tract (Fig. 16-2). The propensity for transmural involvement may lead to serious complications of CD, such as strictures, listulae, and abscesses.4,12 While rectal inflammation is typically less common in CD than UC, several types of perianal lesions may be observed in patients with CD. These include skin tags, hemorrhoids, fissures, anal ulcers, abscesses, and fistulae.15... 

Crohn s disease Fever, tachycardia (with severe disease), dehydration, arthritis, abdominal mass and tenderness, perianal fissure or fistula... 

Formation of strictures, abscesses, fistulae, and obstructions in patients with CD is possible. Patients with CD may develop significant weight loss or nutritional deficiencies secondary to malabsorption of nutrients in the small intestine, or as a consequence of multiple small- or large-bowel resections. Common nutritional deficiencies encountered in IBD include vitamin B12, fat-soluble vitamins, zinc, folate, and iron. Malabsorption in children with CD may contribute to significant reductions in growth and development. 

Surgical intervention is a potential treatment option in patients with complications such as fistulae or abscesses, or in patients with medically refractory disease. Ulcerative colitis is curable with performance of a total colectomy. Patients with UC may opt to have a colectomy to reduce the chance of developing colorectal cancer. Patients with CD may have affected areas of intestine resected. Unfortunately, CD may recur following surgical resection. Repeated surgeries may lead to significant malabsorption of nutrients and drugs consistent with development of short-bowel syndrome. 

Antibiotics have been studied based on the rationale that they may interrupt the inflammatory response directed against endogenous bacterial flora. Metronidazole and ciprofloxacin have been the two most widely-studied agents.32 Metronidazole may benefit some patients with pouchitis (inflammation of surgically-created intestinal pouches) and patients with CD who have had ileal resection or have perianal fistulas. Ciprofloxacin has shown some efficacy in refractory active CD. Both drugs may cause diarrhea, and long-term use of metronidazole is associated with the development of peripheral neuropathy. 

In patients with fistulae, monitor at every infliximab dosing interval for evidence of fistula closure and overall reduction in the number of fistulae. 

Thrombosis associated with hemodialysis most commonly occurs in patients with venous catheter access for dialysis and is a common cause of catheter failure. However, thrombosis can occur in synthetic grafts and less frequently in AV fistulas. 

Both vasoconstrictors and vasodilators have been used in the treatment of priapism. Vasoconstrictors are thought to work by forcing blood out of the cavernosum and into the venous return. Aspiration of the penile blood followed by intracavenous irrigation with epinephrine (1 1,000,000 solution) has been effective with minimal complications.37 In severe cases, surgical intervention to place penile shunts has been used, but there is a high failure rate, and the risk of complications, from skin sloughing to fistulas, limits its use. 

Implementation of source control methods should be instituted as soon as possible following initial fluid resuscitation. The selection of optimal source control methods must weigh benefits and risks of the intervention. Source control measures may cause complications (bleeding, fistulas, and organ injury), therefore the method with the least risk should be employed.24... 

Complications from radical prostatectomy include blood loss, stricture formation, incontinence, lymphocele, fistula formation, anesthetic risk, and impotence. Nerve-sparing radical... 

Gastrointestinal fistulas if enteral nutrition cannot be provided above or below the fistula... 

Trace elements are essential cofactors for numerous biochemical processes. Trace elements that are added routinely to PN include zinc, selenium, copper, manganese, and chromium. There are various commercial parenteral trace element formulations that can be added to PN admixtures (e.g., MTE-5 ). Zinc is important for wound healing, and patients with high-output fistulas, diarrhea, burns, and large open wounds may require additional zinc supplementation. Patients may lose as much as 12 to 17 mg zinc per liter of gastrointestinal (GI) output (e.g., from diarrhea or enterocutaneous fistula losses) however, others have demonstrated that 12 mg/day may be adequate to maintain these patients in positive zinc balance.18 Patients with chronic diarrhea, malabsorption, and short-gut syndrome may have increased selenium losses and may require additional selenium supplementation. Patients with severe cholestasis should have copper and manganese... 

Trace elements Provide standard parenteral trace element preparation (containing zinc, copper, manganese, chromium, and selenium) daily in PN Assess patient for any possible adjustments needed (e.g., delete copper and manganese from PN if the patient has evidence of severe cholestasis, supplemental zinc and selenium for any Gl or fistula losses) or potential deficiencies... 

Severe hemodynamic instability Enterocutaneous fistulae Severe diarrhea Severe malabsorption Severe gastrointestinal hemorrhage Intractable vomiting... 

Fistula Abnormal connection between two internal organs (e.g., arteriovenous fistula, which is a connection between an artery and a vein), or between an internal organ and the exterior or skin (e.g., enterocutaneous fistula, which is a connection between the intestine and the skin). 

Cassia fistula, C. occiden-, tails, Leucaena leucocephala, non-nodulating roots and root extracts inhib d. R. japonicum growth 105... 

Hanif, A.M., Nadeema, R., Zafar, N.M., Akhtar, K., and Haq Nawaz Bhatti, N.H., Kinetic studies for Ni(II) biosorption from industrial wastewater by Cassia fistula (Golden Shower) biomass, Journal of Hazardous Materials, 145, 501-505, 2007. 

Perry GJ, Tatsuhiko M, Wei C-C, Xu XY, Chen Y-F, Oparil S, Lucchesi P, Dell Italia LJ. Genetic variation in angiotensin-converting enzyme does not prevent development of cardiac hypertrophy or upregulation of angiotensin 11 in response to aortocaval fistula. Circulation 2001 103 1012-1016. 

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