Hepatic cyst infection complicated by a hepatobronchial fistula diagnosed with unique features

ABSTRACT A hepatobronchial fistula (HBF) is a rare condition, defined as an abnormal connection of the respiratory system with the liver parenchyma. Although imaging may be helpful for diagnosis, fistulae are often difficult to identify. An 81-year-old woman presented with mild fever and right upper quadrant abdominal pain. Computed tomography (CT) showed bilateral pneumonia and hepatic cyst infection with air-fluid levels. After mechanical ventilation, abdominal CT showed increased air in the hepatic cyst. The drainage bag for the hepatic cyst infection was also inflated by positive pressure ventilation, suggesting a possible HBF. The ventilator was adjusted to minimize pressure on the fistula and prevent retrograde infection. The fistula eventually closed spontaneously. Appropriate antibiotic treatment and continuous drainage resulted in improvement of the hepatic cyst infection; however, the patient died due to respiratory complications. HBF should be suspected when positive pressure ventilation results in increased air at the hepatic infection site.

Analysis of Risk Factors Related to Acute Subarachnoid Hemorrhage After Spinal Surgery

Study Design: A retrospective single-center study.Background: Subarachnoid hemorrhage (SAH) is a rare complication secondary to cerebrospinal fluid (CSF) leakage during spinal surgery, but the specific cause of the bleeding is still unclear. Objective：In this study, we studied cases of acute SAH after spinal surgery to find the related risk factors for bleeding.Methods: A total of 441 patients with CSF leakage who underwent spinal surgery in [BLINDED FOR REVIEW] from 2011 to 2020 were retrospectively analyzed. According to whether postoperative SAH occurred, they were divided into SAH group and Control group. By comparing the two groups of demographic data, past history, imaging data, intraoperative findings, perioperative complications, treatment conditions to find the risk factors of SAH, to provide guidance for the prevention of SAH after spinal surgery.Results: In SAH group, 17 cases (73.9%) had preoperative hypertension and 3 cases (13.0%) had diabetes. The intraoperative CSF leakage was about 118.4±56.9 ml. The mean postoperative drainage was 15.4±5.8 ml/h; Compared with SAH group, Control group had 123 cases (29.4%) with hypertension before operation, 40 cases (9.6%) with diabetes, intraoperative CSF leakage was about 76.3±23.0ml, and the mean postoperative continuous drainage 9.7±2.1ml/h. Binary logistic regression analysis showed that hypertension, intraoperative CSF leakage, and postoperative CSF continuous drainage speed are related to SAH. Conclusion: The rapid leakage of CSF caused by the rupture of the dural sac during operation and the rapid drainage of CSF after surgery are closely related to the occurrence of such complications. In addition, hypertension is a related factor of SAH during spinal surgery.

A Controlled Study of Continuous Lumbar Drainage of Fluid and Lumbar Puncture Drainage for Aneurysmal SAH after Intracranial Aneurysm Clipping

Objective. To analyze the different effects of Continuous Lumbar Drainage of fluid and lumbar puncture drainage for aneurysmal subarachnoid hemorrhage (SAH) after intracranial aneurysm clipping. Method. Seventy-five patients with aneurysmal SAH who underwent aneurysm clipping were retrospectively analyzed and were divided into two groups according to the different postoperative drainage methods. The lumbar spine group received lumbar puncture drainage, and the lumbar cistern group received lumbar pool continuous drainage to compare the efficacy. Result. The time to normalize intracranial pressure and headache relief after drainage treatment in the lumbar cistern group was shorter than that in the lumbar spine group. The GOS score was higher than that in the lumbar spine group, and the cerebral artery flow velocity and NIHSS score were significantly lower than those in the lumbar spine group ( P < 0.05 ). The total effective rate of drainage treatment was 76.32% in the lumbar cistern group, which was higher than that in the lumbar spine group (54.05%) ( P < 0.05 ). The total complication rate was 18.42% in the lumbar cistern group, which was lower than that in the lumbar spine group (40.54%) ( P < 0.05 ). Conclusion. Continuous Lumbar Drainage of fluid after intracranial aneurysm clipping for aneurysmal SAH can control symptoms more rapidly, reduce neurological deficits, and improve prognosis than lumbar puncture. Also, the drainage is safer and more widely used.

Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication

Background Malignant obstruction and associated hydronephrosis is a common complication of advanced cervical cancer. Percutaneous nephrostomy (PCN) followed by antegrade stenting is often required to relieve obstruction as retrograde access fails in considerable proportion of such patients. Reno-pleural fistula is a rare complication of PCN which creates a patent connection between the renal collecting system and the thoracic cavity, and urine accumulation in the pleural space can cause pleural effusion (i.e., urinothorax). Upward or downward migration is a complication of indwelling ureteric stents. Further migration with extrusion outside of the urinary tract is uncommon. Herein we present an unprecedented case in adult of ureteric stent upward migration through a reno-pleural fistula into the thoracic cavity managed by thoracoscopy. Case presentation A 66-year-old female was diagnosed of advanced stage cervical cancer with suspicious bladder invasion. Given her bilateral hydronephrosis with impaired renal function, she underwent bilateral PCN and subsequent antegrade ureteric stenting. However, she presented with dyspnea, right back pain, and oliguria four days after bilateral PCN catheter removal. Computed tomography reported massive right pleural effusion and an intrathoracic ureteric stent within reno-pleural fistula. Thoracoscopy with thoracostomy was performed to remove the ureteric stent and urine in right pleural space. A week later, urinothorax had resolved and right PCN was performed again. She was discharged after regaining normal renal function with right PCN and a left ureteric stent in place. Conclusions A reno-pleural fistula can serve as a route for ureteric stent migration and that continuous drainage of urine can cause urinothorax once the stent reaches the thoracic cavity. Anytime a supracostal approach is used for PCN, even when using small caliber catheters, clinicians should pay special attention given the risk of pleural injury and subsequent complications.

CNS-Draining Meningeal Lymphatic Vasculature: Roles, Conundrums and Future Challenges

A genuine and functional lymphatic vascular system is found in the meninges that sheath the central nervous system (CNS). This unexpected (re)discovery led to a reevaluation of CNS fluid and solute drainage mechanisms, neuroimmune interactions and the involvement of meningeal lymphatics in the initiation and progression of neurological disorders. In this manuscript, we provide an overview of the development, morphology and unique functional features of meningeal lymphatics. An outline of the different factors that affect meningeal lymphatic function, such as growth factor signaling and aging, and their impact on the continuous drainage of brain-derived molecules and meningeal immune cells into the cervical lymph nodes is also provided. We also highlight the most recent discoveries about the roles of the CNS-draining lymphatic vasculature in different pathologies that have a strong neuroinflammatory component, including brain trauma, tumors, and aging-associated neurodegenerative diseases like Alzheimer’s and Parkinson’s. Lastly, we provide a critical appraisal of the conundrums, challenges and exciting questions involving the meningeal lymphatic system that ought to be investigated in years to come.

Consolidation of Viscoelastic Soil With Vertical Drains for Continuous Drainage Boundary Conditions Incorporating a Fractional Derivative Model

In geotechnical engineering, vertical drainage is the most economical method for accelerating the consolidation of a large area of soft ground. In this study, we analyze the viscoelasticity of the soil and the actual drainage conditions on the top surface of the soil, and then we introduce continuous drainage boundary conditions and adopt a fractional derivative model to describe the viscoelasticity of the soil. With the use of a viscoelasticity model, the governing partial differential equation for vertical drains under continuous drainage boundary conditions is obtained. With the application of the Crump numerical inversion method, the consolidation solution for vertical drains is also obtained. Further, the rationality of the proposed solution is verified by several examples. Moreover, some examples are provided to discuss the influence of interface drainage parameters on the top surface of soil and the viscoelasticity parameters of soil on the consolidation behavior of vertical drains. The proposed method can be applied in the fields of transport engineering to predict the consolidation settlement of a foundation reinforced by vertical drains.