Pharyngocutaneous fistula (PCF) is a typical complication after total laryngectomy. It is managed predominantly via conservative techniques, but in cases of a large orifice or a substantial loss of surrounding soft tissue, surgical management is mandatory. Our aim was to apply a new endoscopic surgical approach for closure of a pharyngocutaneous fistula.We report a case of a 61-year-old patient, who had been subjected to total laryngectomy with partial resection of tongue base and postoperative radiotherapy for advanced laryngeal carcinoma. Pharyngocutaneous fistula developed two years after the initial treatment. Barium swallow radiographs revealed a fistula between the neopharynx and the skin at the C2-C4 level. An endoscopic surgical repair was performed. Fat tissue harvested from the abdomen was injected into the area surrounding the pharyngeal opening of the fistula. The opening was sclerosed and sutured. The patient resumed a normal diet after several days and the fistula did not recur throughout the follow-up period.The management of pharyngocutaneous fistula is mainly conservative and only in therapy-refractory cases, surgery is considered. In well-selected cases, an endoscopic approach can be used. Autologous fat injection around the hypopharyngeal opening of the PCF may be one of the possible options.
Adrenal oncocytoma is an extremely rare neoplasm, which is mostly non-functional. Only five cases of childhood adrenal oncocytoma have been described so far, all of which were hormonally active. Currently, guidelines for management and follow-up are not available. We report a 9-year-old girl with benign adrenal oncocytoma, presenting with severe short-term virilization. After diagnostic work-up the patient underwent laparoscopic unilateral adrenalectomy. For the first 2 weeks following surgery she suffered marked mood swings, irritability and fatigue. There were no other clinical and/or laboratory abnormalities except the rapid drop-down of androgen levels to normal values. Follow-up showed no signs of recurrence and in the absence of signs of adrenal insufficiency, we speculate that, the rapid drop of androgen levels after removal of the tumor might be the reason for the deteriorated psychoemotional condition of our patient.
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Type 1 diabetes mellitus (T1DM) is a chronic disease which starts early in life and often
leads to micro- and macrovascular complications. The incidence of the disease is lower than that of
type 2 DM and varies in different countries and ethnical groups, and the etiological and pathogenetic
factors are different from T2DM. The aim of this overview is to investigate the effect of T1DM on
all-cause mortality and CVD morbidity and mortality. During the last decades the treatment of
T1DM has improved the prognosis of the patients. Still, the mortality rates are higher than those of
the age- and sex-matched general population. With the prolonged survival, the macrovascular
complications and the cardiovascular diseases (CVD) appear as major health problems in the
management of patients with T1DM. The studies on the CVD morbidity and mortality in this disease
group are sparse but they reveal that T1DM is associated with at least 30% higher mortality. In
comparison to healthy people, CVD are more common in T1DM patients and they occur earlier in
life. Furthermore, they are a major cause for death and impaired quality of life in T1DM patients.
The correlation with the diabetic control and the duration of T1DM is not always present or is
insignificant. Nevertheless, the early detection of the preclinical stages of the diseases and the risk
factors for their development is important and the efforts to improve the glycemic and metabolic
control are of paramount importance.
Extranodal lymphoma, secondary to or accompanying nodal disease is uncommon, but not unusual finding. 18-Fluorodeoxyglucose positron emission tomography (
The radiographic findings in two children with osteomesopycnosis are described. This is the first report in the Australian literature of this uncommon, recently described entity.
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