599 MEDIASTINITIS SECONDARY TO ESOPHAGEAL PERFORATION: IT’S TOO LATE?

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Emanuele Russo ◽  
Mario Sorice ◽  
Luigi Busiello ◽  
Aniello Della Morte ◽  
Emilia Polimeno ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Esophageal Perforation ◽  
Multiple Organ ◽  
Oesophageal Perforation ◽  
Invasive Treatment ◽  
Emergency Thoracotomy ◽  
Risk Of Death ◽  
Single Center Experience ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment

Abstract   Mediastinitis secondary to esophageal perforation is a rare, progressive, and destructive disease that may often lead to an imminent risk of death. We describe a single center experience showing how early diagnosis and prompt intervention can reduce mortality and complications. Methods From February 2016 to December 2019, 15 consecutive patients were referred to the Emergency Unit of The AORN Cardarelli (Naples) with clinical and radiological (CT scan) diagnosis of acute mediastinitis secondary to oesophageal perforation (post endoscopy or after foreign body ingestion) and furthermore, referred to the Thoracic Surgery Unit, they underwent to early surgical treatment (cervicotomy and\or thoracotomy and chest drainage. Results For early detected case (occurred within 24 hours) an emergency thoracotomy/cervicotomy was performed with surgical repair. For late detected (referred from other hospitals) a Surgical esclusion (abdominal plus cervical) and toilette thoracotomy was performed in emergency. Reconstruction occurred in 5 cases with a median of 46 days after firts care. All patient were admitted to ICU unit and susbsequentily to the thoracic surgery ward. 30 days mortality occurred in two cases. Median hospital staying was 28 days, in six cases a redo surgery was necessary. Empiric antibiotic treatment was started before operation and reviewed under Infectivologist. Conclusion Mediastinitis secondary to esophageal perforation has a fulminating course with a potential risk of sepsis, pericarditis, and multiple organ failure. A prompt identification and an invasive treatment is the best and most successful option to reduce mortality and improve patient’s recovery.

Effect of age on outcome in patients with cerebral stroke

2020 ◽  
pp. 41-45
Author(s):  
G. R. Kuchava ◽  
E. V. Eliseev ◽  
B. V. Silaev ◽  
D. A. Doroshenko ◽  
Yu. N. Fedulaev
Keyword(s):  
Ischemic Stroke ◽  
Neurological Deficit ◽  
Neurological Status ◽  
Statistical Correlation ◽  
Multiple Organ ◽  
The Body ◽  
Social Adaptation ◽  
Cerebral Stroke ◽  
Septic Complications ◽  
Risk Of Death

The aim of the study was to assess the course and outcome of cerebral infarction, depending on the age factor and duration of stay in the neuroblock. Materials and methods: a dynamic observation of 494 patients, men and women, aged 38–84 years with acute ischemic stroke of hemispheric localization, which were divided into the three groups depending on age, was performed. Group 1 – younger than 60 years old, group 2–60–70 years old, group 3 – older than 60 years. All patients underwent standard therapy, according to the recommendations for the treatment of ischemic stroke. The patients underwent comprehensive clinical and instrumental monitoring, which included assessment of somatic and neurological status according to the NIH‑NINDS scales at 1st, 3rd, 10th days and at discharge or death; assessment of the level of social adaptation according to the Bartel scale on 1st, 3rd, 10th days and at discharge, clinical and biochemical blood tests, computed tomography of the brain. Assessment of the quality of therapy was carried out according to specially developed maps using methods of statistical correlation analysis. Results: the most pronounced positive dynamics of neurological status was in the 1st group of patients. The regression of neurological deficit in the 2nd group was worse. The minimal dynamics of neurological deficit was in the 3rd group of patients with cerebral stroke. Most often, the death of patients with cerebral stroke occurred from the development of multiple organ disorders. Conclusions: patients over 70 years of age have the greatest risk of death, due to: a decrease in the reactivity of the body, the presence of initially severe concomitant somatic pathology in patients with admission to hospital; accession of secondary somatic and purulent‑septic complications.

scholarly journals Inferior Vena Cava Filter Retrieval Trends: A Single-Center Experience

TH Open ◽  
2021 ◽  
Vol 05 (01) ◽  
pp. e73-e80
Author(s):  
Filip Ionescu ◽  
Nwabundo Anusim ◽  
Eva Ma ◽  
Lihua Qu ◽  
LeAnn M. Blankenship ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Initial Increase ◽  
Single Institution ◽  
Risk Of Death ◽  
Single Center Experience ◽  
Inferior Vena Cava Filters ◽  
Vena Cava Filters ◽  
Thrombotic Complications

AbstractRecognition of the adverse events of inferior vena cava filters (VCFs) has prompted the Food and Drug Administration (FDA) to issue safety warnings (2010 and 2014), advocating for removal, once the risk of pulmonary embolism has abated. Despite an initial increase in retrieval rates, these remain low (25–30% at 1 year in 2014). We retrospectively investigated retrieval trends in adults with VCFs placed between 2015 and 2018 at a single institution. The rate of retrievable VCF removal accounting for the competing risk of death was the main outcome. There were 494 VCFs placed (305 retrievable). The cumulative incidence of retrieval remained low (21% at 1 year), even after the second FDA warning (2014). Patients who resumed anticoagulation (AC) at any time were more likely to have retrieval (hazard ratio [HR] = 3.6, p < 0.01) and had higher retrieval rates at every time point (31.4 vs. 7.6% at 1 year). Advanced age (HR = 0.98 per year, p = 0.004), stroke (HR = 0.28, p = 0.028), and active malignancy (HR = 0.42, p = 0.006) predicted nonretrieval. Device-related complications were infrequent (<1%) but thrombotic complications occurred early and were more common for nonretrieved VCFs (17 vs. 12%, p = 0.29). Revision of guidelines to recommend active surveillance for the ability to tolerate AC in the immediate postimplantation period may improve retrieval rates.

Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis and Septic Shock From the First Hour

2014 ◽  
Vol 42 (8) ◽  
pp. 1749-1755 ◽  
Author(s):  
Ricard Ferrer ◽  
Ignacio Martin-Loeches ◽  
Gary Phillips ◽  
Tiffany M. Osborn ◽  
Sean Townsend ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Antibiotic Treatment ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Sepsis And Septic Shock

scholarly journals Primary Cutaneous Cryptococcosis in an Immunocompetent 6-Year-Old Female

2018 ◽  
Vol 2 (4) ◽  
pp. 240-242
Author(s):  
Mitchell Hobbs ◽  
Joy King ◽  
Rana El Feghaly ◽  
Robert Brodell
Keyword(s):  
Cryptococcus Neoformans ◽  
Skin Lesions ◽  
Immunocompetent Patient ◽  
Immunocompromised Patients ◽  
Oral Fluconazole ◽  
Healthy Female ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Cutaneous Cryptococcosis ◽  
Superficial Culture

A 6-year-old otherwise healthy female presented to the ED with a right eyebrow lesion for one month.  Previous I&D attempts and empiric antibiotic treatment had failed to improve the lesion.  Following dermatology referral, superficial culture resulted with growth of Cryptococcus neoformans after which completion of oral fluconazole treatment resolved the lesion.  Though Cryptococcus neoformans infections commonly plague immunocompromised patients, primary cutaneous cryptococcosis in the immunocompetent patient is a rare but documented infection with a paucity of reported pediatric cases, and frontline physicians should be aware of such a diagnosis in the setting of persistent skin lesions without response to more commonly utilized therapies.

scholarly journals Adherence to International Empiric Antibiotic Treatment Guidelines in a Tertiary Teaching Hospital in Mexico City

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Marco Antonio Rodríguez-Cervera ◽  
Paulo Francisco Castañeda-Mendez ◽  
Luis Soto-Ramírez ◽  
Lorena Cabrera-Ruiz
Keyword(s):  
Mexico City ◽  
Antibiotic Treatment ◽  
Teaching Hospital ◽  
Treatment Guidelines ◽  
Tertiary Teaching ◽  
Empiric Antibiotic ◽  
Tertiary Teaching Hospital ◽  
Empiric Antibiotic Treatment

Fever in the Young Infant

2020 ◽  
pp. 75-81
Author(s):  
Paul Ishimine
Keyword(s):  
Bacterial Infections ◽  
Young Infant ◽  
Diagnostic Testing ◽  
Screening Tests ◽  
Empiric Antibiotic ◽  
Bacterial Gastroenteritis ◽  
Empiric Antibiotic Treatment ◽  
Serious Bacterial Infections ◽  
Tract Infections ◽  
Urine Testing

Fever is the most common complaint of children who present to the emergency department. Approximately 12% of febrile neonates (aged 0–28 days) and young infants (aged 29—56 days) have serious bacterial infections (bacteremia, meningitis, urinary tract infections, pneumonia, bacterial gastroenteritis, and osteomyelitis). The evaluation and management of the febrile neonate and febrile young infant can be confusing. All febrile neonates require diagnostic testing, treatment with antibiotics, and hospital admission. The workup of the febrile young infant is more controversial. These patients should undergo blood and urine testing, but the need for lumbar puncture is controversial, as is the need for empiric antibiotic treatment. The disposition of these patients will depend on the results of these screening tests.

Sign in / Sign up

Export Citation Format

Share Document