scholarly journals The management of septic shock and Ludwig’s angina: A case report of a life-threatening condition

2020 ◽  
Vol 8 ◽  
pp. 2050313X2093090
Author(s):  
Endang Sjamsudin ◽  
Basaria Manurung ◽  
Asri Arumsari ◽  
Tantry Maulina

Ludwig’s angina is a high severity infection because of the risk of airway obstruction due to the rapid spread of the abscess into the deeper spaces. Therefore, performing the correct treatment is one of the keys to a successful result. A 44-year-old male patient came to the Emergency Unit of Hasan Sadikin Hospital, complaining of shortness of breath, severe pain, and progressive swelling. Extraoral examination showed a localized-fluctuated swelling located at the right lower jaw that extended to the chin, left lower jaw, and the frontal region of the neck region while a sequential organ failure assessment revealed a score of 2. A diagnosis of Ludwig’s angina and septic shock was confirmed. Intravenous infusion of norepinephrine was administered and a tracheostomy was performed. The next treatment phase consisted of a drainage procedure, tooth extraction, and placement of the Penrose drain. The patient was discharged 10 days later with a satisfactory outcome.

Remains of a fossil amphibian have been recovered from an ironstone layer in the Upper Evergreen Formation, dated as late Liassic, of southeast Queensland. Extraction of the skeleton from the very hard matrix has presented a number of problem s which are discussed. The find is an almost complete skull and mandible connected to an articulated postcranial skeleton which is missing only some ribs, the right hind leg and the distal portions of the other limbs and tail. The remains are those of a temnospondyl labyrinthodont described as a new genus and species of the family Chigutisauridae. The new form is notable for its very large size (total length estimated to be in excess of 2.5 m), relatively large marginal dentition, with unique lance-shaped tooth tips, the presence of minute denticles associated with the palate and mandible, a well developed atlas showing a strong link with the axis, neorhachitomous vertebrae that lack ossified pleurocentra and have low, heavily built neural spines, a neck region and a narrow dermal pectoral girdle associated with unreduced limbs. The discovery of this chigutisaur provides the first unequivocal evidence that labyrinthodonts survived beyond the end of the Triassic. T he status of two previously described doubtful Jurassic forms is reviewed. Austropelor Longman, 1941, from the Early Jurassic Marburg Sandstone of southeast Queensland, is confirmed as a fragm ent of temnospondyl lower jaw , probably attributable to the superfamily Brachyopoidea, and there is no longer any reason to consider the earlier suggestion that it is a reworked Triassic fossil. Cyrtura Jaekel, 1904, from the Late Jurassic Solnhofen Shale of Germany, is considered not to be a labyrinthodont, but its exact relationships are uncertain. The unsatisfactory nature of the higher taxonomy of the Temnospondyli is noted. The superfamily Brachyopoidea is reviewed and the family Kourerpetontidae is removed from it, membership of the superfamily thereby being restricted to the Brachyopidae (Late Permian to Middle Triassic) and Chigutisauridae (Early Triassic to Early Jurassic). Diagnoses for the superfamily and its two included families are provided. The relationships of the better characterized members of the two families are examined and a phylogeny based on shared derived character states is proposed. The analysis of relationships indicates that Brachyops allos Howie, 1972 shares few of the characters diagnostic of the type of Brachyops (B. laticeps Owen, 1855), and a new genus is proposed. The diversity of Australia’s brachyopoids, including the presence of the most primitive and earliest-known members of each of the included families, suggests that the superfamily originated in Australia.


2020 ◽  
Vol 11 (SPL3) ◽  
pp. 996-999
Author(s):  
Reshma Thirunavakarasu ◽  
Dhanraj Ganapathy ◽  
Subhashree Rohinikumar

Ludwig's angina is life-threatening cellulitis. It is primarily seen involving the submandibular space followed by secondary involvement of the submental space. This disease has an aggressive character and spreads rapidly causing a compromised airway with little warning. The aim of the study is to determine the level of knowledge and awareness of dental practitioners regarding Ludwig's angina and its management techniques. A total of 10 multiple choice questions were formed and distributed to 100 dental practitoners with more than five years of experience. All ten questions assessed the knowledge of dental practitioners regarding Ludwig's angina and awareness of the various management techniques. After all the participants have given their response, their responses were noted and tabulated. All the respondents were aware of the cause and causative factors of Ludwigs, angina.78% said it is cellulitis. Broad-spectrum antibiotics are the choice in 78% of the respondents.80% are aware this condition involves multiple space infections and 64%said they can diagnose this condition based on clinical features. The awareness of management techniques of Ludwig's angina was high among dental practitioners. The importance regarding knowledge of various disease which mainly affects the head and neck region is crucial for dental practitioners. Thus it is essential for the dental practitioners to have knowledge of the conditions and be aware of the management of these conditions.


2020 ◽  
Vol 5 (2) ◽  
pp. 73-75
Author(s):  
Irina Doinița Oașă ◽  
◽  
Bogdan Popescu ◽  
Cristian Balalau ◽  
Razvan V. Scaunasu ◽  
...  

Deep neck space infections are of great risk for patients considering even death in certain cases. Collection of purulent secretions that can accumulate in a particular region of the neck is due to the anatomy of the deep neck fascia, muscles of the neck and compartments for blood vessels and organs in the neck region. Deep neck spaces communicate with each other and in some patients with morbidities like diabetes or other form of immuno-suppression extension can be great. Ludwig's angina is a form of abscess of the floor of the mouth with origin in teeth located on the mandible. Like any other abscess medical and surgical therapy are ways of treatment, but incision and drainage are mandatory. However, surgical management of such a complication might include other type of surgery as tracheostomy, blood vessels ligation, resection of necrotic tissue or even reconstruction.


2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Takashi Matsushita ◽  
Tomoyasu Kumano ◽  
Kazuhiko Takehara

Primary cutaneous follicle center lymphoma (PCFCL) accounts for the majority of primary cutaneous B-cell lymphomas. We report a 60-year-old womanwith PCFCL. She had a red nodule (25 × 25 mm) on the right side of the lower jaw. She was diagnosed with PCFCL by skin biopsy. And then, she was treated with radiation therapy (total 30.6 Gy), which completely eliminated the nodule. Our case suggests that radiation therapy may be a first choice for PCFCL patients with a solitary lesion or localized lesions.    


ORL ro ◽  
2017 ◽  
Vol 3 (36) ◽  
pp. 38
Author(s):  
Andrei Ştefan Luca ◽  
Adriana Florescu

Author(s):  
Ekaniyere EB

Background: Even though the decompression of the cellulitis phase of Ludwig’s angina (LA) by surgical or pharmacological approach is well documented, it is unclear which approach is more effective. Objective: We aim to compare the outcome of treatment between surgical versus pharmacological decompression in patients with LA. Subjects and Methods: A retrospective cohort study was designed. Data were collected from the case notes of patients that met the inclusion criteria from 2004 to 2018 at the University of Benin Teaching Hospital, Nigeria.The data were age, gender, type of decompression approach, length of hospital stay (LOS) and airway compromise. Result: A total of 62 patients comprising 37(59.7%) surgical decompression group and 25(40.3%) pharmacological decompression group were studied. Thirty-six (58.1%) males and 26 (41.9%) females were studied. Their mean age and standard deviation were 40.6 years and 11.9 years respectively. The mean length of hospital stays between the pharmacological and surgical decompression groups were 8.05 days and 13.8 days respectively. The incidence of airway compromise in the surgical decompression group was 19.9% lower than that of the pharmacological decompression group (P=0.47), which was not significant. The type of decompression approach also failed to influence the incidence of airway compromise (P = 0.41). Conclusion: The use of surgical versus pharmacological decompression does not significantly alter the incidence of airway compromise in the management of LA. The Patients that had surgical decompression had a shorter stay in the hospital as compared to those who had pharmacological decompression. This was not statistically significant.


2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Tiffany A. Perkins ◽  
Alberic Rogman ◽  
Murali K. Ankem

Abstract Background Emphysematous pyelonephritis (EPN) with gas in the inferior vena cava (IVC) is a rare presentation and to our knowledge, this is the first case report in the urologic literature. Case presentation A 35-Year-old obese diabetic Hispanic female presented to the emergency room with a clinical picture of septic shock. Prompt computerized tomography scan revealed EPN with gas throughout the right renal parenchyma and extending to the right renal vein, IVC, and pulmonary artery. She died before surgical intervention Conclusion This case demonstrates that patients presenting with severe EPN have a high mortality risk and providers should acknowledge that septic shock, endogenous air emboli, or a combination of both could result in cardiovascular collapse and sudden death.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takehiro Hashimoto ◽  
Ryuichi Takenaka ◽  
Haruka Fukuda ◽  
Kazuhiko Hashinaga ◽  
Shin-ichi Nureki ◽  
...  

Abstract Background Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown. Case presentation A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse. Conclusions We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.


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