scholarly journals Descending Necrotizing Mediastinitis in Covid- 19 Time

2020 ◽  
pp. 1-4
Author(s):  
Michos Thrasyvoulos ◽  
Michos Thrasyvoulos ◽  
Stamatelopoulos Athanasios ◽  
Roumpaki Anastasia ◽  
Vakouftsi Alexia- Christina ◽  
...  
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Multiorgan Failure ◽  
Peritonsillar Abscess ◽  
Cervical Region ◽  
Descending Necrotizing Mediastinitis ◽  
Surgical Drainage ◽  
Number Of Patients ◽  
Odontogenic Abscess ◽  
Mediastinal Drainage

Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental- odontogenic infections. The aim of this study is to evaluate clinical and surgical feature of the patients with DNM who were managed in our Department during the period of general lockdown in Greece, between March 2020 and June 2020, because of the Covid19. Patients and Methods: During the period of general lockdown in Greece, 4 patients, mean age 46, 25 years (range 39-59), with DNM treated to our Department of General Thoracic Surgery. Primary odontogenic abscess occurred to 2 patients and peritonsillar abscess to other 2 of them. Diagnosis was confirmed by computed tomography (CT) of the neck and chest. All patients underwent surgical drainage of abscesses of the involved cervical region and mediastinum by lateral cervicotomy and left thoracotomy in three of them and cervicotomy, and bilateral thoracotomy in one patient. Results: The delay between the occurrence of thoracic symptoms and mediastinal drainage varied from 1 to 3 days. The side of the thoracotomy depended on the involved mediastinal compartments and side of pleural effusion. The duration of mediastinal drainage varied from 12 to 20 days (mean: 17 days). One patient died of multiorgan failure related to post-op septic shock. Conclusion: Between January 2000 and January 2020, 21 patients with DNM were treated at our Department, whilst during the four - month of lockdown, four patients were treated. We concluded that the patients delay for dentistry recourse because of covid-19, result in the increased number of patients with DNM in the above period. Delayed diagnosis and inadequate drainage are the main causes of the high mortality rate of DNM. If one realistically hopes to avoid the high mortality rate, aggressive surgical drainage and debridement of the neck and drainage of the mediastinum via a posterolateral thoracotomy by a multidisciplinary team of surgeons is a must.

Transcervical Drainage for Descending Necrotizing Mediastinitis May Be Sufficient

2011 ◽  
Vol 145 (5) ◽  
pp. 742-747 ◽  
Author(s):  
Ruey-Fen Hsu ◽  
Pei-Yin Wu ◽  
Chi-Kung Ho
Keyword(s):  
Mortality Rate ◽  
Hospital Stay ◽  
Chart Review ◽  
Medical Center ◽  
Case Series ◽  
Descending Necrotizing Mediastinitis ◽  
Group I ◽  
Significant Difference ◽  
Mediastinal Drainage ◽  
Group Ii

Objective. Descending necrotizing mediastinitis (DNM) is a serious form of mediastinitis with a high mortality rate. It is caused by the downward spread of an oropharyngeal or cervicofascial infection. The optimal surgical approach for this often fatal disease is controversial. This article describes the authors’ experience and characterizes the surgical strategies and treatment outcomes of patients with DNM. Study Design. Case series with chart review. Setting. A tertiary referral medical center. Subjects and Methods. This study conducted a retrospective chart review of patients with deep neck infections treated at a medical center from 1994 to 2007 and identified 29 patients with DNM. The clinical characteristics and outcomes were compared between patients treated with transcervical drainage alone (group I) and those with both cervical and thoracic drainage (group II). Results. There were 20 patients in group I and 9 patients in group II. The overall mortality rate was 10.3%. The mean duration of the hospital stay was 29.3 ± 15.5 days. There was no statistically significant difference in age, sex distribution, or duration from the appearance of symptoms to hospital admission between the 2 groups. The duration of hospital stay, tracheotomy rate, and mortality rate also did not differ significantly between the 2 groups. However, the numbers of surgeries were significantly higher in group II than in group I. Conclusion. Transthoracic mediastinal drainage is not a compulsory therapy, but timely, aggressive, transcervical mediastinal drainage with extensive debridement is very important for a good outcome when treating DNM patients.

scholarly journals Problems of the Diagnosis and Treatment of Acute Mesenteric Ischemia: a SingleCenter Experience

2018 ◽  
Vol 3 (4) ◽  
Keyword(s):  
Blood Flow ◽  
Mortality Rate ◽  
Early Diagnosis ◽  
High Mortality ◽  
Mesenteric Ischemia ◽  
Intestinal Resection ◽  
Acute Mesenteric Ischemia ◽  
Mesenteric Arteries ◽  
Diagnosis And Treatment ◽  
Number Of Patients

Objective: To improve the diagnosis and treatment of acute mesenteric ischemia by using available methods of early diagnosis and modern methods of treatment. Summary Background Data: The number of patients with disorders of the mesenteric circulation is increasing all over the world. In comparison with the occlusion of the coronary, cerebral arteries and peripheral veins, acute obstruction of the mesenteric arteries and veins is diagnosed much later, which causes a high mortality rate from 53 to 100%. Methods: In this study the experience of treatment of 162 patients with acute mesenteric ischemia was analyzed. All patients underwent treatment in Institute of Urgent and Recovery Surgery (IURS NAMS, Donetsk, Ukraine) from 2002 to 2017. Results: From 162 patients: 112 patients were with acute occlusive and 50 patients with acute nonocclusive mesenteric ischemia. The intravital diagnosis was not confirmed in 26 patients (16 %). 119 of patients died, the level of mortality was 73, 5%. 104 patients were operated, 32 patients were discharged (30,8 %), 72 patients died, a mortality rate was 69,2 %. Operations with restore of blood flow were performed in 14 patients, 5 patients died, 9 patients left the hospital. Conservative therapy was performed in 22 patients, in 11 patients with good results (50 %). Conclusions: The early diagnosis of this pathology is crucial and it can reduce the high mortality rate of patients with AMI. Treatment of OAMI should be carried out in a community of general, vascular and endovascular surgeons. Restoration of blood flow through mesenteric vessels with the help of endovascular technology and implementation of thrombembolectomy during open surgical intervention in a number of cases allows to avoid intestinal resection.

scholarly journals Descending necrotizing mediastinitis due to an odontogenic infection: A case report

2021 ◽  
Vol 38 (4) ◽  
pp. 675-677
Author(s):  
Serdar ÖZDEMİR ◽  
Abdullah ALGIN ◽  
Hatice Şeyma AKÇA ◽  
Mehmet Özgür ERDOĞAN
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Soft Tissue ◽  
High Mortality ◽  
Odontogenic Infection ◽  
Deep Fascia ◽  
Descending Necrotizing Mediastinitis ◽  
Cervical Infection ◽  
Mediastinal Drainage ◽  
Deep Cavities

Descending necrotizing mediastinitis a clinical entity formed by the spreading of cervical infection from the dental and oropharyngeal structures through the deep cavities between the deep fascia on the neck to the mediastinum, pleural and pericardial spaces with necrosis of soft tissue and has a high mortality. Herein we present the case of a 73-year-old admitted to emergency department with septic clinic. The patient was diagnosed with descending necrotizing mediastinitis due to odontogenic infection. Although sternal irrigation, sternal debridement and mediastinal drainage were performed patient was died postoperative third day.

scholarly journals How to initiate eHealth in congenital heart disease patients?

2020 ◽  
Vol 1 (1) ◽  
pp. 83-86
Author(s):  
Mark J Schuuring ◽  
Dirkjan Kauw
Keyword(s):  
Health Care ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Mortality Rate ◽  
High Mortality ◽  
Congenital Heart ◽  
High Morbidity ◽  
Vulnerable Patients ◽  
Number Of Patients

Abstract Patients with congenital heart disease (CHD) are a vulnerable subgroup of cardiac patients. These patients have a high morbidity and high mortality rate. As the number of patients with CHD keeps growing, while also getting older, new tools for the care and follow-up of these vulnerable patients are warranted. eHealth has an enormous potential to revolutionize health care, and particularly for CHD patients, by expanding care beyond hospital walls and even moving some of the provided care to the comfort of home. As new eHealth tools continue to grow in number, such as invasive eHealth tools, health care delivered through eHealth continues to evolve. This teaching series summarizes current insights and discusses challenges yet to be overcome. Importantly, none of them are insurmountable. This all lays ground for a promising future for eHealth in the care of patients with CHD.

scholarly journals Descending necrotizing mediastinitis

2006 ◽  
Vol 63 (7) ◽  
pp. 677-680 ◽  
Author(s):  
Vlado Cvijanovic ◽  
Vojkan Stanic ◽  
Aleksandar Ristanovic ◽  
Bojan Gulic ◽  
Savo Durkovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Massive Bleeding ◽  
Peritonsillar Abscess ◽  
Descending Necrotizing Mediastinitis ◽  
Right Thoracotomy ◽  
Oropharyngeal Infection ◽  
Disease Case ◽  
Mediastinal Drainage ◽  
Optimal Approach ◽  
Prompt Diagnosis

Background: Descending necrotizing mediastinitis (DNM) is an acute, serious, septic disease which results from a complication of oropharyngeal infection. The disease requires a prompt diagnosis and radical surgical treatment to reduce high mortality (40%). The optimal form of mediastinal drainage remains controversial. The reason for publishing this report is both the fact that DNM is very rare and our experience preferring thoracotomy as an optimal approach to treating the disease. Case report. We reported a 34-years-old woman with DNM. The disease began as a peritonsillar abscess. After a bilateral double pleural drainage the disease worsened. In order to achieve radical mediastinal debridement and drainage, we carried out posterolateral right thoracotomy. We also had to perform left thoracotomy because of massive bleeding caused by septic erosion. There were no more reoperations. Conclusion. Aggressive surgical treatment, regardless the localization and the extent of changes is the key to success in the treatment of patients with necrotizing mediastinitis.

Encephalitis epidemica and pregnancy

1927 ◽  
Vol 23 (6-7) ◽  
pp. 745-745
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Multiple Births ◽  
Number Of Patients

Of the total number of patients, 7 died, giving a high mortality rate of 70%. The disease is more dangerous for multiple births.

Diffuse descending necrotizing mediastinitis: surgical treatment and outcomes in a single-centre series

2013 ◽  
Vol 20 (3) ◽  
pp. 117-128 ◽  
Author(s):  
Ričardas Janilionis ◽  
Žymantas Jagelavičius ◽  
Pavel Petrik ◽  
Gintaras Kiškis ◽  
Vytautas Jovaišas ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hospital Stay ◽  
Pearson Correlation ◽  
Favourable Outcome ◽  
Cervical Region ◽  
Type I ◽  
Descending Necrotizing Mediastinitis ◽  
Transcervical Approach ◽  
Odontogenic Abscess ◽  
Oropharyngeal Infection

Objectives. Descending necrotizing mediastinitis is a severe infection spreading from the cervical region to the mediastinum. Since this pathology is uncom­mon, only a few reports of large series of patients with descending nec­rotizing mediastinitis have been published. The present aim was to eval­uate our treat­ment strategy and survival for this disease by a retrospective chart review. Methods. Retrospective analysis of 45 cases with descending necrotizing mediastinitis was performed between 2002 and 2011. The mean age was 55.3 ± 15.4 years. The primary oropharyngeal infection was found in 16 (35.6%), an odontogenic abscess in 17 (37.7%) and other causes in 12 (26.7%) patients. Endo type I mediastinitis was assessed in 25 (56%) patients, Endo type IIA in 10 (22%) and Endo type IIB in 10 (22%) patients. Broad spectrum antibiotics were administered empirically and surgical treatment consisting of cervical drainage, thoracotomy with radical surgical debridement of the mediastinum and placement of permanent mediastinal irrigation were performed in all the cases. Results. Collar incision and drainage only were performed in 16 (35.6%) patients, whereas only transthoracic approach was used in five cases (11%). In the remaining 24 (53.4%) patients cervical drainage and thoracic operation were performed. Fifteen patients had severe complications: septic shock, multiple organ failure and haemorrhage from mediastinal vessels. The median hospital stay was 21  days. The outcome was favourable in 35 patients. Ten patients died (overall mortality 22.2%). There was a negative correlation between the time from the onset of symptoms till the first admittance to hospital and hospitalization time (Pearson correlation coefficient 0.357, p = 0.016). That allows us to suggest that time of illness spent at home without appropriate treatment plays a crucial role on the survival. It was found that younger age, Endo type I, negative bacterial culture and longer hospital stay are true precursors of favourable outcome. Conclusions. For descending necrotizing mediastinitis limited to the upper part of the mediastinum a transcervical approach and drainage may be sufficient. However, in advanced cases an immediate and more aggressive surgical approach is required to combat a much higher morbidity and mortality in this subset of patients.

scholarly journals Descending necrotizing mediastinitis in the elderly patients

Open Medicine ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 449-460 ◽  
Author(s):  
Antonio Mazzella ◽  
Mario Santagata ◽  
Atirge Cecere ◽  
Ettore La Mart ◽  
Alfonso Fiorelli ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Mortality Rate ◽  
Elderly Patients ◽  
High Mortality ◽  
Patient Population ◽  
The Elderly ◽  
Therapeutic Management ◽  
Descending Necrotizing Mediastinitis ◽  
Long Time

AbstractDescending Necrotizing Mediastinitis (DNM) is a polymicrobic, dangerous and often fatal process, arising from head or neck infections and spreading along the deep fascial cervical planes, descending into the mediastinum. It can rapidly progress to sepsis and can frequently lead to death. It has a high mortality rate, up to 40% in the different series, as described in the literature. Surgical and therapeutic management has been discussed for long time especially in an elderly patient population. The literature has been reviewed in order to evaluate different pathogenesis and evolution and to recognise a correct therapeutic management.

scholarly journals Descending Necrotizing Mediastinitis: Trends in a Developing Country

2005 ◽  
Vol 84 (4) ◽  
pp. 242-250 ◽  
Author(s):  
Neena Chaudhary ◽  
Sanjay Agrawal ◽  
Anil K. Rai
Keyword(s):  
Computed Tomography ◽  
Developing Countries ◽  
Mortality Rate ◽  
Rapid Diagnosis ◽  
New Delhi ◽  
Descending Necrotizing Mediastinitis ◽  
Surgical Drainage ◽  
Prompt Treatment ◽  
High Index Of Suspicion ◽  
Delays In Diagnosis

Descending necrotizing mediastinitis is believed to be a rare and serious complication of odontogenic and oropharyngeal infections. It is associated with a high (up to 40%) mortality rate, which can be attributed to delays in diagnosis and inadequate surgical drainage. Between May 1999 and September 2002, we treated 7 cases at our institution in New Delhi, indicating that such fulminating infections are not so rare in developing countries. In our 7 cases, a high index of suspicion and early computed tomography helped us make a rapid diagnosis and initiate prompt treatment, which resulted in a favorable outcome in 6 cases (mortality rate: 14.3%).

scholarly journals Does reactivation of cytomegalovirus contribute to severe COVID-19 disease?

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Cecilia Söderberg-Nauclér
Keyword(s):  
Septic Shock ◽  
Acute Respiratory Distress Syndrome ◽  
Mortality Rate ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
High Mortality ◽  
Hospital Care ◽  
Distress Syndrome ◽  
Multiorgan Failure ◽  
Severe Pneumonia

AbstractThe majority of people infected with SARS-CoV-2 are asymptomatic or have mild to moderate symptoms. However, for unknown reasons, about 15 % have severe pneumonia requiring hospital care and oxygen support, and about 5 % develop acute respiratory distress syndrome, septic shock, and multiorgan failure that result in a high mortality rate. The risk of severe COVID-19 is highest among those who are over 70 years of age. Why severe COVID-19 develops in some people but not others is not understood. Could some cases involve reactivation of latent cytomegalovirus (CMV)?

Sign in / Sign up

Export Citation Format

Share Document