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

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.

scholarly journals Descending Necrotizing Mediastinitis: Analysis of 9 Cases in Our Hospital

2020 ◽  
pp. 014556132093396
Author(s):  
Peng Wu ◽  
Fan Ye ◽  
Ziheng Zhang ◽  
Linghao Zhang ◽  
Hailiang Lin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Treatment ◽  
Hospital Stay ◽  
Intensive Care Unit Stay ◽  
Multidisciplinary Approach ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Descending Necrotizing Mediastinitis ◽  
Hospital Deaths

Objectives: Descending necrotizing mediastinitis (DNM) is a serious and progressive infection involving the neck and chest and with high mortality if not treated quickly and properly. The aim of this study is to share our practices for managing this condition. Methods: We retrospectively evaluated 9 patients diagnosed with DNM in our hospital between January 2006 and October 2019. Age, gender, origin of infection, length of hospital stay, microorganisms present, type of surgical treatment, and clinical outcomes were reviewed. Results: All patients underwent surgery to drain neck and mediastinal secretions and collections. Three (33.3%) patients were treated with transcervical drainage alone, and 6 (66.7%) patients were treated with combined transcervical and transthoracic drainage. Reoperations were reported in 3 (33.3%) cases. The average length of hospital stay was 22.78 ± 10.05 days (range: 9-40 days). The average length of intensive care unit stay was 6.44 ± 10.10 days (range: 0-25 days). There were no in-hospital deaths, and all patients were discharged home with good outcomes. Conclusions: To improve the prognosis of DNM, we suggest early and adequate debridement of all affected areas along with the proper use of antibiotics. A multidisciplinary approach involving both cardiothoracic and ENT surgeons is also required.

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.

Health-related quality of life one year after surgical treatment of the type I chronic aortic dissection

2019 ◽  
Vol 38 (1) ◽  
Author(s):  
Oksana Kamenskaya ◽  
Asya Klinkova ◽  
Irina Loginova ◽  
Alexander Chernyavskiy ◽  
Dmitry Sirota ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Aortic Dissection ◽  
Type I ◽  
Health Related Quality ◽  
Chronic Aortic Dissection ◽  
Related Quality ◽  
Health Related ◽  
One Year

MANAGEMENT OF MULTIPLE TRAUMATIC INTRACRANIAL HEMATOMAS

2020 ◽  
Vol 3 (1) ◽  
pp. 70-74
Author(s):  
Rustam Hazratkulov ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Surgical Treatment ◽  
Brain Injury ◽  
Hospital Stay ◽  
Treatment Outcomes ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Diagnostic Approach ◽  
Early Activation ◽  
Intracranial Hematomas

Multiple traumatic hematomas (MG) account for 0.74% of all traumatic brain injuries. A comprehensive diagnostic approach to multiple traumatic intracranial hematomas allows to establish a diagnosis in the early stages of traumatic brain injury and to determine treatment tactics. A differentiated approach to the choice of surgical treatment of multiple hematomas allows to achieve satisfactory results and treatment outcomes, which accordingly contributes to the early activation of the patient, a reduction in hospital stay, a decrease in mortality and disabilityin patients with traumatic brain injury

Macroscopic Anatomy and Brain Vascularization in the Greater Rhea (Rhea americana americana)

2018 ◽  
Vol 46 (1) ◽  
Author(s):  
Herson Da Silva Costa ◽  
Hélio Norberto De Araújo Júnior ◽  
Ferdinando Vinícius Fernandes Bezerra ◽  
Carlos Eduardo Vale Rebouças ◽  
Danilo José Ayres De Menezes ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Carotid Arteries ◽  
Vascular System ◽  
Cerebral Arteries ◽  
Cervical Region ◽  
Type I ◽  
Macroscopic Anatomy ◽  
Rhea Americana ◽  
Vascular Type ◽  
The Brain

 Background: The Rhea americana americana is a wild bird belonging to the group of Ratites, and is important from the scientific point of view given their adaptability to captivity. Considering that information about its morphology is important for the viability of domesticating the species, the aim of this study was to macroscopically identify the brain regions, as well as the cerebral arteries and the cerebral arterial circuit in order to establish the cerebral vascular pattern and systematization.Materials, Methods & Results: Twenty one brains from young and adult Greater Rheas of both sexes were used from animals that had died due to natural causes and were then kept in a freezer. The specimens were thawed and incised in the cervical region to allow exposure of the left common carotid artery, which was cannulated. The vascular system was rinsed with 0.9% saline solution, then perfused with latex Neoprene 650 stained with red pigment. The animals were subsequently fixed in 3.7% aqueous formaldehyde solution for 72 h, and then they were dissected by removing the bones from the skull cap. The brains were analyzed, and the structures were identified, photographed, schematized and denominated. Morphometric measurements were performed on the basilar and cerebellar ventral caudal arteries, recording the values of length and width in millimeters with the aid of a digital caliper. The brain was divided into: telencephalon, diencephalon, brainstem and cerebellum; while externally, the observed structures are: olfactory bulbs, optical lobes, optic nerves, optic chiasm, pituitary and pineal glands. Vascularization was performed by the following arteries: ventral spinal artery, basilar artery, ventricular cerebellar arteries, medium ventricular cerebellar arteries, caudal branches of the carotid arteries of the brain, ventral mesencephalic artery, cerebral caudal arteries, rostral branches of the carotid arteries of the brain, middle cerebral arteries, cerebroethmoidal arteries, rostral intercerebral anastomosis, rostral cerebral arteries, ethmoidal arteries, internal ophthalmic arteries, inter-hemispheric artery, pituitary arteries, dorsal mesencephalic tectal arteries, dorsal cerebellar arteries, occipital, pineal and dorsal hemispherical branches. The cerebral arterial circuit was both caudally and rostrally closed in 100.0% of the samples, being composed of the arteries: basilar artery, caudal branches of the carotid brain, rostral branches of the brain carotid, cerebroethmoidal arteries and rostral intercerebral anastomosis.Discussion: Encephalon classification regarding the presence or absence of gyri is a characteristic associated to evolution­ary aspects among vertebrates, being respectively considered as lisencephalon or girencecephalus when it presents or does not present convolutions. In Greater Rheas, the telencephalon was quite developed, with a relatively rounded shape and the absence of sulci and convolutions in the cortex, which allowed it to be classified as a lisencephalon. Such findings resemble those described for the ostrich and in a comparative study involving kiwis, emus, owls and pigeons, although different sizes and forms of telencephalon development were observed in the latter. Regarding the cerebral arterial circuit, this structure in Rheas was complete and both caudally and rostrally closed in 100.0% of the specimens. Our findings differ from those ob­served for ostriches, in which a rostrally open behavior has been described, while it is caudally closed in 20.0% of cases and opened in 80.0%. Regarding the vascular type of the brain, in the Rhea it was observed that there was only contribution of the carotid system, similar to that found for birds such as ostriches and turkeys which confer a type I encephalic vascularization.Keywords: arteries, brain, arterial circuit, morphometry, ratites.

scholarly journals Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery

2021 ◽  
Author(s):  
Amol S. Dahale ◽  
Siddharth Srivastava ◽  
Sundeep Singh Saluja ◽  
Sanjeev Sachdeva ◽  
Ashok Dalal ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Delayed Diagnosis ◽  
Oral Intake ◽  
Standard Of Care ◽  
Duodenal Perforation ◽  
Type I ◽  
Over The Scope Clip ◽  
Group 2 ◽  
Duodenal Perforations ◽  
Surgical Group

Abstract Background Scope-induced duodenal perforation is a life-threatening complication and surgery remains the standard of care. With the advent of over-the-scope clip (OTSC), scope-induced perforations are increasingly managed conservatively, though there is no study comparing this form of non-surgical treatment with surgery. We aimed to compare OTSC and surgery in the management of scope-induced perforation of the duodenum. Methods We retrospectively collected data of scope-induced duodenal perforation patients. Perforations identified and treated within 24 h of procedure were analyzed. Factors analyzed were spectrum, etiology, baseline parameters, perforation size, outcome, comorbidities, and duration of hospital stay. Results A total of 25 patients had type I duodenal perforations, out of whom five were excluded due to delayed diagnosis and treatment. Of the twenty, eight were treated with OTSC placement while the rest underwent surgery. Age was comparable and the majority were females. Baseline parameters and comorbidities were similar in both the groups. The median size of perforation was 1.5 cm in both the OTSC group and the surgical group. All patients were treated with standard of care according to institutional protocols. Patients in the OTSC group were started orally after 48 h of OTSC placement, while in the surgery group median time to oral intake was 7 days. Two patients in the surgical group died while there was no mortality in the OTSC group (p = 0.48). Median hospital stay was shorter in the OTSC group (2 days vs. 22 days, p = 0.003). Conclusions OTSC is a feasible and better option in type I duodenal perforations with a shorter hospital stay.

Utility of transcervical management of Zenker's diverticulum

2015 ◽  
Vol 130 (S1) ◽  
pp. S16-S19 ◽  
Author(s):  
B Jackson ◽  
Z Ahmad ◽  
R P Morton
Keyword(s):  
Hospital Stay ◽  
Complication Rate ◽  
Length Of Hospital Stay ◽  
Zenker’S Diverticulum ◽  
Cricopharyngeal Myotomy ◽  
Pharyngeal Pouch ◽  
Recent Systematic Review ◽  
Transcervical Approach ◽  
Endoscopic Techniques ◽  
Zenker's Diverticulum

AbstractObjective:To evaluate our results in treating Zenker's diverticulum via the transcervical approach, and to compare our experiences with a recent systematic review of both open and endoscopic approaches to the pharyngeal pouch.Method:An audit yielded 41 consecutive cases of Zenker's diverticulum treated between 2003 and 2013.Results:All 41 patients underwent transcervical cricopharyngeal myotomy; 29 sacs also required ‘inversion’. The median and mean length of hospital stay was 1 night and 2.5 nights respectively. The recurrence rate was 2.4 per cent and the complication rate was 9.8 per cent.Conclusion:When compared to reported endoscopic techniques, transcervical cricopharyngeal myotomy (with or without inversion) in our unit resulted in: shorter hospital stay, a comparable complication rate and fewer recurrences.

Visual and quantitative assessment of COVID-19 pneumonia on chest CT: The relationship with disease severity and clinical findings

2021 ◽  
Vol 17 ◽  
Author(s):  
Furkan Kaya ◽  
Petek Şarlak Konya ◽  
Emin Demirel ◽  
Neşe Demirtürk ◽  
Semiha Orhan ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Disease Severity ◽  
Pearson Correlation ◽  
Laboratory Data ◽  
Length Of Hospital Stay ◽  
Chest Ct ◽  
Laboratory Findings ◽  
Pneumonia Severity ◽  
High Attenuation ◽  
The Relationship

Background: Lungs are the primary organ of involvement of COVID-19, and the severity of pneumonia in COVID-19 patients is an important cause of morbidity and mortality. Aim: We aimed to evaluate the visual and quantitative pneumonia severity on chest computed tomography (CT) in patients with coronavirus disease 2019 (COVID-19) and compare the CT findings with clinical and laboratory findings. Methods: We retrospectively evaluated adult COVID-19 patients who underwent chest CT, clinical scores, laboratory findings, and length of hospital stay. Two independent radiologists visually evaluated the pneumonia severity on chest CT (VSQS). Quantitative CT (QCT) assessment was performed using a free DICOM viewer, and the percentage of the well-aerated lung (%WAL), high-attenuation areas (%HAA) at different threshold values, and mean lung attenuation (MLA) values were calculated. The relationship between CT scores and the clinical, laboratory data, and length of hospital stay were evaluated in this cross-sectional study. The student's t-test and chi-square test were used to analyze the differences between variables. The Pearson correlation test analyzed the correlation between variables. The diagnostic performance of the variables was assessed using receiver operating characteristic (ROC) analysis was used. Results: The VSQS and QCT scores were significantly correlated with procalcitonin, d-dimer, ferritin, and C-reactive protein levels. Both VSQ and QCT scores were significantly correlated with disease severity (p<0.001). Among the QCT parameters, the %HAA-600 value showed the best correlation with the VSQS (r=730,p<0.001). VSQS and QCT scores had high sensitivity and specificity in distinguishing disease severity and predicting prolonged hospitalization. Conclusion: The VSQS and QCT scores can help manage the COVID-19 and predict the duration of hospitalization.

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