Closed suction drainage for deep neck infections

PurposeThere have been various incision and drainage methods for deep neck infection (DNI). Closed-suction drainage (CSD) has been used to decrease hematoma or to drain pus in other forms of medical surgery. The purpose of this investigation was to evaluate the usefulness of CSD for DNI.Patients and methodsThis study consisted of 30 patients who underwent CSD after incision and drainage for DNI between January 2006 and December 2011. The patients' demographics, systemic diseases, methods of airway control, involved spaces, incision, CSD results, duration of hospitalization, and complications were investigated.ResultsCSD was used to treat 30 DNI patients. Eleven patients (37%) had underlying systemic diseases like diabetes mellitus, hypertension, hepatitis, asthma, etc. Twenty four patients (80%) had odontogenic infections in the mandibular molar region. Tracheostomy was performed in 5 patients (17%). The involved spaces were various from parapharyngeal space to mediastinum (mean: 4.8 spaces), and CSD was applied with drainage lines (mean: 3; 2–7 drains) over the course of 4–37 days (mean 14.6 days). The total amount of drained pus was 8–1344 cc (mean: 406 cc) and the daily amount was 1–61 cc (mean: 28 cc) from each patient. The mean length of hospital stay was 26 days, with a range of 9–83 days. Wound rupture happened in 7% of 56 total incision sites and spontaneous removal of the drain tube occurred in 3% of 91 total tubes. Four patients died because of cardiac arrest, pulmonary edema, and hypoxia. A statistical significance was accepted about total and daily amount of drainage at Pearson's correlation test (p < 0.001).ConclusionAccurate diagnosis, safe airway management, and early surgical drainage were important in DNI treatment. Compared to other drainage systems, CSD is clinically useful for treating DNI due to minimal incision, convenience of post-operative management, and less postoperative complications.     

T2-SPACE imaging of the cauda equina for the assessment of leptomeningeal metastatic disease

The diagnosis of leptomeningeal metastatic disease (LMD) is frequently challenging and MRI of the spine is an important part of the diagnostic paradigm. We sought to examine the value of adding 3-dimensional, heavily T2-weighted, Sampling Perfection with Application optimised Contrasts using different flip angle Evolution (T2-SPACE) imaging of the lumbar spine to the MRI protocol for patients with suspected LMD. MRI spine examinations including T2-SPACE imaging of the lumbar spine performed for suspected or known LMD were retrospectively reviewed by a neuroradiologist to determine the additional benefit of the T2-SPACE sequence. The accuracy of T2-SPACE was also compared to contrast-enhanced T1-weighted imaging (ceT1WI) and standard T2-weighted imaging (T2WI). 59 patients with T2-SPACE were identified over a 20-month period, 17 having abnormal appearances on ceT1WI, including 12 with appearances consistent with LMD. In eight of these 12 patients, nodules visible on T2-SPACE were visible on T2WI, though T2-SPACE improved the temporal comparison of slowly progressive cauda equina nodules in two cases. In three patients, T2-SPACE identified nodules which were not readily identifiable on T2WI, though were visible on ceT1WI. In one patient, LMD visible on ceT1WI was not appreciable on T2-SPACE or T2WI due to the lack of a nodular component. In six patients, T2WI showed equivocal nodularity, which could be confidently attributed to facet joint arthropathy or a tortuous vessel. In conclusion, T2-SPACE has high sensitivity and specificity for the detection of nodular lesions of the cauda equina and can confidently characterise equivocal findings on standard T2WI.     

Rupture from cavernous internal carotid artery pseudoaneurysm 11 years after transsphenoidal surgery

Carotid artery pseudoaneurysm is a rare complication of transsphenoidal surgery, usually diagnosed within 90 days post procedure. Sequelae of pseudoaneurysm rupture, such as severe epistaxis or carotid cavernous fistula (CCF), have significant morbidity and mortality. A case of epistaxis from pseudoaneurysm rupture over a decade after transsphenoidal surgery is presented, with staged treatment using coiling, endonasal mucosal flap repair and interval flow-diverting stent insertion. This case illustrates that pseudoaneurysm rupture occurs regardless of time course after transsphenoidal surgery, and treatment strategies using combined endovascular and endonasal techniques are reviewed.     

依据CLSI EP9-A3评价两种方法学检测糖类抗原242的可比性

目的评价两种方法学检测糖类抗原242(CA242)结果的可比性,以评估磁微粒化学发光法检测CA242是否能够满足临床的需求。方法根据美国临床和实验室标准协会(CLSI)新指南EP9-A3文件要求,收集2018年1-7月首都医科大学附属北京康复医院和北京大学首钢医院肿瘤患者检测剩余的新鲜血清标本100例,以Fujirebio Diagnostics AB的酶联免疫法为参比方法,安图生物的磁微粒化学发光法为评估方法,对2种方法检测CA242的结果进行方法学比对和偏移评估。选择Passing-Baklok回归方法进行线性拟合,采用Wilcoxon符号秩检验及Spearman相关分析。结果在4.31~295.63 U/ml范围内,2种方法学的CA242检测结果具有较好的相关性(r=0.991,截距0.652)。参比方法和评估方法比较,差异无统计学意义[(53.75±6.69)U/ml比(56.11±6.86)U/ml,t=0.246,P=0.806]。将CA242的医学决定水平25.00 U/ml代入选取的最佳回归模型拟合方程,计算得到的相对偏移3.52%,<1/2TEa±12.5%(TEa为国家卫生健康委临床检验中心室间质量评审允许总误差),满足要求。结论安图生物的磁微粒化学发光法和Fujirebio Diagnostics AB酶联免疫法检测CA242结果具有可比性,满足临床需要。     

维持性血液透析患者自主神经功能异常与透析中低血压的关系

目的以心率变异性(heart rate variability,HRV)为观察指标,分析维持性血液透析(maintenance hemodialysis,MHD)患者的自主神经功能异常与透析中低血压(intradialytichypotension,IDH)的关系.方法在透析过程中同步监测患者的血压和动态心电图,依据是否发生IDH将60例患者分为2组(血压下降组和对照组),比较2组的HRV指标,其中LFn代表交感神经活性,HFn代表迷走神经活性,LF/HF代表2者之间的平衡状态.以发生IDH为结果变量,以性别、年龄、透析龄、原发病是否糖尿病、心脏指数、中心血容量占体质量百分比、超滤量占体质量百分比和透析前LFn为预测变量,建立Logistic回归模型分析LFn对IDH的预测价值.结果对照组在透析过程中LFn水平和LF/HF比值逐渐升高,且升高趋势稳定(LFn中位数:透析开始时65.47nu,210min时73.79nu,P=0.001;LF/HF中位数:开始时2.17,210min时3.98,P＜0.001),HFn的水平则逐渐减低(HFn中位数:透析开始30.06nu,210min时19.43nu,P=0.002),而血压下降组的上述指标变化趋势不稳定,其中LFn在整个透析过程中都始终低于对照组.logistic回归模型显示,在校正了上述人口学特征和临床基础情况后,LFn对IDH的发生仍有预测价值,OR值为0.943(95%CI0.894～0.966).结论维持性血液透析患者交感神经活性在透析过程不能随血容量的下降持续、稳定的增高,与IDH的发生有密切关系;透析前交感神经活性的基础水平减低是IDH的独立危险因素,表明自主神经功能异常是导致透析中低血压的重要原因之一.