经皮肺静脉成形术治疗纤维纵隔炎所致肺静脉狭窄的短期疗效及安全性探讨

目的:探讨经皮肺静脉成形术治疗纤维纵隔炎所致肺静脉狭窄的短期疗效与安全性。方法:该研究为病例系列研究。回顾性纳入2018年1月至2020年6月在甘肃省人民医院诊断为纤维纵隔炎所致肺静脉狭窄并接受经皮肺静脉成形术治疗的患者。通过电子病历系统收集患者的临床资料,包括年龄、性别、合并症,术前右心导管测得的血流动力学指标、N末...     

MSCT测量健康成人纵隔大血管径线

目的应用MSCT测量健康成年人纵隔各大血管的径线。方法收集236名无心肺疾患的健康成年人,按年龄分为3组:A组(17～40岁)98名,B组(41～60岁)81名,C组(61～87岁)57名,均接受胸部增强CT扫描。于深吸气末增强扫描图像上测量升主动脉(AA)、降主动脉(DA)、肺动脉干(PA)、左肺动脉(LPA)、右肺动脉(RPA)、左肺上叶动脉(LULPA)、右下肺动脉(RLLPA)及上腔静脉(SVC)管径、计算管径比值,并进行统计学分析。结果 C组中男性PA、AA、SVC直径均大于女性(P均<0.05),而A、B组中男、女各血管管径的差异均无统计学意义(P均>0.05);不同年龄组间,AA、DA、PA、LPA及RPA直径的差异均有统计学意义(P均<0.05),rLULPA/AA、rPA/SVC、rAA/SVC及rAA/LPA的差异均有统计学意义(P均<0.05),而LULPA、RLLPA直径及rAA/RPA的差异均无统计学意义(P均>0.05)。结论 61～87岁老年男性PA、AA、SVC直径均大于女性;随着年龄增长,AA、DA、PA、LPA及RPA管径增大。     

16. Die instrumentelle Oesophagusperforation — ihre Behandlung und Ergebnisse

Zusammenfassung Die instrumentelle iatrogene Oesophagusperforation steht in der Ursachenhäufigkeit an vorderster Stelle der endoskopischen Eingriffe, die in neuerer Zeit immer mehr an Bedeutung gewonnen haben. Vom 1. 1. 73 bis 31. 12. 84 sahen wir in Mannheim 46 Oesophagusperforationen. Der jüngste Patient war ein 2jähriges Mädchen mit einer benignen Stenose, der älteste ein 89jähriger Mann mit einem Kardia-Ca. Der Altersdurchschnitt betrug 62 Jahre. 26 Patienten wurden konservativ behandelt und 20 Patienten mußten operiert werden. In 2 Fällen war eine Diskontinuitäts-Operation erforderlich. In 1 Fall erfolgte die Rekonstruktion 6 Monate später erfolgreich. 9 Patienten verstarben. In jedem Fall war die Todesursache kardio-pulmonales Versagen bei septischem Geschehen.     

The ‘Two Bridges Technique’ for sternal wound closure. The use of vacuum‐assisted closure for the treatment of deep sternal wound defects: a centre‐specific technique

The objective is to describe the ‘Two Bridges Technique’ (TBT), which has proven to be successful and has been the standard technique at our centre for vacuum‐assisted closure (VAC) of post‐sternotomy mediastinitis. An extensive literature search was performed in four databases to identify all published articles concerning VAC for post‐sternotomy mediastinitis. Several VAC methods have been used; however, no article has described our specific technique. TBT consists of a two‐bridges construction using two types of foam with different pore sizes, which ensures an equally divided negative pressure over the wound bed and stabilisation of the chest. This guarantees a continuous treatment of the sternal defect and prevents foam displacement. It maintains an airtight seal that prevents skin maceration and provides enough protection to avoid right ventricular rupture. The main advantage of TBT is the prevention of shifting or tilting of the foam during chest movements such as breathing or couching. Along with targeted antibiotic treatment, this alternative VAC technique can be an asset in the sometimes cumbersome treatment of post‐sternotomy mediastinitis.     

扁桃体周脓肿并纵隔脓肿及脓胸1例

扁桃体周脓肿是扁桃体周围间隙的一种化脓性炎症,临床上较常见,绝大多数患者经合理治疗后能于1～2周内痊愈,但如果治疗不及时,可引起一系列严重并发症,现将我院救治1例扁桃体周脓肿合并纵隔脓肿及脓胸的患者介绍如下。     

Long-term medical control of inflow cuff infection in a patient with a left ventricular assist system

We report on a patient fitted with a Toyobo left ventricular assist system who developed inflow cannula exit-site infection. Although the exit-site infection seemed to be overcome by local irrigation and intravenous antibiotic therapy, repeated attempts at discontinuation of the intravenous antibiotic therapy resulted in bacteremia, and long-term administration of intravenous antibiotics was required. At the time of heart transplantation, it was noticed that the exit-site infection had caused ascending infection via the cannula and resulted in abscess formation around the left ventricular apical cuff. The infection was successfully controlled by heart transplantation and prophylactic omentopexy.     

Cryptococcosis associated with crescentic glomerulonephritis

Crescentic glomerulonephritis (CGN) is an uncommon form of renal injury in childhood. Whereas many infectious processes are known to be linked to CGN, fungal infections typically are not. This report describes an 11-year-old girl who presented with CGN, cutaneous anergy, and cryptococcal mediastinitis. Whereas cryptococcal disease in children is usually associated with immunodeficiency (inherited or acquired), extensive immunologic evaluation of the patient was notable only for relative CD4 lymphopenia with normal CD4/CD8 ratios. Testing for human immunodeficiency virus was negative. Clinical and diagnostic studies are presented, along with a review of the literature regarding glomerular disease and cryptococcal infections.     

An analysis of clinical risk factors of deep neck infection

Objectives

To clarify the clinical risk factors that aggravate deep neck infection.

Patients and methods

Sixty-five patients with deep neck infection (abscess or cellulitis), 42 males and 23 females, who were treated at the ear, nose, and throat department in Iwaki Kyoritsu General Hospital in the past 10 years, were retrospectively reviewed. Cases of inflammation of the upper airway including the oral cavity, laryngopharynx, palate tonsil and salivary gland, and cases of lymphadenitis were investigated. These patients were divided into five localized types and one wide range type according to the abscess locations as follows: oral cavity floor type, upper deep cervical type, submandibular type, submental type, retropharyngeal type, and wide range type.

Results

Seventeen of the 65 patients had diabetes, and significantly more diabetics had the wide range type than the localized type (P < 0.05, Fisher's test). Diabetes complication was more often seen in the upper deep cervical type among patients aged 61 years or older, and in the wide range type among males aged 41 years or older and elderly women aged 61 years or older. No patients with odontogenic infection or sialolithiasis had associated diabetes mellitus. Two cases developed mediastinitis, and one was caused by retrotonsillar abscess and needed thoracic drainage. More than half of the wide range type cases and more than a quarter of each of the localized type cases except the upper deep cervical type also had laryngeal edema, and eight of them needed emergency tracheotomy. Thirteen of the 40 cases had bacteria belonging to the Streptococcus milleri group (SMG), and all were detected in patients who underwent surgical drainage. Four of the 13 cases where SMG was detected showed drug resistance to some sorts of antibiotics.

Conclusion

Oral disorders can develop deep neck infection independently of the presence of diabetes mellitus, compared with other causes. The presence of diabetes mellitus is associated with deep neck infection, aggravating parotitis and wide spread of inflammation. Retrotonsillar abscess often spreads to the retropharyngeal and parapharyngeal spaces, causing mediastinitis, so caution is necessary. Infection due to SMG tends to form abscess independently of diabetes mellitus. Since more than half of the wide range type and more than a quarter of each of the localized types except the upper deep cervical type were associated with laryngeal edema, airway management should be considered.