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71.
Shunsuke Saito Goro Matsumiya Taichi Sakaguchi Tomoyuki Fujita Toru Kuratani Hajime Ichikawa Yoshiki Sawa 《Journal of artificial organs》2009,12(1):58-60
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. 相似文献
72.
Suárez-Rivera M Abadeer RA Kott MM Braun MC 《Pediatric nephrology (Berlin, Germany)》2008,23(5):827-830
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. 相似文献
73.
74.
Jun Hasegawa Hiroshi Hidaka Masaru TatedaTakayuki Kudo Shun SagaiMakiko Miyazaki Katsunori KatagiriAyako Nakanome Eiichi IshidaDaiki Ozawa Toshimitsu Kobayashi 《Auris, nasus, larynx》2011,38(1):101-107
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. 相似文献75.
A. Segalin L. Bonavina M. Lazzerini F. De Ruberto C. Faranda A. Peracchia 《Surgical endoscopy》1996,10(9):928-932
The endoscopic management of four selected patients with inveterate esophageal perforations or leaks is presented. One patient had a perforation of the cervical esophagus following endoscopic removal of a foreign body already treated with surgical drainage; two patients had a leak following diverticulectomy and esophagogastrostomy, respectively, persistent after multiple surgical repairs; the last patient had a spontaneous perforation of the thoracic esophagus persistent after two transthoracic repairs. The mean time elapsed between the diagnosis of perforation and the endoscopic treatment was 19 days. In one patient, transesophageal drainage of a mediastinal abscess was performed. In the other three patients, a stent was placed to seal the leak in combination with gastric and esophageal aspiration. Two of these patients underwent endoscopy in critical condition and could have not been candidates for major surgical procedures. All patients received enteral nutrition. No morbidity or mortality related to the endoscopic procedure was recorded; the treatment was effective in all patients who recovered and resumed oral feeding within 3 weeks. We conclude that endoscopic transesophageal drainage and stenting are effective procedures in the management of patients with inveterate esophageal perforations or leaks. 相似文献
76.
Dr. F. Thaler B. Gotainer G. Teodori C. Dubois Ph. Loirat 《Intensive care medicine》1992,18(2):127-128
Nocardia infection classically occurs in immuno-compromized patients. Only a few cases of mediastinal infection due to this pathogen have been described in the literature. We report a patient who developed mediastinitis due toNocardia asteroides after cardiac transplantation. The treatment was surgical debridment, dressing, sugaring and antibiotic therapy. The emergence of a severe acute renal failure possibly induced by drug interaction between Cyclosporin, cyclines and aminoglycosides, led us to modify the antimicrobial treatment. The intravenous use of Imipenem 2g per day and Ciprofloxacin 400 mg per day for four weeks and then oral Ciprofloxacin 1.5g per day for 1 year, was effective and allowed a good outcome, without any drug interaction with Cyclosporin, adverse effect, graft rejection episode or infection relapse. 相似文献
77.
Unilateral pectoralis major muscle flap for the treatment of sternal wounds due to Ludwig's angina
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Antonio Albacete Neto Pedro S Coltro Grazielle S Horácio Ivan R Almeida Jayme A Farina Junior 《International wound journal》2018,15(1):174-177
Necrotising descending mediastinitis may rarely originate from Ludwig's angina, which is an infection of the submandibular space. The use of the bilateral pectoralis major muscle flap for the treatment of sternal wound dehiscence is common, but reports of the unilateral application of this flap are scarce. This study aims to report the use of the unilateral pectoralis major muscle flap for the treatment of sternotomy dehiscence in a patient with mediastinitis due to Ludwig's angina. A 21‐year‐old male patient underwent an exploratory cervicotomy and median sternotomy for drainage of a submandibular infection that extended to the anterior, retropharyngeal and mediastinal cervical spaces. The patient had dehiscence of the sternal wound, and the unilateral pectoralis major muscle flap was used for reconstruction of the defect. This flap was able to completely cover the area of dehiscence of the sternotomy, and the patient presented a good postoperative evolution, without complications. The reconstruction technique using the unilateral pectoralis major muscle flap was considered a good option for the treatment of sternotomy dehiscence. It is an adjuvant method in the treatment of infections such as mediastinitis and osteomyelitis of the sternum secondary to Ludwig's angina, allowing a stable coverage of the sternum. 相似文献
78.
《Enfermedades infecciosas y microbiología clínica》2020,38(8):361-366
IntroductionMediastinitis is an infrequent but serious complication of cardiac surgery. Antimicrobial treatment guidelines are not well established. The aim was to describe the efficacy of sequential intravenous to oral therapy in selected post-surgical mediastinitis patients.MethodsA retrospective observational study including cases of mediastinitis after cardiac surgery, defined according to CDC criteria, at a third-level university hospital between January 2002 and December 2016. Sequential antimicrobial therapy was proposed in clinically stable patients. Rates of cure, relapse, and hospital stay were compared between patients who received sequential intravenous to oral therapy and those who received therapy exclusively by the intravenous route.ResultsEighty-one cases were included. Sequential intravenous to oral therapy was performed in 48 (59.3%) patients on median day 15. No differences in baseline characteristics or causal microorganisms were found between the two cohorts. The average duration of antibiotic therapy was 41.2 ± 10.09 days. The most commonly used drugs in sequential therapy were quinolones in 31 (64.6%) cases and rifampicin, always in association with another antibiotic, in 25 (52.1%). Hospital stay was shorter in the sequential therapy group (57.57 ± 34.03 vs. 84.35 ± 45.67; P = 0.007). Cure was achieved in 77 (92.8%) patients. Overall in-hospital mortality was less frequent in the group that received sequential therapy (2.1% vs. 15.2%; P = 0.039). There were no differences in relapse between the two cohorts (4.2% vs 9.1%; P = 0.366).ConclusionSequential antimicrobial treatment in selected patients with post-surgical mediastinitis may be as effective as exclusively intravenous treatment, reducing risks, hospital stay and associated costs. 相似文献
79.
Teresa Quintanar Verdúguez Adolfo Blanco Jarava María Blanca Martínez-Barbeito Cristina Pangua Méndez Luis López Gómez Jesús Andrade Santiago Ignacio Chacón López-Muñiz 《Clinical & translational oncology》2008,10(2):128-130
A 48-year-old woman with a diagnosis of breast carcinoma was treated with adjuvant chemotherapy through a central venous catheter with subcutaneous reservoir (Port-A-Cath). While doxorubicin was administered, the patient presented thoracic pain and breathing distress due to superior vena cava perforation by the central catheter and subsequent extravasation of the drug into the mediastinum. The patient recovered without sequelae with conservative therapy. Cytostatic extravasation via central catheter is an uncommon complication in clinical practice. In this paper we present the first doxorubicin extravasation through a central catheter in adults and review the only ten cases found in the literature. 相似文献
80.
M. Panduranga Kamath Ashok B. Shetty Mahesh Chandra Hegde Suja Sreedharan Kiran Bhojwani Padmanabhan K. Saurabh Agarwal Manoj Mathew Rajeev Kumar M. 《Indian journal of otolaryngology and head and neck surgery》2003,55(4):270-275
Objective To study the presentation, etiology, microbiology and morbidity of deep neck space infections.
Study Design Retrospective study Methods: 29 patients admitted in Kasturba Medical College Hospital, Mangulore, India between January 1997
and December 2002 with deep neck space infections.,were included in the study.
Remits The most common space involved was the parapharyngeul space. No specific etiology was determined in .38%; an odontogenic cause
was discovered in 28% of the patients; tonsillar/pharyngeal infections in 24% of patients and foreign body impaction in 7%
of cases. The main morbidity was due to mediastinitis (5 patients). I patient succumbed to the disease. Mixed flora with aerobic
and anaerobic infections was identified in most of the cases. 相似文献