جستجوی مقالات مرتبط با کلیدواژه « mediastinitis » در نشریات گروه « پزشکی »

Mediastinitis is a significant complication of open heart surgery and other thoracic operations. Deep sternal wound complications notably increase morbidity and mortality. The optimal treatment for deep sternal wounds following sternotomy remains a topic of discussion. Options such as repeated irrigation and debridement of the wound, closed chest catheter irrigation, and recent plastic surgery approaches like pectoralis major flap transposition all have their proponents.

Given the high prevalence of Deep Sternal Wound Infection (DSWI), we conducted this retrospective descriptive study. We used existing information to compare the conservative method of repeated irrigation and debridement with pectoralis major flap transposition. We presented the results using descriptive and analytic methods. We evaluated a total of 125 patient health records with deep sternal wound infection over a ten-year period (2003-2013).

The results of this study showed that 83.2% of patients who developed DSWI after surgery suffered from underlying diseases such as diabetes, renal failure, etc. However, no relationship was found between the presence of an underlying disease and recovery. Furthermore, no significant relationship was observed between diabetes and recovery. Among the 125 assessed files, 50 patients received a pectoralis flap, among which 48 patients recovered with sternal stabilization and only 2 patients recovered without stabilization. Conversely, among cases without pectoralis flapping, records were available for only 67 patients, of whom only 35 patients recovered with sternal stabilization while 32 patients recovered without sternal stabilization. Recovery was significantly enhanced in the group receiving flapping.

The only factor that improved the outcome in our assessment was the use of pectoralis flapping. This is consistent with the results of studies published in recent years that used plastic surgery methods, i.e., pectorals muscle or omentum flapping, which are associated with a high success rate and reduced length of inpatient stay.

Mediastinitis is a severe complication after cardiac surgery. The aim of this study was to determine the incidence of postoperative mediastinitis, the predictors of mediastinitis, and sternal dehiscence in adult cardiac surgery patients.

In this retrospective study, the records of 60 patients were evaluated regarding mediastinitis and dehiscence after cardiac surgery in a referral cardiovascular hospital in Tehran, Iran.

In the present study, 4360 patients underwent surgery over 18 months from September 2017 through March 2019. Of this total, 60 patients with a diagnosis of mediastinitis and sternal dehiscence were included in the study’s analysis. In our investigation, 1.03% of the cases (45/4360) had mediastinitis and 0.3% (15/4360) cases experienced sternal dehiscence. Among the many risk factors that were examined, there were significant differences between the mediastinitis and dehiscence groups regarding diabetes mellitus (P =0.007), a history of preoperative chronic kidney disease (P =0.02), a history of myocardial infarction (P =0.002), a history of arrhythmia before cardiac surgery (P =0.02), reoperation due to postoperative bleeding (P =0.07), the number of patients transferred to the ICU with the sternum left open (P <0.001), postoperative pulmonary complications (P =0.007), and postoperative arrhythmias (P =0.04).

There were significant differences between the mediastinitis and dehiscence groups regarding diabetes mellitus, a history of preoperative chronic kidney disease, myocardial infarction and arrhythmias before cardiac surgery, reoperation due to postoperative bleeding, the number of patients transferred to the ICU with the sternum left open, postoperative pulmonary complications, and postoperative arrhythmias. (Iranian Heart Journal 2021; 22(3): 6-12)

Parapharyngeal abscess is a life-threatening disease. Upper respiratory tract infection is the main cause in children. We present a 15-month-old boy admitted to the emergency ward with the chief complaint of difficulty in breathing caused by parapharyngealabscess. His condition deteriorated gradually, and he transferred to the operation theater quickly for abscess drainage and because of the difficulty in orotracheal intubation; a tracheostomy was performed. His respiratory condition deteriorated 2 days after PICU admission, and the medical team noticed an unexplainable respiratory distress. A chest x ray obtained and showed a right side pneumothorax and subcutaneous emphysema around theneck area. The case presented here, had not been diagnosed at the first examination; however, there were enough clinical clues (such as respiratory distress, drooling, torticollis, bulging of theneck, previous viral respiratory infection, possible pharyngeal trauma). The story of this case reminds us the importance of the precise physical exam and history taking which could be life-saving.

Spontaneous esophageal perforation or Boerhaave''s syndrome is an uncommon condition that may occur following forceful vomiting and lead to mediastinitis. It is associated with high mortality and morbidity in absence of therapy. We present a case of spontaneous esophageal perforation in a 63 year-old man who developed a right-sided effusion, an unusual presentation. This case report and the relevant literature reveal that delay in prompt surgical repair is associated with a high morbidity and mortality.

A 43-year-old man developed a mediastinal abscess after a redo aortic valve along with an ascending aorta replacement and also a sub-aortic membrane resection. He was surgically revised: as there were no signs of involvement of the valve and vascular prosthesis, a pedunculated tract of the greater omentum was mobilized and positioned around the aortic prosthesis. During a 10-month follow-up, it has been revealed that the patient is doing well and has no recurrence of the infection. Use of the great omentum could be considered in the selected mediastinitis cases.

A 43-year-old man was referred to our institution for a severe aortic regurgitation and an ascending aorta enlargement associated with a relapsing sub-aortic membrane, which had been treated in his childhood. He underwent a redo ascending aorta replacement and an aortic valve replacement (mechanical prosthesis) along with a resection of the relapsing sub-valvular membrane. Some weeks after he was admitted to another hospital for fever, arthromyalgias and chest pain. After a few days, he developed an inflammatory jugular swelling and underwent a chest CT scan showing a bulky anterior mediastinal abscess in the direct continuity with the sternum. A further chest CT scan showed a mediastinal para-aortic capsulated mass, 135 × 85 × 90 mm in dimension, well delimited over the surrounding plans. At the top of the lesion, a further fluid collection was appreciated, extending through the sternum over the subcutaneous tissues, 30 × 20 mm in dimension. Re-sternotomy was performed and the mediastinal mass was opened and drained. After an extension of the median sternotomy through the epigastrium, a pedunculated tract of the greater omentum was mobilized and positioned around the vascular prosthesis to fill the empty space left by the abscess.

The greater omentum is well known in cardiothoracic surgery for its valuable features such as plasticity, immune competence, good blood supply and neovascularization-potential. Dead space can be obliterated by omental flap because of its plasticity qualities. It contains a large number of immunologically active cells likely to be responsible for its anti-infective properties. We can affirm that use of the great omentum could be considered in selected post-operative mediastinitis cases after cardiac surgery.

Purulent mediastinitis is an unusual complication of median sternotomy. This complication often occurs shortly, usually within two weeks, after surgery. This study has been planned to clarify the situation of life-threatening infectious complications after surgical operations at our center and to better the ways of prevention as much as possible.
In this study, all the patients who had undergone median sternotomy were observed over a 4-year period. The documentation of the diagnoses was completed, information about the patients including demographic characteristics, type of surgery, pre-, intra- and postoperative risk factors, clinical and laboratory findings, etiological diagnoses, responsible organisms, management methods and finally the outcome of the patients were collected and analyzed by a statistical software (SPSS-Win).
1.2, and 15% needed preoperative intra aortic balloon pump. The mortality rate was 31%.
This complication is distinguished by its clinical manifestations and positive culturing from the mediastinum. Microbial etiology is influenced by the source of contamination and must be recognized for any center separately. A combination of antimicrobial therapy and surgical intervention has better results. A better evaluation of the patients’ preoperative conditions, promotion of surgical techniques and preventive measures, and an early diagnosis of mediastinitis will be effective in the reduction of this
complication