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infected mediastinitis

Marina Pieri, Anna Mara Scandroglio, Marcus Müller, Panagiotis Pergantis, Alexandra Kretzschmar, Friedrich Kaufmann, Volkmar Falk, Thomas Krabatsch, Georg Arlt, Evgenij Potapov, Marian Kukucka
BACKGROUND AND AIM OF THE STUDY: Driveline infections in patients with implantable left ventricular assist devices (VAD) carry increasing risk for pump infection, thromboembolic events, decreased quality of life, and increased hospitalization. We report our experience with a surgical technique for refractory driveline infections without mediastinitis consisting of translocation and wrapping of the driveline with greater omentum tissue. METHODS: We retrospectively reviewed data of VAD patients who underwent surgical treatment by translocation and wrapping with omentum for severe chronic driveline infection...
October 20, 2016: Journal of Cardiac Surgery
Hanlu Zhang, Yingcai Geng, Yu Zheng, Yun Wang
A 68-year-old female was admitted to our hospital with an acute episode of chest pain, progressive cough and fever. She underwent trans-subxiphoid video-assisted thoracoscopic extended thymectomy (TsVATET) for thymoma with myasthenia gravis (MG) 9 days ago. Chest computed tomography (CT) showed anterior mediastinal oedema, and infiltrative findings involved bilateral lung. Physical examination revealed the subxiphoid wound suppuration. We diagnosed subxiphoid incision infection, anterior mediastinitis and concomitant bilateral pneumonia...
September 2016: Journal of Thoracic Disease
Andrej Spec, Christopher R Barrios, Usama Ahmad, Laurie A Proia
Severe pulmonary or disseminated histoplasmosis often necessitates presumptive antifungal treatment while awaiting definitive diagnosis. Histoplasma antigen assays have improved sensitivity but results may lag up to 7 days. In order to increase diagnostic certainty, "soft clues" may be looked for in laboratory and radiologic data, such as elevated alkaline phosphatase or ferritin levels and findings of mediastinal adenopathy or hepatosplenomegaly. To determine if elevated aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio is specific to histoplasmosis or a non-specific marker for disseminated fungal infection or sepsis in general, we retrospectively examined records of all patients diagnosed with an endemic fungal infection (EFI) at Rush University Medical Center from January of 1997 to October of 2012, and a cohort of septic patients with elevated liver enzymes...
October 14, 2016: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
Jiwon Sarah Park, Jennifer H Kuo, J Nilas Young, Michael S Wong
BACKGROUND: Rigid sternal fixation (RSF) has been shown to reduce sternal wound complications in high-risk patients. However, the higher initial cost continues to deter its use. This study evaluates the cost of caring for high-risk sternotomy patients who underwent RSF compared with those who underwent sternal closure with a modified wire technique (MWT). METHODS: A retrospective single institution review of high-risk patients who underwent MWT (n = 45) and RSF (n = 30) for primary sternal closure from 2006 to 2009 was conducted...
October 6, 2016: Annals of Plastic Surgery
Stephanie Tan, Dimitrios Nikolarakos
Although less frequently encountered in dental practices, subcutaneous emphysema of the face and neck has been reported in patients following dental extractions, particularly when lower molar teeth are extracted with the use of a high speed air turbine drill designed for restorative treatment, which forces air into the cervical fascial spaces. As facial swelling and pain are the most common presentations, subcutaneous emphysema can often be misdiagnosed as an allergic reaction or odontogenic infection. While usually a benign and self limiting condition, subcutaneous emphysema may have life threatening complications such as tension pneumothorax, cardiac tamponade, air embolism, tracheal compression and mediastinitis, which are important to recognise in an emergency setting...
October 14, 2016: Australian Dental Journal
Kristen Nelson-McMillan, Christoph P Hornik, Xia He, Luca A Vricella, Jeffrey P Jacobs, Kevin D Hill, Sara K Pasquali, Diane E Alejo, Duke E Cameron, Marshall L Jacobs
BACKGROUND: Delayed sternal closure (DSC) is commonly used to optimize hemodynamic stability after neonatal and infant heart surgery. We hypothesized that duration of sternum left open (SLO) was associated with rate of infection complications, and that location of sternal closure may mitigate infection risk. METHODS: Infants (age ≤365 days) undergoing index operations with cardiopulmonary bypass and DSC at STS Congenital Heart Surgery Database centers (from 2007 to 2013) with adequate data quality were included...
October 6, 2016: Annals of Thoracic Surgery
Narendra Kumar Narahari, Paramjyothi K Gongati, Shantveer G Uppin, Anu Kapoor, Bhaskar Kakarla, Ramakrishna Dev Tella
A 66-year-old man presented with dry cough and shortness of breath on exertion of 6 months' duration. There were no complaints of fever and hemoptysis. His history was significant for recurrent episodes of respiratory tract infections over the previous 4 years. He had also had episodes of recurrent otitis media and pus discharge from the left ear for 3 years, with progressive loss of hearing. There was no history of recurrent skin infections or diarrhea. He was treated symptomatically with antibiotics by local general practitioners...
October 2016: Chest
Dario Amore, Francesco S Cerqua, Fabio Perrotta, Antonio Cennamo, Carlo Curcio
INTRODUCTION: The mediastinal bronchogenic cysts represents 50%-60% of mediastinal cysts and rarely occurs in the posterior mediastinum. The final surgical resection is indicated for symptomatic patients and is recommended for some asymptomatic patients in order to establish the diagnosis and to avoid any subsequent complications. CASE PRESENTATION: We report a case of 17 years-old male suffering from bronchogenic cysts of the mediastinum. The patient was admitted to our hospital complaining with dry chough and dyspnea; CT scan showed a cystic mass in posterior mediastinum...
September 23, 2016: International Journal of Surgery Case Reports
Paolo Cariati, Almudena Cabello-Serrano, Fernando Monsalve-Iglesias, Maria Roman-Ramos, Blas Garcia-Medina
Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis...
October 2016: Journal of Clinical and Experimental Dentistry
Hannah K Bayes, Neil D Ritchie, Thomas J Evans
Chronic pulmonary infection with Pseudomonas aeruginosa is a feature of cystic fibrosis (CF) and other chronic lung diseases. Cytokines of the IL-17 family have been proposed as important in the host response to P. aeruginosa infection through augmenting antibacterial immune responses, although their pro-inflammatory effect may contribute to lung damage that occurs as a result of chronic infection. We set out to explore the role of IL-17 in the host response to chronic P. aeruginosa infection. We used a murine model of chronic pulmonary infection with CF-related strains of P...
October 3, 2016: Infection and Immunity
Todd C Crawford, J Trent Magruder, Joshua C Grimm, Christopher M Sciortino, Kaushik Mandal, Kenton J Zehr, Duke E Cameron, Glenn J Whitman, John V Conte
BACKGROUND: Mediastinal reexplorations for bleeding are associated with significant morbidity and mortality. This study hypothesized that bleeding patients who undergo delayed chest closure after an initial operation experience similar outcomes in comparison with patients who have initial chest closure and later require an unplanned reexploration. METHODS: This study included all patients in the Johns Hopkins University School of Medicine (Baltimore, MD) institutional Society of Thoracic Surgeons (STS) database who underwent cardiac surgical procedures or thoracic transplantation from 2011 to June 2014, had an intraoperative red blood cell transfusion requirement of 2 units or more, and required mediastinal reexploration for bleeding...
September 22, 2016: Annals of Thoracic Surgery
Juan M Vrancic, Fernando Piccinini, Mariano Camporrotondo, Juan C Espinoza, Juan I Camou, Francisco Nacinovich, Pablo Fernandez Oses, Daniel Navia
BACKGROUND: There is controversy about the risk of mediastinitis associated with the use of both internal thoracic arteries (ITA). METHODS: We performed a case-control study of patients operated on at a single institution from January 2003 to December 2014. A total of 3,118 consecutive patients undergoing isolated coronary artery bypass graft surgery were included; 81.3% (n = 2,533) underwent bilateral ITA (BITA) grafts exclusively and constitute the BITA group, and 18...
September 19, 2016: Annals of Thoracic Surgery
Hengxing Liang, Wenliang Liu, Sichuang Tan, Fenglei Yu
Aortoesophageal fistula (AEF) is a rare but fatal complication caused by foreign body ingestion. Aortic replacement and endovascular stent graft are the common repair surgeries. The materials to repair an aortic defect in AEF are typically homograft or allograft, but the use of an autologous pericardium patch is rarely reported. Here we reported a patient with AEF and severe mediastinal infection induced by chicken bone ingestion. In this case, the autologous pericardium patch was used as the repair material...
September 28, 2016: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
Ronald Tan, Joanne Martires, Nader Kamangar
Fibrosing mediastinitis is a rare condition defined by the presence of fibrotic mediastinal infiltrates that obliterate normal fat planes. It is a late complication of a previous granulomatous infection, such as histoplasmosis or tuberculosis (TB). Due to its rarity, fibrosing mediastinitis is often under-recognized, and the clinical presentation is variable and dependent on the extent of infiltration or encasement of structures within the mediastinum. We present a case of fibrosing mediastinitis in a man with a prior history of TB, who presented with progressive dyspnea and was found to have chronic mediastinal soft tissue opacities and pulmonary hypertension...
2016: Journal of Clinical Imaging Science
Hao Chen, Guobing Xu, Bin Zheng, Wei Zheng, Yong Zhu, Zhaohui Guo, Chun Chen
BACKGROUND: In this study, we evaluate the feasibility and safety of single-port video-assisted thoracoscopic surgery (VATS) sleeve lobectomy (SL) and systematic mediastinal lymphadenectomy and summarize our surgical experience. METHODS: From October 2014 to December 2015, eight cases of single-port VATS SL [seven male patients and one female patient, median age 56.0 (range, 38-63) years] were performed by a single group of surgeons in Fujian Medical University Fujian Union Hospital...
August 2016: Journal of Thoracic Disease
Seth J Kligerman, Aaron Auerbach, Teri J Franks, Jeffrey R Galvin
Castleman disease is a complex lymphoproliferative disease pathologically divided into two subtypes, the hyaline vascular variant (HVV) and the plasma cell variant (PCV). The HVV is the most common, is thought to represent a benign neoplasm of lymph node stromal cells, and is treated with surgical resection. It is most commonly found in the mediastinum, where it classically appears as a unicentric, avidly enhancing mass at computed tomography (CT) and magnetic resonance imaging. This appearance can mimic other avidly enhancing mediastinal masses, and location, clinical history, laboratory data, and nuclear medicine single photon emission CT (SPECT) and positron emission tomography (PET) studies can help narrow the differential diagnosis...
September 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Jorge Barrios-Payán, Alberto Revuelta, Dulce Mata-Espinosa, Brenda Marquina-Castillo, Enrique Becerril Villanueva, María Eugenia Hernández Gutiérrez, Gilberto Pérez-Sánchez, Lenin Pavón, Rogelio Hernandez-Pando
The role of norepinephrine (NE) in the immunopathology of experimental tuberculosis (TB) was studied by measuring pulmonary NE and determining its cellular sources and targets. Functional studies were performed administrating adrenergic and anti-adrenergic drugs at different TB phases. Results showed high production of NE during early infection by adrenergic nerve terminals and lymphocytes located in the lungs and mediastinal lymph nodes, these cells highly expressed β2 adreno-receptors (β2AR) which by an autocrine mechanism promote Th-1 cell differentiation favoring protection...
September 15, 2016: Journal of Neuroimmunology
Jana P Lovell, Christa S Zerbe, Kenneth N Olivier, Reginald J Claypool, Cathleen Frein, Victoria L Anderson, Alexandra F Freeman, Steven M Holland
RATIONALE: Mycobacterium kansasii usually causes chronic pulmonary infections in immunocompetent patients. In contrast, disseminated M. kansasii disease is commonly associated with advanced HIV infection, but is reported infrequently in other immunocompromised patients. OBJECTIVES: To identify common clinical manifestations and potential risk factors for M. kansasii infection in patients with GATA2 deficiency. METHODS: We reviewed M. kansasii disease associated with GATA2 deficiency at one institution and disease associated with primary and other immunodeficiencies reported in the literature...
September 8, 2016: Annals of the American Thoracic Society
Jorge Alvarado Socarras, Juan P Rojas Torres, José A Vargas Soler, Carlos Guerrero
Invasive fungal infections are a considerable cause of morbidity, mortality, increased hospital stay durations, and high health care costs, during neonatal period. In this period, the premature infants are the most affected. Candida species are the leading cause of invasive fungal infections. The majority of neonatal Candida infections are caused by C. albicans, C. parapsilosis, C. glabrata and C. tropicalis, although other fungus species are being reported. One such emerging pathogen is K. ohmeri. This organism has been reported as a pathogen in the neonatal period, principally in premature infants...
October 1, 2016: Archivos Argentinos de Pediatría
Dong Jung Kim, Yoon Chul Shin, Dong Jin Kim, Jun Sung Kim, Cheong Lim, Kay-Hyun Park
OBJECTIVE: This study aimed to investigate the efficiency and safety of resternotomy performed in the intensive care unit (ICU) for emergent bleeding control after cardiac surgery when transport of the patient to the operating room (OR) was unsafe or delayed. METHODS: Medical records were retrospectively reviewed for 101 patients who underwent resternotomy for bleeding control after cardiac surgery between July 2003 and July 2013. A reoperation was performed in the OR for 61 patients (the OR group) and in the ICU for 40 patients (the ICU group)...
September 7, 2016: Journal of Cardiac Surgery
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