ABSTRACT
Abstract Background: Acute mediastinitis is the inflammation of the connective tissue and fat surrounding the mediastinal structures. It is a high-mortality entity and its most frequent causes include sternotomy infections from cardiovascular surgery, esophageal perforation and extension of head and neck infections. Isolated cases of acute mediastinitis from hematogenous spread are described in the literature. Case presentation: 58 year-old man, with history of gouty arthritis managed with steroids, diagnosed with acute mediastinitis by S. aureus, secondary to septic arthritis of the ankle, managed with drainage of mediastinal collections by thoracoscopy and antibiotic therapy, with satisfactory evolution. Conclusions: In patients with acute mediastinitis, hematogenous dissemination should be considered when the etiologies most frequently associated with the entity are ruled out. Early surgical treatment derived from a multidisciplinary diagnostic approach improves the prognosis of these patients.
Resumen Antecedentes: la mediastinitis aguda es la inflamación del tejido conectivo y la grasa que rodea las estructuras mediastínicas. Es una entidad de alta mortalidad y sus causas más frecuentes incluyen infecciones de la esternotomia de la cirugía cardiovascular, perforación esofágica y extensión de infecciones de cabeza y cuello. Casos aislados de mediastinitis aguda por diseminación hematógena se describen en la literatura. Caso: Hombre de 58 años, con antecedente de artritis gotosa manejado con esteroides, diagnosticado de mediastinitis aguda por S. aureus, secundaria a artritis séptica de tobillo, manejada con drenaje de colecciones mediastínicas por toracoscopia y antibioterapia, con evolución satisfactoria. Conclusiones: En pacientes con mediastinitis aguda, se puede considerar la diseminación hematógena cuando las etiologías más frecuentemente asociadas a la entidad están descartados. El tratamiento quirúrgico precoz derivado de un abordaje diagnóstico multidisciplinar mejora el pronóstico de estos pacientes.
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Objective To investigate the metastasis and the prognosis of the axillary lymph nodes in triple-negative and invasive ductal breast cancer patients of different ages.Methods 321 female breast cancer patients diagnosed as triple-negative and invasive ductal carcinoma from Jan.1,2008 to Dec.31,2017 were selected as the samples,all of whom were treated with regular surgical treatment and postoperative radiotherapy and chemotherapy,and were divided into three groups according to their ages,including the younger group(＜40 years old),the middle age group (40 to 60 years old),and the elder group(≥60 years).We compared the metastasis of axillary lymph node,the disease-free survival rate after 1 to 5 years of the operations and the prognostic factors of the three groups.Results Among the 321 patients,there were 94 young patients,151 middle-aged patients and 76 elder patients.Among the three groups,the rate of axillary lymph nodes metastasis was the lowest in the elderly group(11.8％),the highest in the middle-aged group(17.2％)and middle in the young group(13.8％).The patients were followed up for 1 to 5 years.The recurrence rate of the young,middle-aged and elder groups was 56.4％,53.6％ and 17.1％ respectively.There was a significant difference between the three groups (P＜0.05).Conclusion ①he frequency of LN transfer in patients of TNBC is lower in the younger and the elder patients than in the middle-aged patients.②The younger patients of TNBC have a higher recurrence rate and poor prognosis,while the elder patients of TNBC have the lowest recurrence rate and good prognosis.(③The prognosis of TNBC may be related to metabolism,which,of course,needs to be further verified with the proof of blood and cell test.(④The younger patients of TNBC are more likely to suffer blood metastasis,and adjuvant systemic therapy in early period may be more beneficial than local radiotherapy and early axillary dissection.
ABSTRACT
La osteomielitis es una infección de hueso y médula ósea, que se debe a la inoculación de un microorganismo ya sea por contigüidad, directa o hematógena. Esta genera inflamación aguda, aumento de la presión intraósea, trombosis e isquemia que derivan en necrosis ósea. Para establecer el diagnóstico son necesarios la historia clínica, el examen físico, estudios de gabinete así como de imagen, entre ellos rayos X, ultrasonido, TAC, RM y estudios de medicina nuclear.
Osteomyelitis is an infection of bone and bone marrow, which is caused by the inoculation of a microorganism, either contiguous, directly or by hematogenous dissemination. The infection creates acute inflammation, increased intraosseous pressure, thrombosis and ischemia that result in bone necrosis. To establish the diagnosis medical history, physical examination, imaging studies and imaging, including X-rays, ultrasound, CT, MRI and nuclear medicine studies are needed.
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Humans , Osteomyelitis , StaphylococcusABSTRACT
Objective To determine the value of detection of micrometastasis in peripheral blood to hepatocellular carcinoma (HCC) metastasis or recurrence. Methods Reviewed the related literatures, the methods and significances of the detection of HCC micrometastasis in peripheral blood were analyzed. Results Currently, there are mainly two methods, hematogenous dissemination cell detection and HCC specific mRNA biomarker detection, for detection of HCC micrometastasis in peripheral blood. Theoretically, although they are considered as early detections of HCC metastasis or recurrence, researches still not have a abroad agreeable conclusion from different studies. After adjusting and improving the methods and detection time, different studies also have not gotten a quite consistent conclusion. Conclusion There is a great significance in detection of HCC micrometastasis in peripheral blood to understanding the mechanisms of HCC metatasis and recurrence, and also to improving the clinical therapy. Theoretically and practically, the method should be improved for facilitating the mechanism research of HCC metastasis and recurrence, and the application of detection.