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1.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 971-976, jan.-dez. 2020. graf, tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1119071

ABSTRACT

Objetivos: Identificar os fatores de risco pré e pós-operatórios relacionados ao desenvolvimento de mediastinite entre pacientes submetidos à cirurgia cardíaca em um hospital da cidade do Rio de Janeiro, caracterizar a população estudada e analisar a relação entre os fatores de risco e a incidência de mediastinite nos pacientes submetidos à cirurgia cardíaca. Método: Estudo descritivo, abordagem quantitativa, em que foram identificados os fatores de risco para mediastinite em pacientes que realizaram cirurgia cardíaca em um hospital do Rio de Janeiro. Resultados: Obteve-se um n de 192 pacientes, de maioria homens, na faixa etária de 50 a 69 anos e em sobrepeso. Diabetes mellitus e tabagismo foram as comorbidades mais frequentes, e CRVMC a cirurgia mais realizada, 4 pacientes apresentaram mediastinite. Conclusão: A identificação destes fatores contribui para elaboração de estratégias de prevenção para mediastinite, e na implementação de cuidados de enfermagem no pré e pós-operatório de cirurgias cardíacas


Objectives: To identify pre and postoperative risk factors related to the development of mediastinitis among patients submitted to cardiac surgery at a hospital in the city of Rio de Janeiro, to characterize the study population and to analyze the relationship between risk factors and the incidence of mediastinitis in patients undergoing cardiac surgery. Method: descriptive study, quantitative approach, in which the risk factors for mediastinitis were identified in patients who underwent cardiac surgery in a hospital in Rio de Janeiro. Results: a n of 192 patients, mostly males, aged 50 to 69 years and overweight were obtained. Diabetes mellitus and smoking were the most frequent comorbidities, and CRVMC the most performed surgery, 4 patients had mediastinitis. Conclusion: the identification of these factors contributes to the elaboration of prevention strategies for mediastinitis, and the implementation of nursing care in the pre and postoperative period of cardiac surgeries


Objetivos: Identificar los factores de riesgo pre y postoperatorios relacionados al desarrollo de mediastinitis entre pacientes sometidos a la cirugía cardiaca en un hospital de la ciudad de Río de Janeiro, caracterizar a la población estudiada y analizar la relación entre los factores de riesgo y la incidencia de mediastinitis en los pacientes sometidos a la cirugía cardiaca. Método: Estudio descriptivo, abordaje cuantitativo, en que se identificaron los factores de riesgo para la mediastinitis en pacientes que realizaron una intervención cardiaca en un hospital de Río de Janeiro. Resultados: Se obtuvo un n de 192 pacientes, de mayoría hombres, en el grupo de edad de 50 a 69 años y en sobrepeso. La diabetes mellitus y el tabaquismo fueron las comorbilidades más frecuentes, y CRVMC la cirugía más realizada, 4 pacientes presentaron mediastinitis. Conclusión: La identificación de estos factores contribuye a la elaboración de estrategias de prevención para la mediastinitis, y en la implementación de cuidados de enfermería en el pre y postoperatorio de cirugías cardíacas


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Postoperative Complications/prevention & control , Thoracic Surgery/statistics & numerical data , Mediastinitis/epidemiology , Postoperative Complications/epidemiology , Surgical Wound Infection/complications , Retrospective Studies , Risk Factors , Mediastinitis/complications
2.
Rev. bras. cir. cardiovasc ; 34(4): 406-411, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020486

ABSTRACT

Abstract Objective: To describe a new technique of sternal closure, modified from the conventional figure-of-eight approach, which can provide a secure closure and prevent sternal complications. Methods: The modified technique is based on the intercalation of the caudal portion of each steel wire passed along the sternum. This is a retrospective analysis of patients operated with this modified technique at our institution between January 2014 and December 2016. Results: One hundred and forty-three patients underwent sternal closure with the modified technique. In-hospital mortality rate was 1.4% (n=2). No sternal instability was observed at 30 days postoperatively. Two patients developed mediastinitis that required extraction of the wires. Conclusion: Short-term results have shown that the modified sternal closure technique can be used safely and effectively, with complications rates being consistent with worldwide experience.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Sternum/surgery , Surgical Wound Dehiscence/prevention & control , Suture Techniques/instrumentation , Wound Closure Techniques/instrumentation , Postoperative Complications/prevention & control , Postoperative Period , Surgical Wound Dehiscence/etiology , Bone Wires/adverse effects , Retrospective Studies , Risk Factors , Suture Techniques/adverse effects , Wound Closure Techniques/mortality , Mediastinitis/complications
3.
Rev. bras. cir. cardiovasc ; 34(1): 85-92, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985239

ABSTRACT

Abstract Sclerosing mediastinitis (SM), previously named chronic fibrosing mediastinitis, is an inflammatory process that in its end-stage results to sclerosis around the mediastinal structures. SM is quite rare and has been correlated with inflammatory and autoimmune diseases, as well as malignancy. SM may either present in a mild form, with minor symptoms and a benign course or in a more aggressive form with severe pulmonary hypertension and subsequent higher morbidity and mortality. The diagnosis of SM may be difficult and quite challenging, as symptoms depend on the mediastinal structure that is mainly involved; quite often the superior vena cava. However, practically any mediastinal structure may be involved by the fibrotic process, such as the central airways, as well as the pulmonary arteries and veins, leading to obstruction or total occlusion. The latter may be impossible to undergo proper surgical excision of the lesion, and is considered to be a real challenge to the surgeon. We herein report a case of SM that presented with arterial and venous compression. The imaging appearance was that of unilateral pulmonary edema, associated with lung collapse. The case is supplemented by a non-systematic review of the relevant literature.


Subject(s)
Humans , Female , Adult , Pulmonary Edema/etiology , Pulmonary Atelectasis/etiology , Sclerosis/complications , Mediastinitis/complications , Pulmonary Edema/diagnostic imaging , Pulmonary Atelectasis/pathology , Pulmonary Atelectasis/diagnostic imaging , Biopsy , Radiography, Thoracic , Tomography, X-Ray Computed , Constriction, Pathologic/pathology , Constriction, Pathologic/diagnostic imaging , Heart Atria/pathology , Heart Atria/diagnostic imaging , Mediastinitis/pathology , Mediastinitis/diagnostic imaging
4.
Rev. cuba. cir ; 56(3): 1-9, jul.-set. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-900988

ABSTRACT

Introducción: la mediastinitis aguda constituye una complicación grave de la perforación esofágica. No existen clasificaciones ni pautas generales para su tratamiento. Objetivo: desarrollar una clasificación evolutiva, y un algoritmo de tratamiento quirúrgico. Métodos: se efectuó una investigación en el Hospital Provincial Saturnino Lora, de Santiago de Cuba, desde 1990 hasta el 2014. Se utilizó la prueba chi cuadrado de homogeneidad para la validación de los resultados, así como el porcentaje como medida de resumen y el calcula de las tasas de incidencia y de mortalidad. El estudio incluyó dos diseños metodológicos: el primero, de desarrollo tecnológico, para la elaboración de la clasificación y el algoritmo de tratamiento, y un cuasiexperimento, para la aplicación del algoritmo. Resultados: se identificó que en los estados más severos de la mediastinitis aguda, la mortalidad es más elevada. La carga de mortalidad para el primer grupo de pacientes fue del 77,7 por ciento y descendió al 22,3 por ciento en el grupo tratado con el algoritmo (decremento del riesgo del 64,8 por ciento). Conclusiones: la clasificación evolutiva pauta la implementación del algoritmo de tratamiento quirúrgico de la enfermedad. La aplicación del algoritmo de tratamiento quirúrgico de la mediastinitis aguda por perforación esofágica permite disminuir la carga de morbilidad. En consecuencia, disminuye de forma relevante el riesgo de morir por esta enfermedad(AU)


Introduction: acute mediastinitis is a serious complication of esophageal perforation. There are no classifications or general guidelines for its treatment. Objective: to develop an evolutionary classification and a surgical treatment algorithm. Methods: aresearch was carried out at Saturnino Lora Provincial Hospital in Santiago de Cuba, from 1990 to 2014. The chi-square homogeneity test was used for the validation of the results, as well as the percentage as a summary measure and the calculation of incidence rates and mortality. The study included two methodological designs: the first, technological development, for the elaboration of the classification and the treatment algorithm, and a quasi-experiment for the application of the algorithm. Results: in the more severe states of acute mediastinitis, mortality was identified as higher. The mortality load for the first group of patients was 77.7 percent and decreased to 22.3 percent in the group treated with the algorithm (risk reduction of 64.8 percent). Conclusions: the evolutionary classification guides the implementation of the surgical treatment algorithm of the disease. The application of the surgical treatment algorithm of acute mediastinitis through esophageal perforation allows reducing the burden of morbidity. Consequently, the risk of dying from this disease decreases significantly(AU)


Subject(s)
Humans , Esophageal Perforation/therapy , Esophagectomy/methods , Mediastinitis/complications , Morbidity
5.
Medisan ; 21(8)ago. 2017.
Article in Spanish | LILACS | ID: biblio-997598

ABSTRACT

En situaciones de urgencia, la cirugía constituye un desafío a la pericia de los cirujanos, sobre todo cuando se trata de la perforación del esófago, que es una de las roturas orgánicas más graves y complejas de todo el tracto digestivo. Esto ocurre debido a las características anatómicas del órgano, que además, está rodeado de tejidos laxos y cavidades fasciales virtuales; por ello, su perforación permite que la infección se disemine rápidamente en el mediastino, la pleura y el pericardio, lo cual provoca que la mortalidad por mediastinitis aguda sobrepase el 60 por ciento.


Surgery constitutes a challenge to surgeons skill, in situations of emergency mainly when it is an esophageal perforation which is one of the most serious and complex organic breaks in the whole digestive tract. This happens due to the anatomical characteristics of the organ that is also surrounded by relaxed tissues and virtual fascia cavities; reason why, its perforation allows the infection to be quickly disseminated in the mediastinal cavity, pleura and pericardium, which causes that mortality due to acute mediastinitis exceeds the 60 percent.


Subject(s)
Humans , Male , Female , Esophageal Perforation/etiology , Esophageal Perforation/mortality , Mediastinitis/complications , Communication
6.
Rev. bras. cir. plást ; 31(3): 391-397, 2016. ilus
Article in English, Portuguese | LILACS | ID: biblio-2308

ABSTRACT

INTRODUÇÃO: A mediastinite pós-operatória é uma condição grave, com altas taxas de mortalidade. O retalho de omento maior é usado com êxito no tratamento de mediastinites pós-operatórias decorrentes de cirurgia cardíaca. O uso dessa abordagem não foi relatado em lactentes, provavelmente porque nessa idade o omento maior é membranáceo, pouco volumoso e possui tecido adiposo escasso. MÉTODOS: Entre julho de 2010 e agosto de 2014, foram tratados quatro lactentes com mediastinite pós-operatória decorrentes de cirurgia cardíaca, realizada por esternotomia. O tratamento cirúrgico consistiu em remoção dos fios de aço da osteossíntese esternal, desbridamento e lavagem do mediastino, seguidos da transposição de todo o omento maior para a cavidade mediastinal. O tratamento cirúrgico foi feito em um só tempo. Não foi feita nova síntese do esterno com fios de aço. RESULTADOS: Os quatro pacientes sobreviveram ao tratamento e obtiveram alta da unidade de tratamento intensivo sem infecção. CONCLUSÕES: Embora membranáceo e apresentando pequeno volume, o retalho de omento maior se mostrou um excelente método de abordagem da mediastinite pós-operatória do lactente.


INTRODUCTION: Postoperative mediastinitis is a serious condition that presents high mortality rates. The greater omentum flap has been used with good results in postoperative mediastinitis after cardiac surgery. The use of this approach has not been reported in infants probably because at this age, the greater omentum is membranous, not bulky, and has little amount of fatty tissue. METHOD: Between July 2010 and August 2014, four infants who presented with mediastinitis after a cardiac surgery via sternotomy were treated. The surgical treatment consisted of steel wire removal, debridement, and wound washing, followed by transposition of the entire greater omentum to the mediastinal cavity. Surgical treatment was performed in a single step. No rewiring of the sternum was performed. RESULTS: All four patients survived the treatment and were discharged from the intensive care unit without infection. CONCLUSIONS: Although membranous and not bulky, the use of a greater omentum flap proved to be an excellent approach in infant postoperative mediastinitis.


Subject(s)
Humans , Male , Female , Infant , History, 21st Century , Omentum , Postoperative Complications , Cardiovascular Surgical Procedures , Therapeutics , Review , Sternotomy , Infant , Mediastinitis , Mediastinum , Omentum/surgery , Omentum/pathology , Postoperative Complications/surgery , Cardiovascular Surgical Procedures/adverse effects , Cardiovascular Surgical Procedures/methods , Therapeutics/adverse effects , Therapeutics/methods , Sternotomy/adverse effects , Sternotomy/methods , Mediastinitis/surgery , Mediastinitis/complications , Mediastinitis/mortality , Mediastinum/surgery , Mediastinum/injuries
7.
Rev. chil. cir ; 67(2): 191-194, abr. 2015. ilus
Article in Spanish | LILACS | ID: lil-745081

ABSTRACT

Introduction: Mediastinal abscess (MA) is a rare disease in the adult population. Generally presents as a systemic inflammatory response syndrome (SIRS) with high morbidity and mortality. The prognosis improves with an early diagnosis associated with an aggressive surgical drainage. Clinical case: We report a clinical case with a MA with an unusual spontaneous extension across the chest wall.


Introducción: Los abscesos mediastínicos (AM) son una patología poco frecuente en la población adulta. Su presentación clínica más habitual es la de un síndrome de respuesta inflamatoria sistémica (SIRS) con una elevada morbimortalidad. Su pronóstico mejora con un diagnóstico temprano asociado a un drenaje quirúrgico agresivo y precoz. Caso clínico: Presentamos un caso clínico de un AM con una inusual extensión espontánea a través de la pared torácica.


Subject(s)
Humans , Male , Adult , Abscess/surgery , Abscess/complications , Drainage , Mediastinitis/surgery , Mediastinitis/complications , Abscess , Mediastinitis , Necrosis , Tomography, X-Ray Computed
8.
Rev. bras. cir. cardiovasc ; 23(4): 507-511, out.-dez. 2008. ilus
Article in English, Portuguese | LILACS | ID: lil-506034

ABSTRACT

OBJETIVO: Demonstrar a experiência com a reconstrução da parede torácica utilizando suporte metálico como redutor da tensão nas linhas de sutura do retalho miocutâneo em casos de mediastinite. MÉTODOS: No período de julho de 2001 a fevereiro de 2006, foram realizadas 1389 cirurgias cardíacas em nossa instituição, das quais oito (0,6 por cento) evoluíram com mediastinite. Sete pacientes eram do sexo masculino, com idade média de 56,7 anos. Os fatores de risco para infecção foram diabetes e obesidade em sete e desnutrição em um caso. Sete pacientes haviam sido submetidos à cirurgia de revascularização do miocárdio e um, à correção de cardiopatia congênita. A reconstrução da parede torácica consistiu na colocação percutânea de fios de Kirschner paralelos às bordas da ferida para ancoramento das suturas do plano muscular, reduzindo a tensão nos bordos livres da ferida, de modo a permitir a sutura convencional do tecido subcutâneo e pele. RESULTADOS: Ocorreu um óbito no pós-operatório imediato por arritmia e um tardio por sepse. Os demais pacientes apresentaram evolução pós-operatória satisfatória, com boa cicatrização da ferida após a remoção das hastes metálicas, no 21º dia de pós-operatório e no seguimento de 6 a 54 meses. CONCLUSÃO: Neste grupo de pacientes, a reconstrução da parede torácica com a utilização temporária de hastes metálicas mostrou-se um procedimento seguro, eficaz e com bom resultado estético e funcional.


OBJECTIVE: To demonstrate the experience with the reconstruction of the chest wall utilizing metal brace to reduce the tension in the suture lines of myocutaneous flap in cases of mediastinitis. METHODS: From July 2001 to February 2006, 1389 heart surgeries were performed in our institution of which eight (0.6 percent) developed mediastinitis. Seven were male and the mean age was 56.7 years. The risk factors for infection were diabetes and obesity in seven and malnutrition in one case. Seven patients had been undergone CABG and one repair of a congenital heart disease. The chest wall reconstruction consisted of percutaneous insertion of Kirshner wires parallel to the edges of the wound for anchoring of sutures to the muscular plane in order to allow the reduction of tension in the free edges of the wound and subsequent closure of the subcutaneous tissue and skin. RESULTS: There was one death in the immediate postoperative due to arrhythmia and one late death secondary to sepsis. The remaining patients presented satisfactory postoperative course with good healing of the wound after the removal of the metal braces on the 21th postoperative day and in the follow-up of 6 to 54 months. CONCLUSION: The reconstruction of the chest wall utilizing temporary metal braces showed to be a safe and effective procedure with good aesthetic and functional outcomes in this group of patients.


Subject(s)
Female , Humans , Male , Middle Aged , Braces , Cardiac Surgical Procedures , Mediastinitis/complications , Plastic Surgery Procedures/methods , Thoracic Wall/surgery , Bone Wires , Follow-Up Studies , Risk Factors , Plastic Surgery Procedures/adverse effects , Suture Techniques , Sternum/surgery , Surgical Wound Infection/etiology , Treatment Outcome , Wound Healing/physiology
9.
New Egyptian Journal of Medicine [The]. 2007; 36 (4 Supp.): 16-30
in English | IMEMR | ID: emr-127215

ABSTRACT

Bypassing an obstructed superior vena cava represents a challenge to the surgeon due to absence of a suitable graft with a good long term patency. This study was conducted to assess the technique used to fashion the spiral saphenous vein graft, clinical improvement of the patients and postoperative patency of the fashioned graft with mid term follow up. This study was prospectively carried out in the sections of cardiotboracic surgery and chest internal medicine of Kasr El Aini Faculty of Medicine as well as private practice between 1999 and 2006. Eight patients suffering from SVC obstruction due to a nonmalignant cause were submitted to this study. A benign aetiology was proved in all 8 cases [100%]. Thoracic CT scanning showed idiopathic fibro sing mediastinitis in a five patients [62.5%] and dense mediastinal scarring with enlargement of different mediastinal lymph node groups for chronic non-specific mediastinal granuloma in a single patient [12.5%] whereas 2 patients had Behcet Syndrome [25%]. Preoperative tissue diagnosis confirming benignity and excluding malignancy by lymph node sampling of one or two different groups in the thorax: the left supraclavicular group in 4 cases [50%]; axillary group 1 case [12.5%]; or the in ternal mammary group in 3 cases [37.5%]. Preoperatively, these patients were following different regimens of medical treatment that included diuretics. bronchodilatois, as well us corticosteroids. The Saphenous Vein Graft [SVG], harvested from the medial aspect of the thigh, was fashioned spirally and sutured using 7/0 prolene to form a tube graft that was anastomosed proximally to the patent left innominate vein and distally to the right atrial appendage. None of our patients died. All 8 patients had prompt relief of their symptoms [upper limbs, head and neck congestion, and the severe dyspnea and orthopnoea] immediately after surgery together with disappearance of dilated superficial veins, and the negative need for medical treatment, In a mean post operative follow- up period of 3 years and 3 months, 7 patients [87.5%] remained symptom-free with a patent graft visualized by venography. Only one patient [12.5%], who had hypercoagulability due to Behcet syndrome, needed revision of the graft after he stopped Warfarin anticoagulation. In our experience, fashioning the SVG in a spiral manner represented an appealing option as a bypass conduit. Using it to bypass the obstructed SVC in non-malignant cases of SVC occlusion, showed sound safety, alleviated symptomatology, and provided a good postoperative patency rate


Subject(s)
Humans , Male , Female , /transplantation , Mediastinitis/complications , Tomography, X-Ray Computed
10.
J. bras. pneumol ; 32(1): 78-83, jan.-fev. 2006. ilus
Article in Portuguese | LILACS | ID: lil-430882

ABSTRACT

A mediastinite esclerosante é uma doença rara, caracterizada por tecido fibrótico mediastinal extenso, que mimetiza uma neoplasia devido à compressão ou invasão das estruturas mediastinais. Apresentamos três casos de síndrome de veia cava superior em que se comprovou a mediastinite esclerosante. A fisiopatologia relaciona-se a adenomegalias mediastinais, proliferação de fibroblastos e deposição de colágeno. As principais causas são histoplasmose e tuberculose, doenças prevalentes em nosso meio. O diagnóstico histopatológico geralmente é difícil por métodos pouco invasivos. Necessita-se de exploração cirúrgica para o diagnóstico definitivo e resolução da obstrução das vias aerodigestiva e vascular, uma vez que não há tratamento clínico efetivo para esta afecção.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Mediastinal Neoplasms/diagnosis , Mediastinitis/diagnosis , Superior Vena Cava Syndrome/diagnosis , Diagnosis, Differential , Mediastinitis/complications , Mediastinitis/pathology , Mediastinitis/surgery , Sclerosis/complications , Sclerosis/diagnosis , Superior Vena Cava Syndrome/etiology , Superior Vena Cava Syndrome/surgery
11.
Rev. colomb. neumol ; 18(2): 81-83, 2006.
Article in Spanish | LILACS | ID: lil-652792

ABSTRACT

Antecedentes. La mediastinitis aguda es una de lasenfermedades torácicas más agresivas. La mortalidad publicada va del 14 al 42/100. Objetivo. Analizar una serie consecutiva de 52 pacientes. Diseño. Estudio descriptivo retrospectivo de una cohorte. Material y Métodos. Entre enero de 1984-agosto de 2005, se estudiaron 52 pacientes con mediastinitis agudas tratadosquirúrgicamente en el Servicio de Cirugía General número 1 Hospital Universitario Miguel Pérez Carreño en Caracas Venezuela, sin criterios de exclusión, 40 varones y 12 mujeres. Resultados. La mediastinitis aguda fue de origen esofágico en 34 pacientes (16 posquirúrgicas, 10 por ruptura iatrogénica, 6 por rotura no iatrogénica y dos por cuerpo extraño), de origen bucofaríngeo en 12 pacientes y secundarias a esternotomía media en 6. Se trataron quirúrgicamente 52 pacientes; además deldesbridamiento radical se colocaron drenajes, en 31 se practicó la esofaguectomía con plastia gástrica; en 16 suturas primarias de esófago; en tres plastias con el pectoral mayor, y en otro dos esternectomía más omentoplastia. Dos pacientes fallecieron en los 30 días después de la intervención. La mortalidad en nuestromedio resultó más baja que la descrita en la bibliografía.Conclusiones. Los resultados justifican el tratamientoagresivo y temprano en la mediastinitis aguda.


Subject(s)
Mediastinitis/surgery , Mediastinitis/complications , Mediastinitis/diagnosis , Mediastinitis/mortality , Venezuela
12.
Rev. chil. cir ; 57(3): 203-208, jun. 2005. tab
Article in Spanish | LILACS | ID: lil-425195

ABSTRACT

Introducción: La mediastinitis postquirúrgica en cirugía cardíaca (MPQCC) tiene incidencia de 1-2 por ciento, y letalidad de 8,-40 por ciento, siendo complicación temida en cirugía cardíaca. Objetivo: Describir las características de la MPQCC de nuestro equipo y determinar factores asociados a letalidad. Material y método: Estudio descriptivos-retrospectivo. Período 1993-2003. Información de base de datos del equipo y fichas clínicas. Se trataron 19 pacientes, 4 operados en otros centros por lo que no se incluyen en este análisis. Se realizaron en total 1.223 cirugías cardíacas, con 15 MPQCC (1,2 por ciento). Se describen la edad, género, tipo cirugía cardíaca, características clínicas, tiempo de evolución, manejo quirúrgico, morbimortalidad, microbiología y evolución. Se realizó un análisis multivariado de 32 factores pre, intra y postoperatorios, y se utilizó la prueba regresión logística, método forward stepwise. Resultados: 15 casos, 9 masculinos. Edad promedio 53,5 años. Síntomas y signos frecuentes: dolor 14 casos, fiebre 13, taquicardia 13, inestabilidad esternal 9. La cirugía cardíaca fue univalvular en 6, coronaria en 5, endocarditis infecciosa en 3 y bivalvular en 1. El tiempo entre la cirugía y la MPQCC fue en promedio 12,9 días. Se realizó aseo mediastínico, curetaje, cierre e instalación de irrigación en 14. Se aisló Staphylococcus aureus meticilinoresistente en 11. Presentaron complicaciones 8 pacientes y fallecieron 5. La estadía post operatoria fue en promedio 38,6 días. En el análisis multivariado se encontró como factores asociados a letalidad el tabaquismo, la enfermedad pulmonar obstructiva crónica, el uso del balón de contrapulsación aórtica, y en los postoperatorios de mediastinitis: días de ventilación mecánica, uso de hemoderivados, insuficiencia renal aguda y neumonía. Conclusiones: La MPQCC presenta alta morbimortalidad. En nuestra serie existen factores reconocibles asociados a letalidad.


Subject(s)
Adolescent , Adult , Humans , Middle Aged , Mediastinitis/etiology , Cardiac Surgical Procedures/adverse effects , Multivariate Analysis , Mediastinitis/complications , Mediastinitis/microbiology , Mediastinitis/mortality , Postoperative Complications , Retrospective Studies , Risk Factors , Sex Distribution , Signs and Symptoms
13.
ABCD (São Paulo, Impr.) ; 17(4): 155-162, out.-dez. 2004. tab
Article in Portuguese | LILACS | ID: lil-469897

ABSTRACT

As perfurações esofágicas ainda representam um desafio quanto ao diagnóstico e tratamento. Objetivo - Descrever a experiência do serviço no tratamento das perfurações de esôfago...


Perforation of the esophagus remains a diagnostic and therapeutic challenger. Aim - To review our experience in the management of esophageal perforation...


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Mediastinitis/diagnosis , Esophageal Perforation/diagnosis , Prognosis , Mediastinitis/complications , Esophageal Perforation/complications , Esophageal Perforation/therapy
14.
Arch. argent. pediatr ; 102(2): 132-136, abr. 2004. ilus
Article in Spanish | LILACS | ID: lil-481562

ABSTRACT

La mediastinitis necrosante descendente es una complicación primaria de infecciones cervicales y odontológicas que se diseminan hacia el mediastino a través de los espacios anatómicos cervicales. El objetivo de este trabajo es alertar a los pediatras sobre esta posibilidad evolutiva de un absceso odontológico, y revisar algunos aspectos sobre el diagnóstico y el tratamiento de la mediastinitis necrosante descendente.Se presenta una niña que desarrolló esta complicación secundaria a una infección odontológica. Eldiagnóstico se realizó por la historia clínica, radiografías y tomografía computada de cuello y tórax. Se hizo tratamiento con antibióticos y drenaje quirúrgico amplio y agresivo; la niña fue dada de altaa los 41 días, con una incapacidad ventilatoria restrictiva de 56%.El diagnóstico temprano con tratamiento adecuado,tanto médico como quirúrgico, es lo que permite reducir la altísima tasa de mortalidad de la mediastinitis necrosante descendente.


Subject(s)
Child , Early Diagnosis , Mediastinitis/complications , Necrosis , Periapical Abscess , Mouth Floor/pathology
15.
J. bras. pneumol ; 30(1): 56-59, jan.-fev. 2004. ilus
Article in Portuguese | LILACS | ID: lil-360094

ABSTRACT

O cisto broncogênico, apesar da aparência pouco ominosa como opacidade de contornos precisos no mediastino, tem potencial não desprezível para complicar. Relatamos um caso de complicação grave em um paciente de 28 anos com queixa de dor epigástrica irradiada para o dorso, e radiografia de tórax demonstrando massa bem delimitada no mediastino posterior e inferior à direita. Em cinco dias evoluiu para sepse decorrente de mediastinite e empiema pleural à esquerda. O paciente necessitou ser submetido a toracotomia esquerda para descorticação pulmonar precoce e desbridamento do mediastino e, num segundo tempo com intervalo de uma semana, a toracotomia direita para ressecção do cisto mediastinal infectado. Este caso enfatiza a indicação sensata de ressecção dos cistos mediastinais mesmo na apresentação assintomática, face ao risco inerente de complicações.


Subject(s)
Humans , Male , Adult , Bronchogenic Cyst/etiology , Empyema, Pleural/complications , Mediastinitis/complications , Bronchogenic Cyst/surgery , Bronchogenic Cyst , Severity of Illness Index , Thoracotomy
16.
ACM arq. catarin. med ; 32(supl.1): 231-232, out. 2003. graf
Article in Portuguese | LILACS | ID: lil-517778

ABSTRACT

Mediastinite após cirurgia cardíaca por esternotomia mediana é uma condição passível de ocorrer no período pós-operatório. Importantes opções terapêuticas foram descritas e comparadas previamente. Este estudo foi delineado, para relatar a experiência dos autores no tratamento da mediastinite, com a utilização de tecidos autógenos, e para discutir as vantagens e desvantagens de cada técnica.


Mediastinitis following cardiac surgery have become a frequently condition in the immediative postoperatory period. Many techniques to solve this important problem were described previously comparing these therapeutic tools. This study were delineated to quantificate the author´s experience in the utilization of autogenous tissues to perform the thoracic reconstruction and to discuss the advantages and disadvantages of each technique.


Subject(s)
Humans , Male , Female , Mediastinitis , Surgery, Plastic , Mediastinitis/surgery , Mediastinitis/complications , Mediastinitis/pathology
17.
Article in English | IMSEAR | ID: sea-88941

ABSTRACT

A 55 year old female was admitted as a case of pyrexia of unknown origin (PUO) of 2 months duration. She had developed throat ache, progressive dysphagia for both solids and liquids, dry cough and retrosternal pain for one week. Examination revealed fever, tachycardia, tachypnoea and a soft tissue warm tender, erythematous, non-fluctuant swelling in lower anterior neck with chest findings suggestive of bilateral pleural effusion. Plain X-rays of the neck and chest strengthened the clinical suspicion of cellulitis of lower neck with bilateral pleural effusion. CT scan confirmed the radiologic findings and also revealed pericardial effusion and thickening; small mediastinal lymphadenopathy and mediastinitis. Patient responded to parenteral antibiotics (ceftriaxone and metronidazole) and hydrocortisone with complete resolution in 10 days.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/therapeutic use , Ceftriaxone/therapeutic use , Female , Fever of Unknown Origin/etiology , Humans , India , Mediastinitis/complications , Metronidazole/therapeutic use , Middle Aged , Tomography, X-Ray Computed
18.
Indian Heart J ; 2002 Jul-Aug; 54(4): 425-7
Article in English | IMSEAR | ID: sea-3172

ABSTRACT

We present a case of superior vena cava obstruction caused by idiopathic fibrosing mediastinitis treated with a self-expandable Wallstent. A Gortex jump graft had been used previously, which was totally occluded. This procedure relieved symptoms and alleviated the need for re-operation.


Subject(s)
Adult , Humans , Male , Mediastinitis/complications , Stents , Superior Vena Cava Syndrome/etiology
19.
São Paulo; s.n; 2002. 53 p. tab.
Thesis in Portuguese | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP, SESSP-TESESESSP, SES-SP | ID: biblio-1068991

ABSTRACT

A mediastinite pós-cirurgia cardíaca é uma das complicações mais temidas em pacientes que são submetidos a este procedimento, pois, além da mortalidade elevada (10% a 47%), há aumento do tempo de internação e custos hospitalares. O objetivo deste estudo é avaliar os fatores de risco para mediastinite pós-cirurgia cardíaca, taxa de mediastinite e mortalidade em nossa Instituição. Metodologia: para determinar os fatores de risco, foi realizado um estudo do tipo caso-controle pareado, 39 casos e 78 controles, dentre os pacientes submetidos à cirurgia cardíaca no Instituto Dante Pazzanese de Cardiologia, no período de janeiro de 1995 a janeiro de 2001. Resultados: no período de estudo, foram realizadas 9.136 cirurgias cardíacas e a taxa de mediastinite foi 0,5%. Na análise multivariada, os fatores de risco independentes encontrados foram: obesidade (OR 6,49 LC 95% 2,24-18,78), tabagismo (OR 3,27 LC 95% 1,04-10,20), tempo de UTI maior que dois dias (OR 4,50 LC 95% 1,57-12,90), infecção em outro sítio (OR 8,86 LC 95% 1,86-42,27). A mortalidade foi de 23% nos pacientes que desenvolveram mediastinite. Conclusão: observamos dois fatores de risco independentes relacionados a antecedentes do paciente (obesidade e tabagismo) e dois fatores de risco relacionados aos problemas do pós-operatório (tempo de UTI e infecção em outro sítio). Esforços devem ser concentrados para que, em cirurgias eletivas, o paciente perca peso e pare de fumar antes do procedimento, além de haver um programa de prevenção de infecção hospitalar direcionado e intensificado para os pacientes de risco.


Subject(s)
Humans , Thoracic Surgery , Mediastinitis , Mediastinitis/complications , Mediastinitis/mortality
20.
Article in English | IMSEAR | ID: sea-44961

ABSTRACT

The case report of a 28 year old woman with strictured esophagus from corrosive esophagitis for 4 months is presented. Barium swallowing showed a strictured esophagus extending from T2 to the aortic knob and needed frequent dilatations. The patient had a perforated thoracic esophagus and mediastinitis on last dilatation. Cervical esophagostomy, transabdominal esophageal bandaging and jejunostomy feeding were done along with intravenous broad spectrum antibiotics. On esophagoscopy, there was complete stenosis of the cervical esophagus 2 cm from the postcricoid area. The large intestine from the caecum, transverse colon and descending colon was chosen as the esophageal conduit because of adequate length to pass subcutaneously. The caecum was anastomosed to the cervical esophagus and descending colon to the stomach. Seven days postoperatively, the patient could take liquids and soft porridge orally. There was a small leakage from the cervical anastomosed, spontaneous closure was achieved 3 weeks postoperatively. We chose the right side colon as the esophageal conduit because of adequate length to pass subcutaneously. Mediastinal and transhiatal routes could not be passed because of previous mediastinitis from thoracic esophageal perforation. This may be an alternative choice of operation for high cervical esophageal stenosis with previous mediastinitis.


Subject(s)
Adult , Anastomosis, Surgical/methods , Burns, Chemical/complications , Colon/transplantation , Esophageal Stenosis/etiology , Esophagoplasty/methods , Female , Humans , Mediastinitis/complications
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