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1.
Klin Padiatr ; 228(1): 29-34, 2016 Jan.
Article in German | MEDLINE | ID: mdl-26766669

ABSTRACT

BACKGROUND: There still is controversy about surgical treatment of pleural empyema in children. PATIENTS AND METHODS: Retrospective analysis of treatment strategy, focussing on indication for surgery and outcome of children treated in 2 centres for pleural complications due to primary pneumonia from January 1(st) 2008 to December 31(st) 2012. RESULTS were compared to studies published within the last 10 years. RESULTS: 1 451 children with pneumonia were treated during the 5 year period. 187 (average age 6.1 years, sex: 86/101 f/m) developed a pleural effusion. THERAPY: pleural punction in 22 children, chest tube in 78 and operation in 37 children. In 9 cases microorganisms were identified. 34 children were operated for empyema stage II, only 3 for stage III. 3 children were operated due to septicaemia not responding to antibiotics. Time from admission to operation (including referring hospital):14.5 days. Time from operation to discharge: 12,5 days. All children but one were operated by thoracoscopy. COMPLICATIONS: 1 bronchopleural fistula, 1 delayed healing of the wound. All children survived and fully recovered mean (observation period 28 months postoperatively). SUMMARY: In experienced hands thoracic surgery yields excellent results for children suffering from pleural empyema stage II and III. Recent randomised prospective trials comparing fibrinolysis with VATS do not convince regarding the treatment protocols of their surgical arms. Fibrinolysis is nevertheless a valuable treatment in early stage II empyema, especially if thoracic surgical experience is not available. However, the further advanced the empyema presents, the sooner surgical experience should be gathered.


Subject(s)
Empyema, Pleural/surgery , Thoracic Surgery, Video-Assisted , Adolescent , Child , Child, Preschool , Combined Modality Therapy , Female , Fibrinolysis , Humans , Length of Stay , Lung Abscess/surgery , Male , Pneumonia/complications , Postoperative Complications/etiology , Randomized Controlled Trials as Topic , Retrospective Studies
2.
Zentralbl Chir ; 140 Suppl 1: S16-21, 2015 Oct.
Article in German | MEDLINE | ID: mdl-25393732

ABSTRACT

Septic arthritis of the sternoclavicular joint (SCJ) is a relatively rare disease. Due to serious complications including mediastinitis and generalised sepsis early diagnosis and rapid onset of treatment are mandatory. The disease often affects immunocompromised patients, diabetics, or patients with other infectious diseases. The therapeutic options range from administration of antibiotics to extended surgery including reconstructive procedures. Apart from rare situations where conservative treatment with antibiotics is sufficient, joint resection followed by plastic surgical procedures are required. We present a retrospective analysis with data from two hospitals. From January 2008 to December 2012 23 patients with radiographically confirmed septic arthritis of various aetiology were included. Fourteen (60.8 %) male, nine (39.2 %) female patients with an average age of 60.3 ± 14.2 years (range: 23-88 years) with septic arthritis of the SCJ were treated. Seven (30.4 %) patients suffered from Diabetes mellitus, nine (39.1 %) had underlying diseases with a compromised immune system. In 14 (60.8 %) out of 23 patients a bacterial focus was detected. Only six (26 %) patients suffered from confined septic arthritis of the SCG, in 17 (73,9 %) patients osteomyelitis of the adjacent sternum, and the clavicle was present. In addition, 15 (65.2 %) patients already suffered from mediastinitis at the time of diagnosis, eight (35 %) patients even from septicaemia. In conclusion, septic arthritis requires an active surgical treatment. Limited incision of the joint and debridement alone is only successful at early stages of the disease. The treatment concept has to include the local joint and bone resection as well as complications like mediastinitis. After successful treatment of the infection, the defect of the chest wall requires secondary reconstructive surgery using a pedicled pectoralis muscle flap.


Subject(s)
Arthritis, Infectious/surgery , Rare Diseases , Sternoclavicular Joint/surgery , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/diagnostic imaging , Arthritis, Infectious/etiology , Clavicle/diagnostic imaging , Clavicle/surgery , Combined Modality Therapy , Early Diagnosis , Early Medical Intervention , Female , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Male , Manubrium/diagnostic imaging , Manubrium/surgery , Middle Aged , Osteomyelitis/diagnosis , Osteomyelitis/etiology , Osteomyelitis/surgery , Retrospective Studies , Sternoclavicular Joint/diagnostic imaging , Tomography, X-Ray Computed , Young Adult
3.
Ophthalmologe ; 107(6): 549-52, 2010 Jun.
Article in German | MEDLINE | ID: mdl-20024563

ABSTRACT

A solitary synchronous distant metastasis of newly diagnosed non-small cell lung cancer (NSCLC) occurs in only a small number of patients. The available literature suggests a significant rise in long-term survival for these patients when resection of the bronchial carcinoma and the metastasis are feasible and performed. To demonstrate a multidisciplinary concept, we present the case of a patient with a peripheral NSCLC and a solitary synchronous intraocular metastasis. To our knowledge, this concept with curative intention has not been published before regarding a patient with an intraocular metastasis.


Subject(s)
Adenocarcinoma/secondary , Adenocarcinoma/surgery , Choroid Neoplasms/secondary , Choroid Neoplasms/surgery , Lung Neoplasms/surgery , Adenocarcinoma/diagnosis , Adenocarcinoma/pathology , Choroid/pathology , Choroid Neoplasms/diagnosis , Choroid Neoplasms/pathology , Combined Modality Therapy , Cooperative Behavior , Eye Enucleation , Humans , Interdisciplinary Communication , Lung/pathology , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Neoplasm Staging , Patient Care Team , Pneumonectomy
4.
Eur J Cardiothorac Surg ; 21(5): 946-7, 2002 May.
Article in English | MEDLINE | ID: mdl-12062300

ABSTRACT

The development of tracheal stenosis following insertion of a central venous catheter is a rare complication of this procedure. We present the case of an 81-year-old woman, who suffered acute onset of dyspnea, stridor and dysphagia 4 weeks after coronary artery bypass surgery. Investigations revealed a false aneurysm of the right subclavian artery, compressing the trachea and the oesophagus. The iatrogenic lesion was caused by the insertion of a central venous catheter via the right subclavian route. By the time symptoms developed the catheter had already been removed.


Subject(s)
Aneurysm, False/complications , Subclavian Artery/diagnostic imaging , Tracheal Stenosis/etiology , Aged , Aged, 80 and over , Aneurysm, False/diagnostic imaging , Bronchoscopy , Catheterization , Female , Humans , Tomography, X-Ray Computed
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