A 40-Year-Old Woman With Back Pain.

A 40-year-old woman consulted our ED for a 7-month history of left dorsal back pain and dyspnea. The pain was initially dull and mechanical. Her general practitioner started nonsteroidal antiinflammatory drugs and physiotherapy, which provided partial relief. One week before consulting, the intensity of the pain increased, and she started to feel shortness of breath when performing her daily activities. She had lost 5 kg during the previous month. The patient was a healthy woman who lived in an urban area of Barcelona, Spain. She did not smoke or take drugs of abuse, and she worked as a butcher. During the initial evaluation, her blood pressure was 131/76 mm Hg, heart rate was 120 beats/min, temperature was 36.2°C, and ambient air pulse oximetry was 98%.

Factores de riesgo de mortalidad en la mediastinitis necrosante descendente / Mortality Risk Factors in Descending Necrotizing Mediastinitis

IntroducciónEl término de mediastinitis necrosante descendente hace referencia a la infección que se inicia en la región orofaríngea y se disemina a través de los planos fasciales hacia el mediastino. Este trabajo tiene como objetivo estimar la incidencia de mediastinitis necrosante descendente en nuestro centro, conocer la epidemiología y las características clínicas de la enfermedad, así como evaluar los factores pronósticos que influyen en la mortalidad.Pacientes y métodosSe realiza un estudio retrospectivo de 43 pacientes consecutivos diagnosticados en el Hospital Universitari Vall d’Hebron de Barcelona desde enero de 1996 a diciembre 2006. Se efectúa un estudio descriptivo y un análisis bivariado y multivariado de las variables recogidas.ResultadosLa mortalidad global fue del 21%, pero al subdividir el estudio en 2 periodos (1996–2000 y 2001–06) se aprecia un importante descenso de la misma (40% vs. 4,3%). Los factores de riesgo detectados en el análisis bivariado fueron: el periodo diagnóstico 1996–2000, el antecedente de diabetes mellitus, la presencia de comorbilidad asociada, el número de intervenciones menor de 2, la lateralidad izquierda, la morbilidad postoperatoria y el choque séptico. En el análisis multivariado, solo la presencia de choque séptico demostró ser un predictor independiente de mortalidad.ConclusionesLa mediastinitis necrosante descendente es una enfermedad de baja incidencia que debe sospecharse por su clínica y confirmarse inmediatamente con la realización de una TC. El tratamiento precoz multidisciplinario nos ha permitido disminuir la mortalidad del 40% en un primer periodo inicial hasta el 4,3% actual(AU)

IntroductionThe term descending necrotizing mediastinitis (MND) refers to an infection that begins in the oropharyngeal region and spreads through the fascial planes into the mediastinum. This study aims to estimate the incidence of MND in our centre, the epidemiology and clinical features of the disease and to evaluate prognostic factors influencing mortality.Patients and methodsWe performed a retrospective study on 43 consecutive patients diagnosed at the Hospital Universitari Vall d'Hebron in Barcelona from January 1996 to December 2006. We performed a descriptive study and a bivariate and a multivariate analysis of variables collected.ResultsOverall mortality was 21%, but when we subdivided the study into two periods (1996–2000 and 2001–2006) it shows a significant decrease (40% versus 4.3%). Risk factors identified in the bivariate analysis were: diagnosis period 1996–2000, diabetes mellitus, comorbidity, number of surgeries, left lateral surgery, postoperative morbidity and septic shock. In multivariate analysis, only the presence of septic shock proved to be an independent predictor of mortality.ConclusionsMND is a disease of low incidence and should be suspected clinically and confirmed immediately with a computed tomography (CT). Multidisciplinary and early treatment has allowed us to reduce mortality by 40% in the first initial period to 4.3% today(AU)

[Mortality risk factors in descending necrotizing mediastinitis]. / Factores de riesgo de mortalidad en la mediastinitis necrosante descendente.

INTRODUCTION: The term descending necrotizing mediastinitis (MND) refers to an infection that begins in the oropharyngeal region and spreads through the fascial planes into the mediastinum. This study aims to estimate the incidence of MND in our centre, the epidemiology and clinical features of the disease and to evaluate prognostic factors influencing mortality. PATIENTS AND METHODS: We performed a retrospective study on 43 consecutive patients diagnosed at the Hospital Universitari Vall d'Hebron in Barcelona from January 1996 to December 2006. We performed a descriptive study and a bivariate and a multivariate analysis of variables collected. RESULTS: Overall mortality was 21%, but when we subdivided the study into two periods (1996-2000 and 2001-2006) it shows a significant decrease (40% versus 4.3%). Risk factors identified in the bivariate analysis were: diagnosis period 1996-2000, diabetes mellitus, comorbidity, number of surgeries, left lateral surgery, postoperative morbidity and septic shock. In multivariate analysis, only the presence of septic shock proved to be an independent predictor of mortality. CONCLUSIONS: MND is a disease of low incidence and should be suspected clinically and confirmed immediately with a computed tomography (CT). Multidisciplinary and early treatment has allowed us to reduce mortality by 40% in the first initial period to 4.3% today.