Cases reported "Mediastinitis"

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1/36. life-threatening mycoplasma hominis mediastinitis.

    mycoplasma hominis infections are easily missed because conventional methods for bacterial detection may fail. Here, 8 cases of septic mediastinitis due to M. hominis are reported and reviewed in the context of previously reported cases of mediastinitis, sternum wound infection, pleuritis, or pericarditis caused by M. hominis. All 8 patients had a predisposing initial condition related to poor cardiorespiratory function, aspiration, or complications related to coronary artery surgery or other thoracic surgeries. mediastinitis was associated with purulent pleural effusion and acute septic symptoms requiring inotropic medication and ventilatory support. Later, the patients had a tendency for indolent chronic courses with pleuritis, pericarditis, or open sternal wounds that lasted for several months. M. hominis infections may also present as mild sternum wound infection or as chronic local pericarditis or pleuritis without septic mediastinitis. Treatment includes surgical drainage and debridement. Antibiotics effective against M. hominis should be considered when treating mediastinitis of unknown etiology.
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ranking = 1
keywords = wound infection, wound
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2/36. mediastinitis due to Gordona sputi after CABG.

    Genus Gordona is included in mycolic acid containing bacteria. This genus infection is very rare and occurs classically in immuno-compromised patients. We report a patient who developed mediastinitis due to Gordona sputi after coronary artery bypass grafting (CABG) using left internal mammary artery. Immunocompromised factors were not noticed in this case but postoperative bleeding, the most important risk factor of mediastinitis, was found in his course. The treatment was antibiotic therapy, surgical soft tissue debridement and open irrigation with dilute povidone-iodine solution. However, infectious reaction continued and Gordona sputi repeated cultured from wound. Next procedure, debridement of sternal bone and omental transfer, was performed and skin was closed primarily. Inflammatory reaction was attenuated and the wound was healed Broad debridement and omental transfer were very effective for mediastinitis due to Gordona sputi after CABG.
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ranking = 0.015737679200417
keywords = wound
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3/36. Poststernotomy mediastinitis treated by rectus muscle flap plugging.

    The current standard treatment of mediastinitis following median sternotomy is radical sternal curettage and plugging of the anterior mediastinal dead space with muscle flap or omentum. This paper will report our experience with a pediculated flap of the rectus muscle after mediastinal irrigation and drainage. The patient was a 75-year-old man diagnosed as having aortic arch aneurysm. The patient underwent a total aortic arch replacement with the bovine-collagen sealed vascular prosthesis (Hemashield). As an early postoperative complication, he was diagnosed with mediastinitis which was the result of infection of the drainage fluid. Mediastinal curettage and plugging of the rectus muscle flap was successfully performed. Without recurrence of infection, the wound healed completely. We conclude that early curettage and rectus muscle flap plugging are the most effective treatment of the poststernotomy mediastinitis.
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ranking = 0.0078688396002084
keywords = wound
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4/36. Sternal osteomyelitis and mediastinitis after open-heart operation: pathogenesis and prevention.

    Sternal osteomyelitis and mediastinitis caused by pseudomonas cepacia developed in a patient undergoing coronary artery bypass two weeks after the operation. P. cepacia bacteremia from a contaminated pressure transducer had preceded and probably caused the chest infection. While other authors have suggested that postoperative sternal osteomyelitis and mediastinitis result from local wound contamination, this case suggests the importance of bacteremia as a cause of such gram-negative infections. Since patients undergoing open-heart operation are exposed to many sources of bacteremia, prevention of severe postoperative chest infections may depend in large part on careful preoperative evaluation of each patienc antibiotic regimens, and, as shown in this patient, on very thorough periodic review of equipment sterilization and intravascular monitoring practices.
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ranking = 0.0078688396002084
keywords = wound
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5/36. Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery.

    Mediastinal sepsis following open heart surgery is a significant cause of death. Open drainage of the mediastinumalone was employed originally in management of this problem. More recently, debridement, drainage, and reclosure have been used. Various irrigation solutions, such as antibiotics and Betadine, have been advocated to control severe mediastinal sepsis. Three principles of management in patients unresponsiveness to the above techniques have proved successful in two patients with life-threatening mediastinal sepsis: (1) radical, complete excision of the sternum and adjacent costal cartilages; (2) transposition of the greater omentum on a vascular pedicle to the mediastinum; and (3) primary closure with full-thickness rotational skin flaps. The radical excision of the sternum removes residual foci of sepsis in cartilage and sternal bone marrow. The transposition of the omentum provides a highly vascular, rapidly granulating covering for the contaminated great vessels and hase been successfully to prevent recurrence of suture line bleeding of an exposed ascending aortic anastomosis site. Primary closure of the wound with full-thickness skin flaps provides a suprisingly satisfactory covering for the heart. Preoperative and postoperative measurements of ventilatory mechanics have shown relatively small ventilatory impairment after the alteration of the thoracic cage imposed by excision of the sternum. Two patients have returned to active lives. A treatment failure probably due to incomplete adherence to these guidelines also is presented.
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ranking = 0.0078688396002084
keywords = wound
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6/36. Successfully treated descending necrotizing mediastinitis through mediansternotomy using a pedicled omental flap.

    A 21-year-old man with an oropharyngeal abscess admitted to our institution was initially treated with systemic antibiotics but was referred to our department when his condition rapidly deteriorated. His respiratory insufficiency required circulatory support. A computed tomographic scan showed a parapharyngeal abscess descending into the mediastinum with multiple right-side capsulized empyema and pericardial effusion. We conducted emergency surgery through a mediansternotomy using a pedicled omental flap. Postoperative clinical and radiologic assessment showed a normal chest X-ray and primary wound healing without sternal dehiscence. Mediansternotomy using a pedicled omental flap offers excellent exposure for a complete one-stage operation with debridement of all affected tissues of the subauricular region, the mediastinum, and both pleural cavities. We conclude that this method yields good results for patients with acute widespread descending necrotizing mediastinitis.
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ranking = 0.0078688396002084
keywords = wound
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7/36. mediastinitis after percutaneous dilatational tracheostomy.

    In our experience, PDT after total arch replacement, especially after dissection of neck vessels, should be approached with caution. A long skin incision that allows discharge to drain from the wound and a sufficiently long postoperative tracheostomy period to allow tissue healing in the neck are necessary for prevention of mediastinitis.
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ranking = 0.0078688396002084
keywords = wound
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8/36. vacuum-assisted closure in the paediatric patient with post-cardiotomy mediastinitis.

    mediastinitis has a high mortality and is a major cause for concern in the neonatal cardiac surgical population. vacuum-Assisted Closure (V.A.C.) is a newly established technique for expediting healing in the management of wounds resistant to established treatments; this includes the treatment of post-cardiotomy mediastinitis in the adult cardiac surgical patient. We describe the previously unreported use of the V.A.C. device for the successful treatment of post-cardiotomy mediastinitis in an infant. The device also improved the mechanics of respiration. We discuss potential risks and benefits of V.A.C. and suggest guidelines for its use.
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ranking = 0.0078688396002084
keywords = wound
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9/36. saphenous vein graft pseudoaneurysm formation after postoperative mediastinitis.

    Pseudoaneurysm formation involving the body of an aortocoronary saphenous vein graft is a rare event. True aneurysmal dilatation of the graft and anastomotic pseudoaneurysm formation occur more commonly. We present the case of a 73-year-old woman in whom a pseudoaneurysm communicating with the body of a posterior descending coronary artery saphenous vein graft developed, presumably after a postoperative sternal wound infection. The aneurysm was excised and the defect within the saphenous vein graft repaired using hypothermia and circulatory arrest.
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ranking = 0.4960655801999
keywords = wound infection, wound
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10/36. Spontaneous right ventricular disruption following treatment of sternal infection.

    BACKGROUND: Spontaneous right ventricular disruption is a rare and frequently catastrophic event that occurs during the treatment of mediastinitis complicating median sternotomy wound. OBJECTIVE: The purpose of this study is to understand the pathogenesis of the spontaneous right ventricular disruption and to suggest strategies for the prevention and treatment of this rare but potentially fatal complication of cardiac surgery. methods: We report three cases as an introduction to the review of 39 cases found in the English-language literature. RESULTS: The majority of patients (71%) underwent coronary artery bypass grafting as the primary procedure prior to the development of a sternal infection. staphylococcus aureus and staphylococcus epidermidis were cultured most frequently from the sternal wound (31% and 24%, respectively). The mean interval between sternal debridement and the right ventricular disruption was 2.9 days. Most patients (24 of 42) required cardiopulmonary bypass for the repair of the right ventricular disruption. Biologic patches and adjuncts were used in 15 patients (36%). Eight patients (19%) died either preoperatively or on the operating-room table. CONCLUSIONS: Spontaneous right ventricular disruption is a potentially preventable complication. To prevent this complication we recommend: (1) avoidance of delay between diagnosis and operative treatment of mediastinitis; (2) complete lysis of adhesions between the posterior sternal edge and anterior surface of the right ventricle under general anesthesia with heart-lung machine stand-by; (3) repair of the right ventricular tear using biologic patches with heart-lung machine stand-by; (4) early (if possible immediate) closure of the chest with a myocutaneous flap.
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ranking = 0.015737679200417
keywords = wound
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