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The Journal of International Medical... May 2020Acute mediastinitis (AM) is a rare but life-threatening disease. Here, we report a case of AM secondary to endobronchial tuberculosis (EBTB) and pseudomembranous... (Review)
Review
Acute mediastinitis (AM) is a rare but life-threatening disease. Here, we report a case of AM secondary to endobronchial tuberculosis (EBTB) and pseudomembranous tracheobronchitis (PMATB) co-infection. EBTB was confirmed by tissue culture for and GeneXpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) detection (simultaneous detection of and resistance to rifampin) using endobronchial biopsies; PMATB was confirmed by histopathology. Even with antibiotic treatment and systemic support treatment, the patient died of massive hemoptysis on day 10 after admission. When immunocompromised hosts have AM, especially with central airway involvement, EBTB and aspergillosis should be considered potential causes. Bronchoscopy is helpful for rapid diagnosis and administering precise treatment.
Topics: Anti-Bacterial Agents; Antifungal Agents; Antitubercular Agents; Aspergillosis; Aspergillus; Bronchi; Bronchoscopy; Coinfection; Diabetes Complications; Fatal Outcome; Female; Humans; Hyphae; Immunocompromised Host; Mediastinitis; Mediastinum; Middle Aged; Mycobacterium tuberculosis; Sputum; Tomography, X-Ray Computed; Tuberculosis, Pulmonary
PubMed: 32431185
DOI: 10.1177/0300060520918469 -
Medical Ultrasonography Feb 2022In the present study, a meta-analysis was performed to evaluate the diagnostic value of endobronchial ultrasound (EBUS) elastography for differentiating benign and... (Meta-Analysis)
Meta-Analysis Review
Diagnostic value of endobronchial ultrasound elastography for differentiating benign and malignant hilar and mediastinal lymph nodes: a systematic review and meta-analysis.
AIMS
In the present study, a meta-analysis was performed to evaluate the diagnostic value of endobronchial ultrasound (EBUS) elastography for differentiating benign and malignant hilar and mediastinal lymph nodes (LNs).
MATERIAL AND METHODS
A comprehensive literature search was carried out through PubMed, Embase, and Cochrane Library. Two authors screened the papers and extracted the data independently and any discrepancies were resolved by discussion. The methodolog-ical quality of each included study was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the curve were calculated to evaluate the value of EBUS elastography for hilar and mediastinal LNs.
RESULTS
Seventeen studies with the number of 2307 LNs were included. There was significant heterogeneity across the included studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for the diagnosis of hilar and mediastinal LNs by EBUS elastography were 0.90 (95% confidence interval [CI], 0.84-0.94), 0.78 (95% CI, 0.74-0.81), 4.1 (95% CI, 3.4-4.9), 0.12 (95% CI, 0.07-0.21) and 33 (95% CI, 17-64), respectively. Furthermore, area under the curve was calculated to be 0.86 (95% CI, 0.82-0.88).
CONCLUSION
EBUS elastography is a valuable technology in the differentiation of benign and malignant hilar and mediastinal LNs and could provide supplementary diagnostic information during endobronchial ultrasound-guided transbronchial needle aspiration. The combination of EBUS elastography and B-mode EBUS could improve the diagnostic accuracy for hilar and mediastinal LNs.
Topics: Bronchoscopy; Elasticity Imaging Techniques; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Lymph Nodes; Mediastinum; Sensitivity and Specificity
PubMed: 33793697
DOI: 10.11152/mu-2971 -
The Journal of Thoracic and... Oct 2021Perioperative bacterial decolonization and prophylactic antibiotic therapy at the Veterans Affairs Health Care System have changed over the past decade. Our objectives...
OBJECTIVES
Perioperative bacterial decolonization and prophylactic antibiotic therapy at the Veterans Affairs Health Care System have changed over the past decade. Our objectives were to identify associated changes in the microbiology of mediastinitis and to perform a contemporary survival analysis in patients with mediastinitis after isolated coronary artery bypass grafting procedure.
METHODS
From January 2006 to December 2015, 45,323 consecutive patients underwent coronary artery bypass grafting at 83 medical centers. The Veterans Affairs Health Care System nationwide administrative database was queried to identify patients with postoperative mediastinitis and obtain patient-level data. Simple descriptive statistics and multivariable logistic regression were used to analyze microbiologic data and identify risk factors for infection. Poisson regression was used to determine yearly incidence estimates. Cox proportional hazard model identified predictors of long-term survival from date of operation.
RESULTS
During the study period, 348 patients (0.78%) developed postoperative mediastinitis-with a stable rate of incidence (Cochrane-Armitage test, P = .69). Of patients with microbiologic data, 75.5% of infections (n = 188) were caused by gram-positive and 24.5% (n = 61) gram-negative organisms. The incidence of methicillin-resistant Staphylococcus aureus mediastinitis decreased during the study period (Cochrane-Armitage test, P = .013). Gram-negative mediastinitis occurred earlier than gram-positive mediastinitis (median, 15.0 vs 25.0 days; P < .0001). Patients with mediastinitis did not have increased 30-day mortality (2.0% vs 1.9%; P = .9), but had worse long-term survival compared with uninfected patients (P < .0001).
CONCLUSIONS
The incidence of methicillin-resistant S aureus mediastinitis has decreased over the past decade. Gram-negative bacteria are responsible for 1 in 4 cases of mediastinitis and infection is diagnosed earlier in the postoperative period than gram-positive mediastinitis. These findings highlight the need for efforts to prevent gram-negative and methicillin-susceptible S aureus mediastinitis.
Topics: Aged; Antibiotic Prophylaxis; Coronary Artery Bypass; Female; Humans; Incidence; Male; Mediastinitis; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Outcome Assessment, Health Care; Postoperative Complications; Proportional Hazards Models; Staphylococcal Infections; Surgical Wound Infection; United States; Veterans Health
PubMed: 32386766
DOI: 10.1016/j.jtcvs.2020.02.116 -
European Journal of Cardio-thoracic... Jan 2017Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an... (Review)
Review
Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also occur as extension of infection from adjacent structures such as the oesophagus, airways and lungs, or as descending necrotizing infection from the head and neck. In addition, there is a chronic form of 'chronic fibrosing mediastinitis' usually caused by granulomatous infections. In this expert consensus, the evidence for strategies for treatment and prevention of mediatinitis is reviewed in detail aiming at reducing the incidence and optimizing the management of this serious condition.
Topics: Consensus; Disease Management; Europe; Humans; Mediastinitis; Societies, Medical; Surgical Wound Infection; Thoracic Surgery; Thoracic Surgical Procedures
PubMed: 28077503
DOI: 10.1093/ejcts/ezw326 -
The Netherlands Journal of Medicine Nov 2005
Topics: Humans; Male; Mediastinum; Middle Aged; Pancreatic Pseudocyst; Radiography
PubMed: 16301762
DOI: No ID Found -
The Journal of Thoracic and... Jun 2015Sternal wound infections are serious postoperative complications that increase the length of hospital stay and healthcare costs. The benefit of implantable... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Sternal wound infections are serious postoperative complications that increase the length of hospital stay and healthcare costs. The benefit of implantable gentamicin-collagen sponges in reducing sternal wound infections has been questioned in a recent multicenter trial. We aimed to perform a comprehensive meta-analysis of studies assessing the efficacy of implantable gentamicin-collagen sponges in sternal wound infection prevention.
METHODS
Multiple databases were screened for studies assessing the efficacy of implantable gentamicin-collagen sponges after heart surgery. The primary end point was sternal wound infection, and secondary end points were the occurrence of deep sternal wound infection, superficial sternal wound infection, mediastinitis, and mortality. Randomized controlled trials and observational studies were analyzed separately. By means of meta-regression, we examined the correlation between sternal wound infection and extent to which the bilateral internal thoracic artery was harvested.
RESULTS
A total of 14 studies (N = 22,135, among them 4 randomized controlled trials [N = 4672]) were included in the analysis. Implantable gentamicin-collagen sponges significantly reduced the risk of sternal wound infection by approximately 40% when compared with control (risk ratio [RR], 0.61; 95% confidence interval [CI], 0.39-0.98; P = .04 for randomized controlled trials and RR, 0.61; 95% CI, 0.42-0.89; P = .01 for observational studies). A similar, significant benefit was demonstrated for deep sternal wound infection (RR, 0.60; 95% CI, 0.42-0.88; P = .008) and superficial sternal wound infection (RR, 0.60; 95% CI, 0.43-0.83; P = .002). The overall analysis revealed a reduced risk of mediastinitis (RR, 0.64; 95% CI, 0.45-0.91; P = .01). The risk of death was unchanged. A significant positive linear correlation (P = .05) was found between the log RR of sternal wound infection and the percentage of patients receiving bilateral internal thoracic artery grafts.
CONCLUSIONS
Implantable gentamicin-collagen sponges significantly reduce the risk of sternal wound infection after cardiac surgery, with evidence consistent in randomized and observational-level data. However, the extent of this benefit might be attenuated in patients receiving bilateral internal thoracic artery grafts.
Topics: Anti-Bacterial Agents; Cardiac Surgical Procedures; Chi-Square Distribution; Drug Carriers; Gentamicins; Humans; Internal Mammary-Coronary Artery Anastomosis; Mediastinitis; Odds Ratio; Protective Factors; Risk Assessment; Risk Factors; Sternotomy; Surgical Sponges; Surgical Wound Infection; Time Factors; Treatment Outcome
PubMed: 25703409
DOI: 10.1016/j.jtcvs.2015.01.034 -
Ear, Nose, & Throat Journal Jun 2021Descending necrotizing mediastinitis (DNM) is a serious and progressive infection involving the neck and chest and with high mortality if not treated quickly and...
OBJECTIVES
Descending necrotizing mediastinitis (DNM) is a serious and progressive infection involving the neck and chest and with high mortality if not treated quickly and properly. The aim of this study is to share our practices for managing this condition.
METHODS
We retrospectively evaluated 9 patients diagnosed with DNM in our hospital between January 2006 and October 2019. Age, gender, origin of infection, length of hospital stay, microorganisms present, type of surgical treatment, and clinical outcomes were reviewed.
RESULTS
All patients underwent surgery to drain neck and mediastinal secretions and collections. Three (33.3%) patients were treated with transcervical drainage alone, and 6 (66.7%) patients were treated with combined transcervical and transthoracic drainage. Reoperations were reported in 3 (33.3%) cases. The average length of hospital stay was 22.78 ± 10.05 days (range: 9-40 days). The average length of intensive care unit stay was 6.44 ± 10.10 days (range: 0-25 days). There were no in-hospital deaths, and all patients were discharged home with good outcomes.
CONCLUSIONS
To improve the prognosis of DNM, we suggest early and adequate debridement of all affected areas along with the proper use of antibiotics. A multidisciplinary approach involving both cardiothoracic and ENT surgeons is also required.
Topics: Adult; Anti-Bacterial Agents; Debridement; Female; Humans; Length of Stay; Male; Mediastinitis; Mediastinum; Middle Aged; Necrosis; Prognosis; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 32627617
DOI: 10.1177/0145561320933964 -
Medicina (Kaunas, Lithuania) Nov 2022: Cervical space infection could also extend to the mediastinum due to the anatomical vicinity. The mortality rate of descending necrotizing mediastinitis is 85% if...
: Cervical space infection could also extend to the mediastinum due to the anatomical vicinity. The mortality rate of descending necrotizing mediastinitis is 85% if untreated. The aim of this study was to identify risk factors for the progression of deep neck abscesses to descending necrotizing mediastinitis. : We retrospectively reviewed the medical records of patients undergoing surgical treatment of deep neck abscesses from August 2017 to July 2022. Computed tomography (CT) was performed in all patients. Before surgery, lab data including hemoglobulin (Hb), white blood cell count, neutrophil percentage, C-reactive protein (CRP) level, and blood glucose were recorded. Patients' characteristics including gender, age, etiology, and presenting symptoms were collected. Hospitalization duration and bacterial cultures from the wound were also analyzed. : The C-reactive protein (CRP) level was higher in patients with a mediastinal abscess than in patients without a mediastinal abscess (340.9 ± 33.0 mg/L vs. 190.1 ± 72.7 mg/L) ( = 0.000). The submandibular space was more commonly affected in patients without a mediastinal abscess ( = 0.048). The retropharyngeal ( = 0.003) and anterior visceral ( = 0.006) spaces were more commonly affected in patients with a mediastinal abscess. : Descending necrtotizing mediastinitis results in mortality and longer hospitalization times. Early detection of a mediastinal abscess on CT is crucial for treatment. Excluding abscesses of the anterior superior mediastinum for which transcervical drainage is sufficient, other mediastinal abscesses require multimodal treatment including ENT and thoracic surgery to achieve a good outcome.
Topics: Humans; Abscess; Mediastinitis; Retrospective Studies; C-Reactive Protein; Neck; Risk Factors; Necrosis
PubMed: 36556959
DOI: 10.3390/medicina58121758 -
The Journal of Thoracic and... Oct 2021
Commentary: Mediastinitis: Know the perps-keep the lights on and adapt strategy to asymptotically approach the Centers for Medicare and Medicaid Services "never-event" status.
Topics: Adaptation, Physiological; Aged; Centers for Medicare and Medicaid Services, U.S.; Genes, Tumor Suppressor; Humans; Mediastinitis; Medicaid; Medicare; Membrane Proteins; United States
PubMed: 32408959
DOI: 10.1016/j.jtcvs.2020.03.090 -
The Journal of International Medical... Aug 2021Fibrous mediastinitis is a rare progressive disease characterized by invasive proliferation of fibrous tissue in the mediastinum. This tissue proliferation leads to... (Review)
Review
Fibrous mediastinitis is a rare progressive disease characterized by invasive proliferation of fibrous tissue in the mediastinum. This tissue proliferation leads to compression of the mediastinal structures in the thoracic cavity, including the pulmonary vessels, esophagus, and trachea, causing corresponding symptoms and complications such as pulmonary hypertension. In clinical practice, the diagnosis of fibrous mediastinitis is often delayed or missed because of the rarity and variable clinical manifestations of this condition. This article presents a case of idiopathic fibrous mediastinitis that manifested as pleural effusion of unknown etiology along with a review of the relevant literature.
Topics: Humans; Hypertension, Pulmonary; Mediastinitis; Mediastinum; Pleural Effusion
PubMed: 34459275
DOI: 10.1177/03000605211040264