Clinical management and prognosis for descending necrotizing mediastinitis / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the clinical characteristics, treatment experiences and prognostic factors for descending necrotizing mediastinitis (DNM). Methods: A retrospective analysis was performed on the data of 22 patients with DNM diagnosed and treated in Henan Provincial People's Hospital from January 2016 to August 2022, including 16 males and 6 females, aged 29-79 years. After admission, all patients underwent CT scanning of the maxillofacial, cervical, and thoracic regions to confirm their diagnoses. Emergency incision and drainage were performed. The neck incision was treated with continuous vacuum sealing drainage. According to the prognoses, the patients were divided into cure group and death group, and the prognostic factors were analyzed. SPSS 25.0 software was used to analyze the clinical data. Rusults: The main complaints were dysphagia (45.5%, 10/22) and dyspnea (50.0%, 11/22). Odontogenic infection accounted for 45.5% (10/22) and oropharyngeal infection accounted for 54.5% (12/22). There were 16 cases in the cured group and 6 cases in the death group, with a total mortality rate of 27.3%. The mortality rates of DNM typeⅠand typeⅡwere respectively 16.7% and 40%. Compared with the cured group, the death group had higher incidences for diabetes, coronary heart disease and septic shock (all P<0.05). There were statistically significant differences between the cure group and the death group in procalcitonin level (50.43 (137.64) ng/ml vs 2.92 (6.33) ng/ml, M(IQR), Z=3.023, P<0.05) and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score (16.10±2.40 vs 6.75±3.19, t=6.524, P<0.05). Conclution: DNM is rare, with high mortality, high incidence of septic shock, and the increased procalcitonin level and APACHE Ⅱ score combined diabetes and coronary heart disease are the poor prognostic factors for DNM. Early incision and drainage combined with continuous vacuum sealing drainage technique is a better way to treat DNM.

The operative technique selection of lung transplantation for end-stage emphysema / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the operation of lung transplantation for end-stage emphysema.</p><p><b>METHODS</b>From September 2002 to February 2005, 9 patients with chronic obstructive pulmonary disease (COPD) underwent lung transplantation. The types of surgery included single lung transplantation in 2 patients, lung transplantation with asynchronous contralateral lung volume reduction (one week later) in 1, single lung transplantation with synchronized contralateral lung volume reduction in 4, and bilateral sequential lung transplantation without cardiopulmonary bypass in 2.</p><p><b>RESULTS</b>The volume of chest drainage was more than 2000 ml at the first postoperative day in 2 patients, one was reoperated for hemostasis and another was successfully responded to conservative therapy. The ventilation time was ranged from 3 to 22 days postoperatively. Two patients were received tracheotomy. Seven patients achieved good results, two of them had returned to work, and 1 patient had lived for 30 months. One patient was died of severe acute rejection (4A) at 15th postoperative day and 1 succumbed to multisystem organ failure due to severe bacterial infection combine fungal infection.</p><p><b>CONCLUSION</b>End-stage emphysema is an indication for single lung transplantation. Single lung transplantation with contralateral lung volume reduction is a good way to utilize donor. If patient suffered from infection, double-lung transplantation should be considered first.</p>