[Diagnosis and treatment of suppurative mediastinitis - a special chapter in the history of surgery (in Russian only)]. / Diagnostika i lechenie gnoinogo mediastinita - osobaia glava v istorii khirurgii.

It was reviewed a history of diagnosis and treatment of suppurative mediastinitis from ancient times to our time depending on inflammation type, localization and clinical features. An important role of national surgical school in the development of surgical treatment was emphasized.

Invasive Trichosporon infection in solid organ transplant patients: a report of two cases identified using IGS1 ribosomal DNA sequencing and a review of the literature.

Trichosporon species are rare etiologic agents of invasive fungal infection in solid organ transplant (SOT) recipients. We report 2 well-documented cases of Trichosporon inkin invasive infection in SOT patients. We also conducted a detailed literature review of Trichosporon species infections in this susceptible population. We gathered a total of 13 cases of Trichosporon species infections. Any type of organ transplantation can be complicated by Trichosporon infection. Bloodstream infections and disseminated infections were the most common clinical presentations. Liver recipients with bloodstream or disseminated infections had poor prognoses. Although the most common species was formerly called Trichosporon beigelii, this species name should no longer be used because of the changes in the taxonomy of this genus resulting from the advent of molecular approaches, which were also used to identify the strains isolated from our patients. Antifungal susceptibility testing highlights the possibility of multidrug resistance. Indeed, Trichosporon has to be considered in cases of breakthrough infection or treatment failure under echinocandins or amphotericin therapy. Voriconazole seems to be the best treatment option.

Propolis-induced descending necrotizing mediastinitis and aspiration pneumonia.

Propolis is a resinous substance collected by bees as a sealant for their hives. It is also used in traditional medicine as an antioxidant and antiinflammatory agent to treat ulcers, superficial burns, and microbial diseases. In this report, a 40-year-old woman who took liquid propolis for relief of her common cold experienced severe sore throat, dysphagia, and easy choking followed by fever and chills. Descending necrotizing mediastinitis and concomitant aspiration pneumonia were evident on the image studies. We performed video-assisted thoracoscopic surgery to achieve immediate and adequate drainage, and the patient resumed normal deglutition 2 months later. Early diagnosis and prompt video-assisted thoracoscopic surgery intervention are paramount to manage this life-threatening situation.

[Chest pains in emergency admission. Diagnostics and treatment]. / Brustschmerzen in der Notaufnahme. Diagnostik und Behandlung.

Thoracic pain is a common symptom in the emergency medicine setting and represents a diagnostic and therapeutic challenge. A multitude of differential diagnoses must be considered many of which are associated with a high mortality. Management of this situation is complicated by the fact that rapid and unexpectedly occurring and rapidly progressing deterioration are not uncommon in patients who initially did not appear to be seriously ill. Also for some underlying pathologies the physical examination can have an inconspicuous or"false negative" result and atypical presentations can give rise to false interpretations. The clinical and technical diagnostic methods, the implementation and interpretation including possible sources of error and limitations will be described in detail.

Trombosis de la vena yugular interna y mediastinitis aguda necrosante descendente debido a una faringoamigdalitis aguda / Thrombosis of the internal jugular vein and descending necrotizing mediastinitis due to acute pharyngotonsilitis

El síndrome de Lemierre es una patología muy infrecuente en la época actual, pero muy grave, y siempre debe considerarse ante un cuadro de fiebre con antecedente de infección orofaríngea, tumefacción laterocervical a lo largo del músculo esternocleidomastoideo y signos de sepsis. El diagnóstico de este síndrome es fundamentalmente clínico, y las pruebas complementarias tan sólo ayudan a confirmar el cuadro. Presentamos el caso de un varón de 31 años que acudió a urgencias con clínica de faringoamigdalitis junto con tumefacción en la región submandibular izquierda e importante dolor cervical ipsilateral, que mostró un deterioro rápido y progresivo del estado general pese al tratamiento antibiótico intravenoso. Finalmente tuvo que ser intervenido debido al desarrollo de mediastinitis aguda necrosante descendente desde la región pretiroidea hasta el diafragma, con trombosis de la vena yugular interna izquierda. Se le realizó toracotomía urgente y cervicotomía izquierda con drenaje de abundante material purulento y ligadura de la vena yugular interna(AU)

Lemierre syndrome is a potentially fatal condition after an oropharyngeal infection. It is characterized by thrombophlebitis of head and neck veins with systemic dissemination of septic emboli. The diagnosis of this syndrome is mainly clinical and complementary test only serve as aid to confirm it. We report an unusual case of Lemierre syndrome in a 31-year-old man caused by Gemella spp. and Streptococcus pyogenes. It developed following a pharyngotonsillitis infection, which deteriorated rapidly and progressively despite intravenous antibiotic treatment. He finally had to be intervened due to developing acute descending necrotizing mediastinitis from the pre-thyroid region to the diaphragm, with thrombosis of the internal jugular vein. An urgent thoracotomy and left cervicotomy was performed, with drainage of abundant purulent material and ligature of the internal jugular vein. We also discuss its atypical clinical presentation, the crucial role of imaging in the early diagnosis, and the different treatment options of this life-threatening syndrome(AU)

[A rare case of gaseous gangrenous mediastinitis]. / Rzadki przypadek zgorzeli gazowej sródpiersia.

We report a case of a cervical phlegmone and mediastinitis descending from peridental abscess in 32-year old student. Emergency left thoracotomy was performed after CT evaluation in which multiple fluid levels and gas spaces were found. After 72 hours bacterial strains showed Clostridium perfringens in fluid taken from left pleural cavity and patient was sent to Hiberbaric Center in Gdynia, where he underwent hyperbaric oxygen therapy. After 10 days the patient was brought back in good condition to our Department. After 3 days he died because of sudden massive bleeding caused by necrosis of aorta wall.

[Descending necrotizing mediastinitis: a diagnosis not to miss]. / La cellulite cervico-médiastinale nécrosante: un diagnostic à ne pas méconnaître.

Descending necrotizing mediastinitis is a severe disease which occurs after a mild otorhinolaryngologic or dental infection. The diagnosis must be established rapidly with the help of clinical and computed tomography of the neck and chest data. Treatment is based on antibiotics, surgery and hyperbaric oxygen. The outcome is poor with high mortality. We report a case of septicemia complicating descending necrotizing mediastinitis after dental infection.

Successful treatment of mediastinal gas gangrene due to esophageal perforation.

Esophageal perforation and mediastinal gas gangrene developed in a 55-year-old male after the endoscopic ethanol injection of a Mallory-Weiss ulcer. Initially, extensive gangrene of the esophagus and the mediastinum was treated by esophagectomy; however, an abundance of Clostridium perfringens in the Gram stain verified the presence of gas gangrene. Subsequently, the patient was transferred to a hyperbaric oxygen center, wherein a total of seven hyperbaric treatments were administered. The patient survived, and 4 months later, after having undergone several reoperations because of pleural empyema, mediastinal abscess, splenic rupture, and acalculous cholecystitis, was discharged and is still surviving.

Necrotizing fasciitis and mediastinitis.

Necrotizing fasciitis and mediastinitis are two rare but grave complications of orofacial infections. The clinical presentation, diagnostic modalities, anatomic pathways, microbiologic make-up, surgical management, and the use of adjuvant HBO therapy for both entities have been discussed.