Assuntos
Neoplasias Cardíacas/secundário , Neoplasias Pulmonares/secundário , Neoplasias do Mediastino/cirurgia , Pericárdio , Teratoma/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , Pericárdio/cirurgia , Teratoma/diagnóstico por imagem , Teratoma/patologia , Tomografia Computadorizada por Raios XRESUMO
Mycotic subclavian artery aneurysms are rare but challenging pathology. We report a 67-year-old woman who presented with recurrent bacteremia secondary to chronic clavicular osteomyelitis. Imaging demonstrated a right subclavian artery aneurysm near the innominate artery bifurcation and in close proximity to the infected clavicle. Owing to the anatomic location, among other factors, she underwent open repair using a rifampin-soaked Dacron conduit. Analysis of the aneurysm wall identified bacteria consistent with intraoperative bone and blood cultures. Contributions from multiple surgical and medical specialties provided a favorable, long-term outcome for the patient.
Assuntos
Carcinoma Anaplásico da Tireoide/diagnóstico por imagem , Tireotoxicose/diagnóstico por imagem , Idoso , Biópsia por Agulha Fina , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Neoplasias Pulmonares/secundário , Metástase Linfática , Carcinoma Anaplásico da Tireoide/patologia , Testes de Função Tireóidea , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Surgical site infections (SSI) are common complications after open ventral hernia repair (OVHR), potentially requiring further intervention. Antibiotic lavage before abdominal closure has been shown to lower the incidence in intra-abdominal and soft tissue SSI. A retrospective review of OVHR was performed with mesh at Greenville Health System Hernia Center between 2008 and 2017. Patients were divided into three groups, receiving no antibiotic irrigation (Grp 1, n = 260), gentamicin alone (Grp 2, n = 263), or gentamicin + clindamycin (G + C) irrigation (Grp 3, n = 299). Differences in categorical variables among the three groups were tested using chi-squared or Fischer's exact test (for n < 5). Analysis of continuous variables was performed using analysis of variance or Kruskal-Wallis test for differences in length of stay. Logistic regression was performed using all clinically relevant variables to determine the effects of irrigation on SSI. Incidence of surgical site occurrence was significantly lower after G + C irrigation (Grp 1, 28.1%; Grp 2, 35.4%; Grp 3, 19.7%; P < 0.001). Incidence of SSI was significantly lower after G + C irrigation, but not G alone (Grp 1, 16.5%; Grp 2, 15.2%; and Grp 3, 5.4%; P < 0.001). Multivariate logistic regression demonstrated significantly increased SSI with contaminated wounds (OR 2.96; 95% confidence interval (CI) 1.39-6.21), dirty wounds (OR 3.84; 95% CI 1.49-9.69), and chronic obstructive pulmonary disease (OR 3.70; 95% CI 2.16-6.38), as expected. Use of G + C was an independent predictor of decreased SSI (OR 0.33; 95% CI 0.16-0.67). Irrigation with a combined G + C antibiotic irrigation significantly reduces the incidence of surgical site infection after OVHR with mesh.
Assuntos
Antibacterianos/administração & dosagem , Clindamicina/administração & dosagem , Gentamicinas/administração & dosagem , Hérnia Ventral/complicações , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/terapia , Irrigação Terapêutica , Adulto , Idoso , Quimioterapia Combinada , Feminino , Hérnia Ventral/epidemiologia , Hérnia Ventral/cirurgia , Herniorrafia/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , South Carolina/epidemiologia , Telas Cirúrgicas/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Irrigação Terapêutica/métodos , Resultado do TratamentoRESUMO
This article describes 2 patients who presented to our institution with left atrial esophageal fistula after atrial fibrillation ablation; it also compares our experience with other atrial esophageal fistula cases reported in the literature. We performed a retrospective review of 2 patients who presented to our hospital between July 2015 and September 2015 with atrial esophageal fistula. Patient A, a 57-year-old man, presented 31 days postablation with a fever and right-sided weakness. A chest computed tomography showed gas in the left atrium and esophagus; an echocardiogram confirmed the diagnosis of atrial esophageal fistula. The patient subsequently underwent a left thoracotomy. Postoperative recovery was poor and included significant coagulopathy, sepsis, cardiogenic shock, and multisystem organ failure. The patient died on postoperative day 28. Patient B, a 77-year-old man, presented 21 days post-atrial fibrillation ablation with left-arm weakness and altered mental status. An esophagram was performed and showed no evidence of an esophageal perforation. Because of positive cultures and worsening altered mental status, the patient underwent a head computed tomography, which showed pneumocephalus, leading to our suspicion of the atrial esophageal fistula. A follow-up chest computed tomography confirmed the atrial esophageal fistula. Treatment included an esophagectomy and repair of the atrium. Unfortunately, the atrial esophageal fistula closure dehisced, and the patient developed acute respiratory failure and cardiac tamponade, which led to cardiopulmonary arrest, and the patient died on postoperative day 10. Based on our experience, and the literature, we recommend that a chest computed tomography be immediately performed on patients presenting with the described symptoms after a recent atrial fibrillation ablation.