Resección quirúrgica de papilomatosis glandular endobronquial / Surgical Resection of Endobronchial Glandular Papilloma

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Tratamiento quirúrgico de la mediastinitis necrosante descendente / Surgical management of descending necrotizing mediastinitis

Introducción La mediastinitis necrosante descendente (MND) consiste en una infección grave que aparece como complicación de una infección orofaríngea. Aún existe controversia a propósito del tratamiento quirúrgico y si está indicado un abordaje transtorácico rutinario. En este artículo presentamos nuestra experiencia en el tratamiento de la mediastinitis necrosante descendente y revisamos en la bibliografía las diferentes opciones de abordaje propuestas. Material y métodos Estudio observacional retrospectivo de los pacientes con mediastinitis necrosante descendente intervenidos entre 1988 y 2009. Se analizan variables demográficas, origen de la infección, estadio de la enfermedad según la clasificación de Endo, técnica quirúrgica realizada y evolución. Resultados En dicho periodo se intervino a 29 pacientes. El tratamiento quirúrgico consistió en el drenaje y desbridamiento radical a nivel cervical y mediastínico. El drenaje mediastínico se realizó por vía transcervical en 10 casos y transtorácica en 19, en función de la extensión de la mediastinitis. De ellos, 24 presentaron buena evolución y 5 fallecieron (mortalidad 17,2%).Conclusiones De acuerdo con nuestros resultados y las conclusiones de los principales autores, se debe realizar un tratamiento quirúrgico precoz y agresivo que incluya un abordaje transtorácico en casos de mediastinitis extendida (AU)

Introduction Descending necrotizing mediastinitis (DNM) is a serious infection which occurs as a complication of oropharyngeal infection. Its surgical management and the routine transthoracic approach remain controversial. In this article we report our experience in the management of this disease, and review the different surgical approaches that have been reported in the medical literature. Material and methods A retrospective review was made of the clinical records of 29 patients treated between 1988 and 2009. Several demographic variables were analyzed, origin of the initial infection, stage of the disease according to Endo's classification, surgical technique and outcome. Results Surgical treatment consisted of both cervical and mediastinal drainage and radical debridement. The mediastinal drainage was made through a transcervical approach in 10 cases and transthoracic in 19, depending on the extent of the mediastinitis. The outcome was satisfactory in 24 patients and 5 died (mortality 17.2%).Conclusions According to our results and the conclusions of the main authors, we recommend a prompt and aggressive surgery with a transthoracic approach in cases of widespread DNM (AU)

[Surgical management of descending necrotizing mediastinitis]. / Tratamiento quirúrgico de la mediastinitis necrosante descendente.

INTRODUCTION: Descending necrotizing mediastinitis (DNM) is a serious infection which occurs as a complication of oropharyngeal infection. Its surgical management and the routine transthoracic approach remain controversial. In this article we report our experience in the management of this disease, and review the different surgical approaches that have been reported in the medical literature. MATERIAL AND METHODS: A retrospective review was made of the clinical records of 29 patients treated between 1988 and 2009. Several demographic variables were analyzed, origin of the initial infection, stage of the disease according to Endo's classification, surgical technique and outcome. RESULTS: Surgical treatment consisted of both cervical and mediastinal drainage and radical debridement. The mediastinal drainage was made through a transcervical approach in 10 cases and transthoracic in 19, depending on the extent of the mediastinitis. The outcome was satisfactory in 24 patients and 5 died (mortality 17.2%). CONCLUSIONS: According to our results and the conclusions of the main authors, we recommend a prompt and aggressive surgery with a transthoracic approach in cases of widespread DNM.