Document Detail


Descending necrotizing mediastinitis: a 10-year surgical experience in a single institution.
MedLine Citation:
PMID:  18603075     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Early diagnosis and aggressive surgical drainage are very important for successful treatment of descending necrotizing mediastinitis. However, the surgical techniques used for this condition remain controversial. We report our 10-year experience of managing this devastating disease, focusing on the multidisciplinary, minimally invasive operative procedures and the unique bacteriologic factors in Taiwan. METHODS: Between January 1997 and January 2007, we retrospectively reviewed 18 patients with descending necrotizing mediastinitis who were treated in the National Taiwan University Hospital. Diagnosis and Endo classification were confirmed by computed tomography of the neck and chest. RESULTS: Eight women and 10 men were included in this study. The mean age was 57.8 +/- 15.2 years. Cervical drainage was performed in the involved area in all patients. The methods for mediastinal drainage included transcervical (n = 10), video-assisted thoracic surgical drainage (n = 6), subxiphoid drainage (n = 1), and mediastinoscopy-assisted drainage (n = 1). We could not rescue 3 patients because of uncontrolled sepsis before surgery, for a mortality rate of 16.7%. Klebsiella pneumoniae uniquely represents the most common pathogen in diabetic patients (P = .01), leading to more complicated courses in older patients (P =.04) and requiring more surgical interventions (P =.05) than other pathogens. CONCLUSION: Transcervical mediastinal drainage is first justified in patients with limited disease in the upper mediastinum. For those with involvement of the lower anterior mediastinum, an additional subxiphoid approach is suggested. Cervicotomy with video-assisted mediastinal drainage is an excellent combination for involvement of the posterior mediastinum and pleural space. Klebsiella pneumoniae uniquely represents the most important and threatening causative pathogen for diabetic patients with descending necrotizing mediastinitis.
Authors:
Ke-Cheng Chen; Jin-Shing Chen; Shuenn-Wen Kuo; Pei-Ming Huang; Hsao-Hsun Hsu; Jang-Ming Lee; Yung-Chie Lee
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Publication Detail:
Type:  Journal Article     Date:  2008-05-22
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  136     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-08     Completed Date:  2008-07-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  191-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Abscess / epidemiology,  microbiology
Adult
Aged
Causality
Comorbidity
Coronary Artery Disease / epidemiology
Debridement
Diabetes Mellitus / epidemiology
Drainage
Female
Foreign Bodies / epidemiology,  microbiology
Humans
Hypertension / epidemiology
Liver Cirrhosis / epidemiology
Male
Mediastinitis / microbiology,  mortality*,  radiography,  surgery*
Mediastinum / surgery
Middle Aged
Pleura / surgery
Retrospective Studies
Taiwan / epidemiology
Thoracic Surgery, Video-Assisted
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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