Search

The objective of this study was to explore the added value of spectral computed tomography (CT) parameters to conventional CT features for differentiating tuberculosis-associated fibrosing mediastinitis (TB-associated FM) from endobronchial lung cancer (EBLC). Chest spectral CT enhancement images from 109 patients with atelectasis were analyzed retrospectively. These patients were divided into two distinct categories: the TB-associated FM group (n = 77) and the EBLC group (n = 32), based on bronchoscopy and/or pathological findings. The selection of spectrum parameters was optimized with the least absolute shrinkage and selection operator regression analysis. The relationship between the spectrum parameters and conventional parameters was explored using Pearson's correlation. Multivariate logistic regression analysis was used to build spectrum model. The spectrum parameters in the spectrum model were replaced with their corresponding conventional parameters to build the conventional model. Diagnostic performances were evaluated using receiver operating characteristic curve analyses. There was a moderate correlation between the parameters ㏒(L-AEF NIC) - ㏒(L-AEF C) (r = 0.419; p < 0.0001), ㏒(O-AEF 40KeV) - ㏒(O-AEF C) (r = 0.475; p < 0.0001), [L-A-hydroxyapatite {HAP}(I)] - (L-U-CT) (r = 0.604; p < 0.0001), {arterial enhancement fraction (AEF) derived from normalized iodine concentration (NIC) of lymph node (L-AEF NIC), AEF derived from CT 40KeV of bronchial obstruction (O-AEF 40KeV), arterial-phase Hydroxyapatite (Iodine) concentration of lymph node [L-A-HAP(I)], AEF derived from conventional CT (AEF C), unenhanced CT value (U-CT)}. Spectrum model could improve diagnostic performances compared to conventional model (area under curve: 0.965 vs 0.916, p = 0.038). There was a moderate correlation between spectrum parameters and conventional parameters. Integrating conventional CT features with spectrum parameters could further improve the ability in differentiating TB-associated FM from EBLC. • Spectrum parameters correlated moderately with conventional parameters. • Spectrum parameters may be helpful for identifying atelectasis due to tuberculosis-associated fibrosing mediastinitis. • Integrating spectrum parameters with computed tomography features could further improve the differential ability. [ABSTRACT FROM AUTHOR]

Introduction: Descending necrotizing mediastinitis is one of the most lethal forms of acute mediastinitis. It originates from an odontogenic or deep neck infection, which descends to the mediastinum through the fascial planes. It is a rare condition, but mortality rates remain high, especially in the presence of comorbidities or predisposing factors. Delay in diagnosis has been shown to be one of the most important factors for the disease outcome. Therefore, early diagnosis and treatment by a multidisciplinary team are of utmost importance. Case series: Four healthy young males with descending necrotizing mediastinitis were treated at our institution. None of them had any comorbidities, but all of them waited between 3 and 4 days before seeking medical help. Upon their arrival at the hospital, in addition to the presence of a severe neck infection, the presence of mediastinitis was also found. Despite the timely surgical treatment of both the source of the infection and the mediastinitis, three of the four cases had a fatal outcome. Conclusion: We believe that the time factor is of greater importance for the outcome of acute descending mediastinitis than the factors of age and presence of accompanying diseases. Proper and rapid treatment by a multidisciplinary team is essential, even for young and healthy people. [ABSTRACT FROM AUTHOR]

Neck infections are often prone to being underestimated and can manifest insidiously. The spread of infection can lead to translocation into thoracic areas, causing descending necrotizing mediastinitis (DNM). However, the application of the post-mortem approach in such cases is not well-described in the literature. A literature review was carried out according to the PRISMA methods. Nine papers were included in the final review, revealing different levels of involvement of neck layers that can be linked to different causes. Expertise with respect to the anatomy of the fasciae and spaces of the neck enables an understanding of the pathogenesis of DNM. However, a clear autoptic description was not provided in any of the articles. Therefore, we also employed a practical post-mortem approach to cases of death due to DNM. It is fundamental for pathologists to identify the exact head and neck structures involved. Providing dissectors with support from an otolaryngologist could be useful. This paper could help address such difficult cases. [ABSTRACT FROM AUTHOR]

Boerhaave's syndrome, also known as spontaneous esophageal rupture, is a rare but life-threatening condition characterized by a tear in the esophagus. It is most commonly caused by a sudden increase in intraesophageal pressure, often due to severe vomiting or retching. Early diagnosis of Boerhaave's syndrome is crucial for improving patient outcomes. The classic triad of symptoms includes severe chest pain, vomiting, and subcutaneous emphysema (air under the skin). However, not all patients present with this triad, and the diagnosis can be challenging, especially in patients without the typical symptoms. In this case report, we present the clinical details of a 52-year-old male patient who presented to the emergency department (ED) with severe abdominal pain and vomiting for several days. The patient had a history of chronic alcohol abuse and a recent episode of vigorous vomiting. [ABSTRACT FROM AUTHOR]

Background This study aimed to characterize the demographics, microbiology, management and treatment outcomes of mediastinitis according to the origin of the infection. Methods This retrospective observational study enrolled patients who had mediastinitis diagnosed according to the criteria defined by the Centers for Disease Control and Prevention and were treated in Strasbourg University Hospital, France, between 1 January 2010 and 31 December 2020. Results We investigated 151 cases, including 63 cases of poststernotomy mediastinitis (PSM), 60 cases of mediastinitis due to esophageal perforation (MEP) and 17 cases of descending necrotizing mediastinitis (DNM). The mean patient age (standard deviation) was 63 (14.5) years, and 109 of 151 patients were male. Microbiological documentation varied according to the origin of the infection. When documented, PSM cases were mostly monomicrobial (36 of 53 cases [67.9%]) and involved staphylococci (36 of 53 [67.9%]), whereas MEP and DNM cases were mostly plurimicrobial (38 of 48 [79.2%] and 8 of 12 [66.7%], respectively) and involved digestive or oral flora microorganisms, respectively. The median duration of anti-infective treatment was 41 days (interquartile range, 21–56 days), and 122 of 151 patients (80.8%) benefited from early surgical management. The overall 1-year survival rate was estimated to be 64.8% (95% confidence interval, 56.6%–74.3%), but varied from 80.1% for DNM to 61.5% for MEP. Conclusions Mediastinitis represents a rare yet deadly infection. The present cohort study exhibited the different patterns observed according to the origin of the infection. Greater insight and knowledge on these differences may help guide the management of these complex infections, especially with respect to empirical anti-infective treatments. [ABSTRACT FROM AUTHOR]

Tracheomediastinal fistula is a rare but life‐threatening complication of cancer. We report a case of tracheomediastinal fistula induced by concurrent chemoradiotherapy in limited stage small cell lung cancer. Despite the treatment response, the metastatic paratracheal lymph node increased gradually during concurrent chemoradiotherapy, resulting in the occurrence of tracheomediastinal fistula and mediastinitis. Without any surgical intervention, the patient achieved successful recovery from mediastinitis through antibiotic treatment, although the tracheomediastinal fistula remained open. In this report, we also review previous studies of tracheomediastinal and bronchomediastinal fistulas and summarize the clinical features. [ABSTRACT FROM AUTHOR]

Despite evidence suggesting the benefit of prophylactic regional antibiotic delivery (RAD) to sternal edges during cardiac surgery, it is seldom performed in clinical practice. The value of topical vancomycin and gentamicin for sternal wound infections (SWI) prophylaxis was further questioned by recent studies including randomized controlled trials (RCTs). The aim of this systematic review and meta-analysis was to comprehensively assess the safety and effectiveness of RAD to reduce the risk of SWI.We screened multiple databases for RCTs assessing the effectiveness of RAD (vancomycin, gentamicin) in SWI prophylaxis. Random effects meta-analysis was performed. The primary endpoint was any SWI; other wound complications were also analysed. Odds Ratios served as the primary statistical analyses. Trial sequential analysis (TSA) was performed.Thirteen RCTs (N = 7,719 patients) were included. The odds of any SWI were significantly reduced by over 50% with any RAD: OR (95%CIs): 0.49 (0.35–0.68); p < 0.001 and consistently reduced in vancomycin (0.34 [0.18–0.64]; p < 0.001) and gentamicin (0.58 [0.39–0.86]; p = 0.007) groups (psubgroup = 0.15). Similarly, RAD reduced the odds of SWI in diabetic and non-diabetic patients (0.46 [0.32–0.65]; p < 0.001 and 0.60 [0.44–0.83]; p = 0.002 respectively). Cumulative Z-curve passed the TSA-adjusted boundary for SWIs suggesting adequate power has been met and no further trials are needed. RAD significantly reduced deep (0.60 [0.43–0.83]; p = 0.003) and superficial SWIs (0.54 [0.32–0.91]; p = 0.02). No differences were seen in mediastinitis and mortality, however, limited number of studies assessed these endpoints. There was no evidence of systemic toxicity, sternal dehiscence and resistant strains emergence. Both vancomycin and gentamicin reduced the odds of cultures outside their respective serum concentrations’ activity: vancomycin against gram-negative strains: 0.20 (0.01–4.18) and gentamicin against gram-positive strains: 0.42 (0.28–0.62); P < 0.001. Regional antibiotic delivery is safe and effectively reduces the risk of SWI in cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Background: Descending necrotizing mediastinitis (DNM) is a life-threatening condition, generally caused by downward dissemination of oropharyngeal infections through cervical fascial planes. Mediastinal drainage is conventionally achieved by thoracotomy, but a Video-Assisted Thoracoscopic Surgery (VATS) approach is gaining interest due to the reduced invasiveness of procedure. We aimed to evaluate the effectiveness of VATS treatment in patients with DNM. Methods: We conducted a retrospective multicenter study including patients with descending mediastinitis that underwent mediastinal drainage through VATS (VATS group) or thoracotomy (thoracotomy group), both in association with cervical drainage. Patients with mediastinitis secondary to cardiac, pulmonary, or esophageal surgery were excluded. The intergroup differences regarding surgical outcome and postoperative morbidity and mortality were compared. Results: A total of 21 patients were treated for descending mediastinitis during the study period. Cervicotomy and thoracotomy were performed in 15 patients (71%), while cervicotomy and VATS were performed in 6 patients (29%). There were no significant differences in surgical outcome, postoperative morbidity, and mortality between groups. VATS treatment was not associated with a higher complication rate. Patients in the VATS group had a shorter operative time (p = 0.016) and shorter ICU stay (p = 0.026). Conclusions: VATS treatment of DNM is safe and effective. The comparison with thoracotomy showed no significant differences in postoperative morbidity and mortality. The VATS approach is associated with a shorter operative time and ICU stay than thoracotomy. [ABSTRACT FROM AUTHOR]

The occurrence of ectopic pancreas in the mediastinum is rare. Herein, we report a 22-year-old female who presented with right shoulder pain, dysphagia, fever and headaches. Chest computer tomography revealed a mass in the posterior mediastinum with accompanying signs of acute mediastinitis. Needle biopsy and fine-needle aspiration revealed ectopic gastral tissue and ectopic pancreas tissue, respectively. Surgical resection was attempted due to recurring acute pancreatitis episodes. However, due to chronic-inflammatory adhesions of the mass to the tracheal wall, en-bloc resection was not possible without major tracheal resection. Since then, recurring pancreatitis episodes have been treated conservatively with antibiotics. We report this case due to its differing clinical and radiological findings in comparison to previous case reports, none of which pertained a case of ectopic pancreas tissue in the posterior mediastinum with recurring acute pancreatitis and mediastinitis. [ABSTRACT FROM AUTHOR]

A cluster of deep sternal wound infections caused by Candida spp. occurred at our institution. Investigation did not disclose a common environmental source. We postulate that broad-spectrum antibiotic surgical prophylaxis and liberal use of antibiotics contributed to these infections. [ABSTRACT FROM AUTHOR]

The article aims to evaluate safety and effects CR program on physical capacity and QoL in patients after open-heart surgery complicated with sternomediastinitis. This observational cohort study included 104 patients, of them 58 were males and 34 females, who underwent cardiac surgery made by sternotomy. We divided the cohort into two groups: 1st group clustered of 92 patients, who did not have sternomediastinitis complications after the surgery; 2nd group clustered of 12 patients, who had sternomediastinitis complications after the surgery. We assessed following variables: physical capacity using 6-minute walk test (6MWT) and the metabolic equivalent (MET) and maximal oxygen consumption (VO2max), QoL using SF36 survey. Statistical analyses were performed using the IBM SPSS Statistics software (version 19). The Kolmogorov-Smirnov and Shapiro-Wilk tests were used to check the normality of distributions. Then, the Mann-Whitney U test was performed to compare not normally distributed independent variables, in order to see the difference (significance level was accepted at p<0.05). After that, the Pearson's two tailed correlation test was used to find the connection between variables of two groups. Properly selected physical exercises during CR improve the fitness and physical activity of patients after sternomediastinitis, as well as, QoL mesures - general health and mental status. [ABSTRACT FROM AUTHOR]

Background: Acute coronary artery obstruction is a rare but lethal complication of surgical aortic valve replacement (SAVR), which may be caused by embolization of resected native tissue such as calcium plaque, thrombus, or perivalvular aortic tissue like fat embolus. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the main treatment modalities. PCI is less invasive, but it is difficult to determine its feasibility intraoperatively. Case presentation: We report an 86-year-old woman who had asymptomatic severe aortic stenosis. She had scleroderma with an intractable left leg ulcer and bilateral leg varices. Considering the possibility of the spread of infection from the leg wound, SAVR was performed via right anterior thoracotomy to avoid complications such as mediastinitis. Coronary artery occlusion was suspected after weaning of cardiopulmonary bypass in the operation room due to asynergy with ST elevation and new severe mitral regurgitation. Transoesophageal echocardiography (TEE) helped diagnose coronary obstruction by embolus based on the degree of stenosis and the movement of the stenosis site. Percutaneous catheter intervention was performed successfully to restore coronary perfusion. Conclusion: TEE facilitated the diagnosis of coronary artery stenosis caused by an embolus and helped in determining the feasibility of percutaneous catheter intervention, thus allowing us to choose PCI over CABG as a less invasive surgery. This is especially invaluable in cases where obtaining a saphenous graft for CABG is difficult or where CABG would have required conversion from minimally invasive surgery (anterolateral approach) to median sternotomy. [ABSTRACT FROM AUTHOR]

Introduction: Patients with congenital heart disease are at increased risk for requiring cardiac pacing during their lifetime. Methods: We present the first described case of using two leadless pacing systems manufactured by separate companies implanted within the same patient to provide atrial and ventricular pacing due to complex congenital anatomy. Results: A 27‐year‐old male with dextrocardia with double outlet right ventricle, subaortic ventricular septal defect, and pulmonary stenosis status‐post pulmonary valve replacement complicated by ventricular pacing dependence and subsequent atrial pacing dependence after atriotomy‐based atypical flutter ablation developed recurrent mediastinitis and pocket infection with erosion despite prolonged antibiotic treatment. Due to atrial and ventricular pacing dependence, a comprehensive congenital care team concluded the need for lead extraction and replacement of pacemaker via leadless peacemaking device. Laser‐lead extraction and temporary atrial pacemaker placement was performed. Afterward, a transesophageal echocardiogram guided implantation of both a Micra AV 2 (Medtronic) leadless pacemaker in the interventricular septum within the right ventricle and an Aveir (Abbott) leadless pacemaker in the superior base of the right atrial appendage was performed with successful pacing. Although there is no communication between these devices, atrial‐mechanical ventricular pacing was reliable with good implant thresholds, impedances and sensing from both devices. Conclusion: Our case demonstrates the feasibility of using dual leadless pacing modalities to simultaneously pace someone at complex, prohibitive risk for temporary permanent or permanent pacemaker devices. [ABSTRACT FROM AUTHOR]

Fatal hemoptysis secondary to severe pulmonary veins stenosis and fibrosing mediastinitis is an exceptional late complication of radiofrequency ablation for atrial fibrillation. We report the case of a 53-year-old male with a history of atrial fibrillation treated by radiofrequency ablation and admitted in our center 6 months after the procedure because of aggravating dyspnea and fatigability. Transthoracic echocardiography showed moderate dilation of right heart cavities, severe pulmonary hypertension and a turbulent flow in superior pulmonary veins. The cardiologist suspected pulmonary vein(s) stenosis and so cardiac computed tomography (CT) angiography was performed, with findings of severe stenosis of the right superior, right inferior and left inferior pulmonary veins, near-occlusion of the left superior pulmonary vein and the vein draining the apical segment of the right lower lobe. The CT scan also revealed soft tissue attenuation of the mediastinum posterior to the left atrium suggesting fibrosing mediastinitis together with parenchymal findings consistent with pulmonary veno-oclusive disease and an area of hemorrhagic infarction. Fatal hemoptysis occurred 3 days later, before treatment was attempted. In conclusion, severe pulmonary vein stenosis and fibrosing mediastinitis are rare but devastating complications of radiofrequency ablation. Prevention and early diagnosis are the key elements as these entities are potentially life-threatening. [ABSTRACT FROM AUTHOR]

A 59-year-old male underwent Bio-Bentall + total arch replacement with a frozen elephant trunk for acute type A aortic dissection before at another hospital. He was diagnosed as mediastinitis and previous graft infection, followed by wound closure with omental flap installation. However, the recurrent graft infection from the aortic root to the FET in the descending aorta was diagnosed by 18-fluorodeoxyglucose positron emission tomography. Redo modified Bio-Bentall procedure, total arch replacement, and descending aortic replacement for previous graft infection using anterolateral thoracotomy with partial sternotomy was successfully performed. Anterolateral thoracotomy with partial sternotomy provided not only the excellent exposure from the aortic root to the descending aorta but also sure myocardial protection with antegrade and selective delivery of cold crystalloid cardioplegia and stable brain protection with antegrade selective cerebral perfusion. The patient is doing well without recurrent of infection after 2 years of the operation. [ABSTRACT FROM AUTHOR]

Background: Descending necrotizing mediastinitis (DNM) is a rare and life-threatening condition, with high morbidity and mortality. Consequently, appropriate and prompt diagnosis and treatment are necessary. Herein, we report a case of esophageal perforation and bronchial ulcer secondary to DNM, for which thoracoscopic esophagectomy was performed after the failure of conservative treatment. Case presentation: A 63-year-old man was diagnosed with mediastinitis affecting the posterior mediastinum after presenting with a sore throat, back pain, and dyspnea. He also had type 2 diabetes mellitus and renal failure. The patient developed septic shock the following day, and intensive treatment was initiated. The condition of the patient gradually improved; however, the laboratory data revealed that levels of C-reactive protein remained high. On day 22, the esophageal perforation was demonstrated on esophagogastroduodenoscopy. Bronchoscopy was remarkable for the ulcer on the membranous tracheal wall, though he did not go into respiratory failure. The emergency thoracoscopic esophagectomy was performed on day 27. The reconstruction surgery was performed on day 100. Conclusions: Despite the fact that the general condition is stable with conservative treatment, DNM can develop esophageal perforation. Thus, it is essential to determine the appropriate timing of surgical intervention if levels of inflammation markers continue to be high. [ABSTRACT FROM AUTHOR]

Introduction: Fibrosing mediastinitis is a benign but fatal disorder characterized by the proliferation of fibrous tissue in the mediastinum, causing encasement of mediastinal organs and extrinsic compression of adjacent bronchovascular structures. FM-associated pulmonary hypertension (FM-PH) is a serious complication of FM, resulting from the external compression of lung vessels. Pathologic assessment is important for etiologic diagnosis and effective treatment of this disease. Case Presentation: A 59-year-old male patient presented at our hospital and was diagnosed with FM-PH. He declined surgical biopsy that is the reference standard for pathologic assessment, in consideration of the potential risks. Therefore, an endobronchial ultrasound examination was performed, which identified the subcarinal lesion. Under ultrasound guidance, four needle aspirations were carried out, followed by one cryobiopsy. Histopathological examination of transbronchial needle aspiration specimens was inconclusive, while samples from cryobiopsy suggested a diagnosis of idiopathic FM. Further immunophenotyping demonstrated the infiltration of lymphocytes, macrophages, and FOXP3-positive cells in FM-PH. Conclusion: Mediastinal cryobiopsy might be a novel and safe option for FM-PH patients who are unwilling or unsuitable for surgical procedure. [ABSTRACT FROM AUTHOR]

Tracheal rupture is a very rare but life‑threatening complication of endotracheal intubation. It is more common in women and patients older than 50 years old. Overinflation of endotracheal tube cuff and tracheal wall weakening are the most important pathogenetic mechanisms. Laceration sites are located in the posterior membranous wall in most cases. Subcutaneous and mediastinal emphysema and respiratory distress are the most common manifestations. A 55‑year‑old female presented with postoperative subcutaneous and mediastinal emphysema without dyspnea because of a tear in the posterior tracheal wall. The diagnosis was based on clinical manifestation, chest computer tomography scans (CT), and endoscopic findings. A conservative approach by broad‑spectrum antibiotic therapy was decided because of patients’ vital signs stability and the absence of esophageal injury. The follow‑up showed that there was no lesion in the posterior tracheal wall. Our case showed that in clinically stable patients without mediastinitis and with spontaneous breathing, conservative management of tracheal tears is a safe procedure. [ABSTRACT FROM AUTHOR]

Mediastinal tumours represent a heterogeneous group of entities derived from the manifold structures located in or adjacent to the mediastinum. Due to the occurrence of some of these tumours in characteristic mediastinal compartments, an anatomical subdivision of the mediastinum in the prevascular (anterior), visceral (middle), and paravertebral (posterior) is helpful for the differential diagnosis. Benign anterior mediastinal tumours linked to an enlargement of the thymic gland mainly consist of thymic cysts and several types of thymic hyperplasia: true thymic hyperplasia, rebound hyperplasia, lymphofollicular hyperplasia, and so‐called thymic hyperplasia with lymphoepithelial sialadenitis (LESA)‐like features. Mature teratomas, ectopic (para)thyroid tissue, and benign thymic tumours such as thymolipoma or thymofibrolipoma represent further typical tumours of the anterior mediastinum. Pericardial, bronchogenic, or oesophageal duplication cysts predominate in the middle mediastinum, whereas neurogenic tumours and myelolipomas are characteristic findings in the posterior compartment. Vascular tumours, lipomas, adenomatoid tumours, Castleman disease, or mediastinitis are further examples of less frequent tumours or tumorous lesions affecting the mediastinum. This review focuses on benign mediastinal lesions with an emphasis on benign tumours of the thymus. Besides histology, characteristic epidemiological and clinical aspects prerequisite for the correct diagnosis and patient management are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Culture of extracted drains or epicardial pacing wires is an easy and noninvasive method for detecting mediastinitis after open-heart surgery, although studies on its sensitivity and specificity are limited. We, therefore, investigated the usefulness of this approach for diagnosing mediastinitis. Methods: We retrospectively studied the culture results of drains and epicardial pacing wires extracted from 3308 patients. Prediction models of mediastinitis with and without culture results added to clinical risk factors identified by a logistic regression analysis were compared. Results: The incidence of mediastinitis requiring surgery was 1.89% (n = 64). Staphylococcus was the causative bacterium in 64.0% of cases. The sensitivity, specificity, and positive and negative predictive values of positive culture results were 50.8%, 91.8%, 10.7%, and 99.0%, respectively. Methicillin-resistant Staphylococcus aureus had the highest positive predictive value (61.5%). A multivariate analysis identified preoperative hemodialysis (OR 5.40 [2.54−11.5], p < 0.01), long operative duration (p < 0.01), postoperative hemodialysis (OR 2.25 [1.01−4.98], p < 0.05), and positive culture result (OR 10.2 [5.88−17.7], p < 0.01) as independent risk factors. The addition of culture results to pre- and postoperative hemodialysis and a lengthy operative time improved the prediction of mediastinitis. Conclusions: A culture survey using extracted drains and epicardial pacing wires may provide useful information for diagnosing mediastinitis. [ABSTRACT FROM AUTHOR]

Fibrosing mediastinitis (FM) is a rare disease caused by different causes. If left untreated, the prognosis is poor. The common causes of FM are Tuberculosis and Histoplasma capsulatum infection. Esophageal perforation is also a rare condition that is often easily under‐ and mis‐diagnosed due to the lack of specificity of symptoms. Here we report a case of FM caused by esophageal perforation. [ABSTRACT FROM AUTHOR]

A 21-year-old woman with severe pulmonary hypertension and circulatory collapse was referred to our hospital for possible lung transplantation with extracorporeal membrane oxygenation support. Computed tomography revealed severe stenosis of all 4 pulmonary veins, and fibrosing mediastinitis was suspected. Surgical reconstruction of the pulmonary veins was performed, and extracorporeal membrane oxygenation support was weaned off. After surgery, pulmonary vascular resistance normalized. This successful case demonstrates that surgical pulmonary venous reconstruction is an important treatment for fibrosing mediastinitis induced by pulmonary venous stenosis and pulmonary hypertension. [ABSTRACT FROM AUTHOR]

This study describes 5 mediastinitis cases secondary to invasive group A Streptococcus (iGAS) disease in a recent outbreak in Spain. Among 398 iGAS cases between January 2019—March 2023, 5 (1.3%) were mediastinitis, 4 occurring in December 2022, all secondary to pneumonia or deep neck infection. We outline the clinical outcome with a review of the scarce pediatric literature. Conclusion: mediastinistis is a rare but severe complication of iGAS and a high level of suspicion is required to diagnose it. What is Known: • Group A Streptococcus can cause invasive and severe infections in children. • Mediastinitis is a severe complication from some bacterial infections, mainly secondary due to deep-neck abscesses. What is New: • Mediastinitis is an unrecognized complication due to an invasive group A Streptococcus (iGAS) infection. • In cases of a deep-neck abscess or complicated pneumonia a high clinical suspicion of iGAS mediastinitis is required, especially when the clinical course is not favorable. [ABSTRACT FROM AUTHOR]

Introduction: Descending necrotizing mediastinitis (DNM) is a type of acute mediastinitis that is rarely reported but is regarded as a fatal disease despite improvements in technological methods and antibiotic therapies. We aimed to determine the demographic, clinical, and paraclinical features of patients diagnosed with acute DNM. Methods: In this retrospective study, patients' hospital records with a diagnosis of DNM admitted to the Namazi hospital in southern Iran during 18 years (2002–2019) were reviewed. Demographic and clinical features were recorded and subsequently analyzed via SPSS 22. Results: Out of 67 mediastinitis patients, 25 (37.3%) were diagnosed as DNM with an average age of 37.2 ± 16.7 years, and 68% were male. Regarding etiology, 52.0% were due to neck infection. Based on the technique of surgery, 52% of the patients underwent the combined method, which was mostly among type I and IIA DNM, while thoracotomy was mostly performed on type IIB DNM (P = 0.08). Based on the incision, type IIA and IIB had the highest frequency of thoracotomy and cervicothoracic incisions (P = 0.02 and 0.002). Puss discharge was significantly lower in type I DNM (P = 0.01). Based on the presenting symptoms of our patients, the majority (72.0%) had a chief complaint of neck pain, followed by chills and fever (48%). There were no reports of mortality during our short-term follow-up. Conclusion: We report one of the largest retrospective studies of DNM patients in our referral center, with a high prevalence of the disease among younger populations, especially under 40 years. The method of treatment should be chosen based on the extent of infection and can be limited to neck exploration in upper mediastinal infections, though thoracic or combined approach in more broad infections. [ABSTRACT FROM AUTHOR]

Dental caries is a prevalent chronic disease on a global scale, affecting individuals at some point in their lives. Odontogenic infections (OIs) arise from dental origins and can be caused by several pathologies, such as caries, trauma, pericoronitis, gingivitis, and iatrogenic factors. Dental caries is a prevalent chronic disease on a global scale, affecting individuals at some point in their lives. The objective of this review is to provide clinicians with information regarding uncommon yet severe complications that can arise from OIs. These complications include necrotizing fasciitis, cerebral abscess, orbital cellulitis, descending necrotizing mediastinitis, sepsis, and cavernous sinus thrombosis. The review encompasses the origin of complications, the progression of infection, as well as their diagnosis and treatment. Early diagnosis and treatment are crucial for determining the clinical course of odontogenic infections. Treatment and diagnosis of OIs in a timely manner prevent complications. Dental professionals play a critical role in the prevention and assessment of OIs, particularly those that are progressive and difficult to treat and identify. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Infective endocarditis caused by atopic dermatitis is common in young patients and has a high potential for causing embolism. Because of the high risk of mediastinitis postoperatively, minimally invasive cardiac surgery could be effective. [ABSTRACT FROM AUTHOR]

Retropharyngeal abscess (RPA) is a rare, potentially fatal condition found more frequently in young children usually who were having a history of Upper respiratory infection. RPA is an acute suppurative infection of the retropharyngeal space. In view of scarce literature availability and atypical presentation in infants, it poses a definitive diagnostic dilemma to the clinicians. Here, we are reporting a three-month-old male infant presented with feeding difficulty, obstructive sleep apnea and intermittent inspiratory stridor. Child was managed in a pediatric ICU with a multidisciplinary approach which involved pediatrician, otorhinolaryngologist pediatric anesthesiologist, microbiologist, and radiologist. With the recent advances, early radio imaging have a vital role in diagnosing the condition and also helps in planning of surgery. Prompt diagnosis and surgical management with appropriate antimicrobial therapy for this condition is imperative to prevent complications such as airway obstruction and mediastinitis. Timely surgical intervention, preferably intraoral transpharyngeal approach, to drain the abscess is recommended. [ABSTRACT FROM AUTHOR]

Background: Fibrous mediastinitis (FM) is a rare mediastinal lesion characterized by proliferation of fibrous tissue within the mediastinum. Previous reports have shown that this lesion can be caused by histoplasmosis and tuberculosis. In extremely rare cases, FM can also be caused by autoimmune diseases such as antineutrophil cytoplasmic antibody-associated vasculitis and large-vessel arteritis. Case presentation: In our case, we report unexpected fibrous mediastinitis found after robotic thymectomy in a patient with myasthenia gravis (MG). The preoperative imaging indicated no obvious lesion in the mediastinum and the patient denied histories of both histoplasmosis and tuberculosis. After the operation, both proliferation of fibrous tissue and ectopic germinal centres (GCs) could be found in the thymus. Conclusion: This rare case might enrich our knowledge of the relationship between FM and autoimmune diseases. [ABSTRACT FROM AUTHOR]

Background: Deep sternal wound/mediastinitis is a rare but feared complication in coronary artery bypass grafting (CABG) patients and seems to increase the risk of cardiac death, and is also associated with the risk of early internal mammary artery (IMA) graft obstruction. The pathological mechanism explaining the link between mediastinitis and IMA graft obstruction and the impact on mortality is complex, multifactorial, and not fully investigated. Objectives: Mediastinitis has been associated with increased concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin T (TnT) at mid-term follow-up, representing persistent low-grade myocardial injury and impaired cardiac function. However, whether mediastinitis is associated with all-cause mortality, or whether the association is driven by these cardiac-specific biomarkers (NT-proBNP and TnT), is not investigated. Methods: The present study provides the longest and most complete follow-up data in 82 patients undergoing CABG, including 41 with post-sternotomy mediastinitis. Results: The annualized incidence rate of mediastinitis was 0.14%/year and remained stable at 0.14% throughout the study period. During a mean follow-up of 12.7 ± 3.5 years, a total of 42 deaths occurred (27 [65.9%] in mediastinitis and 15 [36.6%] in non-mediastinitis group, p = 0.008). No association was found between IMA or saphenous vein graft obstruction with all-cause mortality. Mediastinitis was associated with a 1.9-fold increased risk of all-cause mortality. However, in the multivariable-adjusted models, age and higher TnT and NT-proBNP levels, but not mediastinitis per se were associated with all-cause mortality. Conclusions: Mediastinitis after CABG surgery was associated with a poor prognosis during a 15-year follow-up, showing a nearly two-fold higher frequency of all-cause mortality compared with non-mediastinitis group, with the differences in mortality rate occurring primarily after 10 years. The association between mediastinitis and all-cause mortality was modulated by subclinical myocardial damage and stretch, reflected by elevated TnT and NT-proBNP, measured at 2.7-year follow-up, underscoring that these could represent prognostic markers in CABG patients. [ABSTRACT FROM AUTHOR]

Background and objective: Limited data exist regarding the adverse events of advanced diagnostic bronchoscopy, with most of the available information derived from retrospective datasets that primarily focus on early complications. Methods: We conducted a 15-month prospective cohort study among consecutive patients undergoing endosonography and/or guided bronchoscopy under general anesthesia. We evaluated the 30-day incidence of severe complications, any complication, unplanned hospital encounters, and deaths. Additionally, we analyzed the time of onset (immediate, within 1 h of the procedure; early, 1 h–24 h; late, 24 h–30 days) and identified risk factors associated with these events. Results: Thirty-day data were available for 697 out of 701 (99.4%) enrolled patients, with 85.6% having suspected malignancy and multiple comorbidities (median Charlson Comorbidity Index (IQR): 4 (2–5)). Severe complications occurred in only 17 (2.4%) patients, but among them, 10 (58.8%) had unplanned hospital encounters and 2 (11.7%) died within 30 days. A significant proportion of procedure-related severe complications (8/17, 47.1%); unplanned hospital encounters (8/11, 72.7%); and the two deaths occurred days or weeks after the procedure. Low-dose attenuation in the biopsy site on computed tomography was independently associated with any complication (OR: 1.87; 95% CI 1.13–3.09); unplanned hospital encounters (OR: 2.17; 95% CI 1.10–4.30); and mortality (OR: 4.19; 95% CI 1.74–10.11). [ABSTRACT FROM AUTHOR]

Intrathoracic esophageal perforation is a devastating event bearing high mortality rates. Prompt recognition and aggressive treatment are key. Traditionally, most patients required surgical treatment, but recently, endoscopic techniques, mainly endoscopic vacuum-assisted closure (EVAC), have been recognized as a valuable alternative in selected patients. Herein, we describe a novel technique in which a nasogastric tube (NGT) was placed endoscopically into a mediastinal abscess and covered with a self-expanding metal stent to treat esophageal defects in three patients. [ABSTRACT FROM AUTHOR]

Mediastinitis is an inflammation of the mediastinum. Descending necrotizing mediastinitis (DNM) is the most common form of mediastinitis. Symptoms of severe oropharyngeal infection, radiological evidence of mediastinitis, documentation of necrotising mediastinitis at surgery, and a relationship between the infection and a necrotizing process are all diagnostic criteria. The worsening conditions of fever, neck and chest pain, and respiratory distress are presenting features. Without aggressive surgical drainage, DNM may become fatal. Early diagnosis and prompt therapy play a crucial role in the management of mediastinitis. We aimed to compare the clinical features of mediastinitis. DNM cases that were treated in our clinics in the last 10 years were retrospectively reviewed. Patients with DNM were divided into three groups according to tomographic images. Demographic characteristics, accompanying diseases, anatomical localization, medical and surgical management, other clinical features, and morbidity and mortality rates of patients were collected and compared with univariate analysis. The adequacy of neck exploration or the need for additional surgery was determined by preoperative and postoperative computerized tomography evaluation. The etiologic causes of DNM were oropharyngeal in 12 cases and dental in 18 cases. The mean age of the 19 men and 11 women was 37 years. Mediastinal localization according to a computerized tomography image was type I in 11 patients, type IIA in 6 patients, and type IIB in 13 patients. The most common accompanying disorders were diabetes mellitus in 16.6%, cardiac disease in 10.0%, and hepatic in 3.3%. Neck exploration was performed in almost all cases. When the physicians failed to manage the patient with a single neck exploration procedure, mediastinoscopy, tube thoracostomy, and thoracotomy were added. In the series, 7/30 (23%) patients died. The mean duration of an intensive care unit stay was 29 days. Bacterial growth was cultured in 14 patients including all nonsurvivors. Because the prognosis is poor and the disease is more likely to spread below the carina in delayed cases, regardless of the aetiology or type of mediastinitis, aggressive surgery should be performed immediately. [ABSTRACT FROM AUTHOR]

Simple Summary: This study confirmed the overall safety of endosonography and guided bronchoscopy, even in a cohort of patients with multiple comorbidities and a high prevalence of advanced cancer. However, it suggested that implementing a 30-day follow-up in routine clinical practice would also help identify and treat clinically relevant late complications promptly while establishing a more realistic rate of adverse events for these procedures. Background and objective: Limited data exist regarding the adverse events of advanced diagnostic bronchoscopy, with most of the available information derived from retrospective datasets that primarily focus on early complications. Methods: We conducted a 15-month prospective cohort study among consecutive patients undergoing endosonography and/or guided bronchoscopy under general anesthesia. We evaluated the 30-day incidence of severe complications, any complication, unplanned hospital encounters, and deaths. Additionally, we analyzed the time of onset (immediate, within 1 h of the procedure; early, 1 h–24 h; late, 24 h–30 days) and identified risk factors associated with these events. Results: Thirty-day data were available for 697 out of 701 (99.4%) enrolled patients, with 85.6% having suspected malignancy and multiple comorbidities (median Charlson Comorbidity Index (IQR): 4 (2–5)). Severe complications occurred in only 17 (2.4%) patients, but among them, 10 (58.8%) had unplanned hospital encounters and 2 (11.7%) died within 30 days. A significant proportion of procedure-related severe complications (8/17, 47.1%); unplanned hospital encounters (8/11, 72.7%); and the two deaths occurred days or weeks after the procedure. Low-dose attenuation in the biopsy site on computed tomography was independently associated with any complication (OR: 1.87; 95% CI 1.13–3.09); unplanned hospital encounters (OR: 2.17; 95% CI 1.10–4.30); and mortality (OR: 4.19; 95% CI 1.74–10.11). Conclusions: Severe complications arising from endosonography and guided bronchoscopy, although uncommon, have significant clinical consequences. A substantial proportion of adverse events occur days after the procedure, potentially going unnoticed and exerting a negative clinical impact if a proactive surveillance program is not implemented. [ABSTRACT FROM AUTHOR]

Background: Deep neck infection (DNI) is a serious infectious disease, and descending mediastinitis is a fatal infection of the mediastinum. However, no study has applied artificial intelligence to assess progression to descending mediastinitis in DNI patients. Thus, we developed a model to assess the possible progression of DNI to descending mediastinitis. Methods: Between August 2017 and December 2022, 380 patients with DNI were enrolled; 75% of patients (n = 285) were assigned to the training group for validation, whereas the remaining 25% (n = 95) were assigned to the test group to determine the accuracy. The patients' clinical and computed tomography (CT) parameters were analyzed via the k-nearest neighbor method. The predicted and actual progression of DNI patients to descending mediastinitis were compared. Results: In the training and test groups, there was no statistical significance (all p > 0.05) noted at clinical variables (age, gender, chief complaint period, white blood cells, C-reactive protein, diabetes mellitus, and blood sugar), deep neck space (parapharyngeal, submandibular, retropharyngeal, and multiple spaces involved, ≥3), tracheostomy performance, imaging parameters (maximum diameter of abscess and nearest distance from abscess to level of sternum notch), or progression to mediastinitis. The model had a predictive accuracy of 82.11% (78/95 patients), with sensitivity and specificity of 41.67% and 87.95%, respectively. Conclusions: Our model can assess the progression of DNI to descending mediastinitis depending on clinical and imaging parameters. It can be used to identify DNI patients who will benefit from prompt treatment. [ABSTRACT FROM AUTHOR]

Introduction Eggerthia catenaformis, a non-spore-forming anaerobic Gram-positive bacillus component of the human fecal microbiota has rarely been reported in human diseases. In almost every case described in current literature to date, dental diseases (abscesses, periodontitis, or caries), are the most common source of the infection which extends to the brain, cervical spaces, pulmonary parenchyma, the pleural cavity, the abdominal wall, and the abdominal cavity. Case report An 82-year-old male Caucasian patient was admitted to our Emergency Department (ED) with a painless, right submandibular mass, dyspnea, and inspiratory stridor. A CT scan of the head, neck, and chest with intravenous contrast material revealed a retrotonsillar fluid collection. Air bubbles and minimal fluid were present from the right sub-mandibular area to the lower mediastinum between the spine, the descending thoracic aorta, and the trachea. The patient underwent surgical treatment and a broad-spectrum antibiotic. The retropharyngeal fluid collection culture showed the presence of Eggerthia catenaformis. After a first period in the Intensive Care Unit, he was admitted to a Step-Down Unit (SDU) where he underwent respiratory weaning, motor rehabilitation, and gradual oral feeding resumption. At discharge, the patient maintained the tracheal cannula as he still had impaired swallowing of solid foods. Conclusions Here we report the first case of descending necrotizing mediastinitis in a patient with a retropharyngeal abscess, in the absence of dental diseases. [ABSTRACT FROM AUTHOR]

Button battery ingestion in infants is an increasingly common surgical emergency which can lead to oesophageal perforation, mediastinitis, trachea-oesophageal fistulation, airway compromise and death. One exceedingly rare complication of battery ingestion is discitis and osteomyelitis in the cervical and upper thoracic spine. Diagnosis is normally delayed due to the non-specific presentation, delayed imaging findings and the initial clinical focus on dealing with the immediate, and potentially life-threatening, complications. We describe a case of a 1-year-old girl who presented with haematemesis and an oesophageal injury, secondary to button battery ingestion. Sagittal reconstruction of the CT chest demonstrated a suspicious area of vertebral erosion in the cervicothoracic spine which prompted a further evaluation with MRI demonstrating spondylodiscitis of C7-T2 with vertebral erosion and collapse. The child was successfully treated with long course of antibiotics. We wish to highlight the importance of clinical and radiological spinal assessment in children with button battery ingestion to avoid delayed diagnosis and complications of spinal osteomyelitis. [ABSTRACT FROM AUTHOR]

Background: Descending necrotizing mediastinitis (DNM) is a fatal disease that originates from odontogenic, pharyngeal, and cervical infections and spreads to the mediastinum. Although adequate drainage of the neck and mediastinum is important, it may be excessively invasive. We report a case of DNM treated using a cervical approach with artificial pneumomediastinum and video-assisted thoracoscopic surgery (VATS). Case presentation: A 69-year-old male patient who underwent gastrointestinal endoscopy 4 days prior to presentation was referred to our hospital for mediastinal air observed using computed tomography. He was diagnosed with DNM, and an emergency surgery was performed. We created a collar incision and performed drainage and debridement of the cervix. Then, we performed drainage of the retropharyngeal and upper mediastinum by inserting the mediastinoscope through the collar incision and creating artificial pneumomediastinum. Next, drainage of the thoracic cavity was performed during VATS. Subsequently, the abscess resolved, and the patient was discharged on postoperative day 28 without severe complications. Conclusions: Surgical drainage using a cervical approach with artificial pneumomediastinum and VATS was useful for treating this case of DNM. This procedure could be a viable option for minimally invasive surgery for DNM. [ABSTRACT FROM AUTHOR]

Background: The present descriptive study shares the overall experience of treating all these patients where different surgical process was adopted depending on the treatment required after carefully evaluating the risk factors and comorbidities. Methods: The present study was conducted at the Department of Thoracic Surgery, Choray Hospital, Vietnam between the period of 2010 to 2020. We have treated 95 patients altogether in this duration. Results: We were able to save most of the patients by applying thoracotomy and thoracic irrigation for most of the patients based on the observed indications that were identified immediately after the compulsory standard cervicotomy. The indication for thoracic interference was considered when the infection was deeply spread into the mediastinum and cannot get out through cervicotomy, although the most effective method of drainage was applied. Conclusion: Our statistical investigation of the patient data suggested the possible association and influence of comorbidity such as diabetes. Therefore, we recommend that in specific cases thoracotomy along with thoracic irrigation and repetitive surgical draining could be a better option to reduce the infection and the mortality rate. Trial registration: Retrospectively registered. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the relationship between age and sex in regard to the development of deep sternal wound infections and sternal instability following median sternotomy. Methods: A propensity-score-matching analysis was conducted on 4505 patients who underwent cardiac surgery between 2009 and 2021, all of whom had a BMI of ≥30 kg/m2. A total of 1297 matched pairs were determined in the sex group, and 1449 matched pairs we determined in the age group. The distributions of sex, age, diabetes mellitus, delirium, unstable sterna, wire refixation, wire removal, superficial vacuum-assisted wound closure, deep vacuum-assisted wound closure, clamp time, bypass time, logistic EuroSCORE, and BMI were determined. Results: The 30-day in-hospital mortality was found to be similar in the older and younger groups (8.149% vs. 8.35%, p = 0.947), and diabetes mellitus was also equally distributed in both groups. However, postoperative delirium occurred significantly more often in the older group (29.81% vs. 17.46%, p < 0.001), and there was a significantly higher incidence in men compared with women (16.96% vs. 26.91%, p < 0.001). There were no differences found in the incidence of sternum instability, fractured sternum, superficial vacuum-assisted wound closure, and deep vacuum-assisted wound closure between the age and sex groups. Conclusions: In conclusion, this study found that sternal instability and deep-wound-healing problems occur with equal frequency in older and younger patients and in men and women following median sternotomy. However, the likelihood of postoperative delirium is significantly higher in older patients and in men. These findings suggest that a higher level of monitoring and care may be required for these high-risk patient groups to reduce the incidence of postoperative delirium and improve outcomes following median sternotomy. [ABSTRACT FROM AUTHOR]

A rare case of a patient with chronic obstructive pulmonary disease who developed secondary anthracofibrosis to biomass exposure, fibrosing mediastinitis due to anthracotic enlarged lymph nodes in the mediastinum, and pulmonary hypertension because of compression of the lymph nodes on the pulmonary arteries is presented. This is a case report of a 71-year-old female patient who has been followed up with chronic obstructive pulmonary disease for 10 years, has no history of smoking, and has been exposed to biomass for many years. The patient, who had been hospitalized in various centers for the last 3 years due to progressive shortness of breath and dry cough, applied to us with dry cough and dyspnea complaints. On echocardiography, systolic pulmonary arterial pressure was found to be 59 mmHg. For the etiology of pulmonary hypertension, dual-energy thoracic computed tomography was performed with the suspicion of chronic thromboembolic pulmonary hypertension. No filling defect compatible with thromboembolism was detected. In right heart catheterization, mean pulmonary artery pressure was 27 mmHg, pulmonary capillary tip pressure was 7 mmHg, and pulmonary vascular resistance was 3.71 woods units. Endobronchial ultrasound was applied to the patient with the preliminary diagnoses of lymphoma, anthracosis, fibrosing mediastinitis, and infection. Widespread anthracosis was observed in all lobes and segments macroscopically. The lymph node in the subcarinal area was interpreted as anthracotic lymph node. Anthracosis is defined as black pigmentation involving the mucosal, and submucosal layers of the tracheobronchial tree and the lung parenchyma. If anthracosis is associated with luminal obliteration and/or mucosal proliferation causing obstruction, it is considered anthracofibrosis. In this case, we saw that secondary anthracofibrosis, fibrosing mediastinitis due to anthracotic enlarged lymph nodes in the mediastinum, and pulmonary hypertension may develop because of compression of the lymph nodes on the pulmonary arteries, and we wanted to draw attention to it was a rare case. [ABSTRACT FROM AUTHOR]

Descending mediastinitis is defined as the spread of oropharyngeal or odontogenic infection into the mediastinum. It occurs uncommonly and has a high mortality rate. Prompt commencement of broad-spectrum antibiotics combined with surgical drainage is crucial to limit further spread of infection. We report a case of extensive deep neck infection in a 66-year-old female which rapidly progressed to the contralateral neck complicated by descending anterior mediastinitis. She underwent a combined transcervical and video-assisted thoracoscopic surgery (VATS) for drainage of abscess and was put on 3 weeks of intravenous antibiotics coupled with another 3 weeks of oral antibiotics. Deep neck infection with descending mediastinitis can be successfully treated with antibiotics and early surgical drainage via a combined transcervical and VATS approach. [ABSTRACT FROM AUTHOR]

Introduction. Recent national guidelines recommending mitral valve replacement (MVR) for severe secondary mitral regurgitation have resulted in an increased utilization of mitral bioprosthesis. There is a paucity of data on how longitudinal clinical outcomes vary by prosthesis type. We examined long-term survival and risk of reoperation between patients having bovine vs. porcine MVR. Study Design. A retrospective analysis of MVR or MVR + coronary artery bypass graft (CABG) from 2001 to 2017 among seven hospitals reporting to a prospectively maintained clinical registry was conducted. The analytic cohort included 1,284 patients undergoing MVR (801 bovine and 483 porcine). Baseline comorbidities were balanced using 1 : 1 propensity score matching with 432 patients in each group. The primary end point was all-cause mortality. Secondary end points included in-hospital morbidity, 30-day mortality, length of stay, and risk of reoperation. Results. In the overall cohort, patients receiving porcine valves were more likely to have diabetes (19% bovine vs. 29% porcine; p < 0.001), COPD (20% bovine vs. 27% porcine; p = 0.008), dialysis or creatinine >2 mg/dL (4% bovine vs. 7% porcine; p = 0.03), and coronary artery disease (65% bovine vs. 77% porcine; p < 0.001). There was no difference in stroke, acute kidney injury, mediastinitis, pneumonia, length of stay, in-hospital morbidity, or 30-day mortality. In the overall cohort, there was a difference in long-term survival (porcine HR 1.17 (95% CI: 1.00–1.37; p = 050)). However, there was no difference in reoperation (porcine HR 0.56 (95% CI: 0.23–1.32; p = 0.185)). In the propensity-matched cohort, patients were matched on all baseline characteristics. There was no difference in postoperative complications or in-hospital morbidity and 30-day mortality. After 1 : 1 propensity score matching, there was no difference in long-term survival (porcine HR 0.97 (95% CI: 0.81–1.17; p = 0.756)) or risk of reoperation (porcine HR 0.54 (95% CI: 0.20–1.47; p = 0.225)). Conclusions. In this multicenter analysis of patients undergoing bioprosthetic MVR, there was no difference in perioperative complications and risk of reoperation of long-term survival after matching. [ABSTRACT FROM AUTHOR]

Pulmonary vein stenosis (PVS) can arise from several etiologies, including congenital, acquired, and iatrogenic sources. PVS presents insidiously, leading to significant delays in diagnosis. A high index of suspicion and dedicated noninvasive evaluation are key to diagnosis. Once diagnosed, both noninvasive and invasive evaluation may afford further insights into the relative contribution of PVS to symptoms. Treatment of underlying reversible pathologies coupled with transcatheter balloon angioplasty and stenting for persistent severe stenoses are established approaches. Ongoing refinements in diagnostic modalities, interventional approaches, postintervention monitoring, and medical therapies hold promise to further improve patient outcomes. [Display omitted] • PVS has various etiologies, and symptoms may overlap those of other conditions. • It is important to manage reversible underlying etiologies of PVS. • Transcatheter interventions may improve symptoms and clinical outcomes in patients with PVS. [ABSTRACT FROM AUTHOR]

Treatment of esophageal perforation or rupture is complicated and controversial, especially in advanced cases. In fact, it is generally accepted that this disease must be treated individually according to the location, causes and clinical features of rupture or perforation. A very rare case was admitted to our department, who was injured 5 days ago by high-pressure gas of a running air compressor and resulted in a long-term longitudinal rupture of the thoracic esophagus. Although the patient suffered from empyema and mediastinitis at the same time, and his condition was very serious, the debridement and desquamation of empyema were still implemented, followed by left thoracic esophagectomy and left neck approach esophagogastrostomy in the same period successfully. The patient got a good result finally. [ABSTRACT FROM AUTHOR]

Mycoplasma hominis and Ureaplasma species infections in the post‐transplant setting are believed to be donor‐derived and can be associated with poor outcomes. Difficulty in culturing and identifying these organisms is a significant barrier to diagnosis and early intervention. Tetracyclines, macrolides and fluoroquinolones are the mainstay treatments to cure these infections; however, there are increasing reports of antibiotic resistance. In this case series, we report our single‐centre experience with M. hominis and U. urealyticum infection after lung transplantation (9 recipients, all men, mean age 56 years). Delayed diagnosis was common. Young donor age (mean age 23 yrs) and high‐risk donor social history (67%) were repeatedly noted in these cases, and all infections were associated with significant morbidity (anastomosis and sternal wound infection, empyema, mediastinitis, pericarditis). Two patients died; with one directly related to Ureaplasma urealyticum infection. In conclusion post lung transplant M. hominis, and U. urealyticum infections are challenging and carry high morbidity. More prospective studies are required to assess the true prevalence, full spectrum of complications and utility of molecular diagnostics to aid early diagnosis and identify antibiotic susceptibility of Mycoplasma and Ureaplasma infections in the post‐lung transplant setting. [ABSTRACT FROM AUTHOR]

Deep Sternal wound infection (Mediastinitis) after cardiac surgery can be potentially caused by both Gram-positive and Gram-negative bacteria. The incidence of sternal infection appears to be on the rise in current practice and is associated with increased hospital stay, cost of care, and mortality. Due to the unmet need for mediastinitis treatment or prevention, we developed and characterized an antibacterial, biocompatible bone adhesive cement composed of tetracalcium phosphate, phosphoserine, and the antibacterial drugs, amikacin and vancomycin (TPAV). Vancomycin and amikacin show a continuous release pattern from TPAV for up to 60 and 90 days, respectively. In vitro and ex vivo analysis of TPAV's antibacterial properties shows inhibitory activity against the growth of Escherichia coli (E. coli) , Klebsiella pneumoniae (K. pneumoniae) and Staphylococcus aureus (S. aureus) , and their biofilm formation. TPAV is also capable of inhibiting the growth of E. coli, K. pneumoniae and S. aureus when grown together as co-culture. Furthermore, the in vivo studies are done in a rat sternotomy model infected with S. aureus and E. coli , and TPAV demonstrated significant inhibitory activity when compared to the infected control group. This study highlights the potential of the developed antibacterial bone adhesive cement for preventing mediastinitis in clinics. [ABSTRACT FROM AUTHOR]

Introduction: Mediastinal infection is a persistent and difficult widespread infectious disease caused by secondary complications of adjacent organs. It spreads easily and is often misdiagnosed because of the lack of typical manifestations. Material and methods: To highlight the clinical features, medical and surgical strategy of descending necrotizing mediastinitis we performed a retrospective study of 25 documented cases during a 10-year period at our hospital, all treated surgically, 10 from the ORL department and 15 from our thoracic surgery department. Results: Patients were aged from 20 to 84 years, with a median age of 41 years, male predominance (19 men and 6 women), sex ratio of 3.6. A cervicotomy (in 40% of cases) was associated or not with videothoracoscopy (one case) or thoracotomy (in 20% of cases) and wide-spectrum antibiotherapy. In the postoperative period, an irrigation-suction system was used on the drains in 15 patients. In 1 case a rethoracotomy was necessary to remove a residual right pyothorax, and one patient required a tracheostomy. Twenty-two (88%) patients recovered from their mediastinitis. Death of 3 patients by sepsis multiorgan failure occurred. Postoperative follow-up during one year was uneventful without recurrence. Conclusions: According to our experience, we believe the more aggressive local treatment is, the better are the results. [ABSTRACT FROM AUTHOR]

• Clonal complex 398 (CC398) methicillin-resistant Staphylococcus aureus (MRSA) is a new rising threat of community-associated (CA) MRSA infection in humans. • Panton-Valentine-leukocidin-positive ST1232-V MRSA is a noteworthy CA CC398 MRSA strain. • Children, as well as adults, are also at risk of CA CC398 MRSA infection. Invasive community-associated methicillin-resistant Staphylococcus aureus (MRSA) diseases caused by clonal complex 398 MRSA without animal contact have become a new emerging threat. We report a case of bacteremic mediastinitis caused by a Panton-Valentine leukocidin-positive community-associated sequence type 1232 MRSA in a Taiwanese baby aged 4 months without animal contact. [ABSTRACT FROM AUTHOR]

Purpose: The primary aim of this retrospective study was to analyze the progression of descending necrotizing mediastinitis (DNM), evaluate the impact of comorbidities on complications and mortality and to observe long-term consequences of DNM on dysphagia and measurements quality of life. DNM is a serious infectious disease that requires multimodal treatment. Current literature varies in conclusions of risk factors, management and outcome of DNM. In addition, little is known about persisting effects on quality of life. Methods: Retrospective data analysis of 88 patients with DNM representing the largest single-center study. Recording data of patients and diseases as well as clinical progression from 1997 to 2018. Two questionnaires were sent to the participants to measure quality of life and to detect dysphagia. Results: 88 patients were included. The most frequently found pathogen were Streptococcus spp. (52%). 75% of the patients underwent multiple surgeries, mean count of surgical procedures was 4.3 times. 84% received intensive care treatment. Median length of stay on the intensive care unit was 7 days. 51% had pre-existing comorbidities associated with reduced tissue oxygenation (e.g., diabetes). The most common complication was pleural effusion (45%). During the observation period, the mortality rate was 9%. 12 questionnaires could be evaluated. 67% of the participants were affected by dysphagia at the time of the survey. Conclusions: Descending necrotizing mediastinitis (DNM) is a severe disease requiring an immediate initiation of multimodal treatment. Although quality of life usually isn´t impaired permanently, dysphagia may often persist in patients after DNM. [ABSTRACT FROM AUTHOR]

Objectives: Vacuum-assisted closure therapy is useful in treating mediastinitis, which is related to high mortality and morbidity rates after cardiac surgery. This study aimed to present our experience with vacuum-assisted closure therapy in mediastinitis after pediatric cardiac surgery. Methods: This retrospective review included 10 patients who underwent vacuum-assisted closure therapy for mediastinitis in a single institution from 2020 to 2022. Patients with wound discharge or abscess, sternal dehiscence, fever, and positive wound culture were considered to have mediastinitis. The vacuum sponge was cut at the appropriate size for the mediastinal defect and the skin edges were approximated with prolene sutures. The vacuuming continuously started at −50 mm Hg. Results: Six (60%) patients were female and the median age during therapy was 1.9 months (range: 0.1–54 months). Five (50%) patients were neonates. The median duration of vacuum-assisted closure therapy was 14.5 days (range: 4–78). The median duration to obtain negative mediastinal culture was 14.5 days (range: 6–76). The sternum could be closed without difficulty in all patients except one who died due to low cardiac output. Hospital mortality occurred in 3 (30%) patients who needed extracorporeal membrane oxygenation support postoperatively. The median duration of follow-up was 10 months (range: 2–28). Conclusion: Mediastinitis is an important problem associated with high morbidity and mortality rates after pediatric cardiac surgery. Data suggest that vacuum-assisted closure therapy can safely treat mediastinal infections without recurrence. [ABSTRACT FROM AUTHOR]