RESUMEN
OBJECTIVE: Sternoclavicular joint (SCJ) infections are rarely encountered and their management is not well standardised. We reviewed our experience with the management of this condition in order to evaluate the role of surgery in the management of the SCJ infection and to provide an algorithm for its treatment. METHODS: It is a multicentre study in which we retrospectively reviewed the data files of the patients who were referred to us for surgical management of SCI infection. RESULTS: From March 2003 to June 2009, 14 patients (12 men and two women) were treated surgically for infected SCJ. No patients were found in the paediatric age group. Mean age was 49.8 years with a range between 26 and 77 years. All patients were symptomatic. The prevalent symptom was either anterior chest wall swelling (21%) or pain (29%); while 50% of them presented with both swelling and pain. Associated risk factors were elicited in 12 patients (86%) while it could not be identified in two patients (14%). These risk factors were in the form of drug addiction in three patients, diabetes mellitus (DM) in four, chronic renal failure (CRF) in three patients and two patients had both DM and CRF. Surgical management was performed in all patients in the form of either incision and drainage in two patients (14%); or SCJ curettage in three patients (21%), while resection of the SCJ was done in nine patients (62%). Mean postoperative hospital stay period (PHS) was 8.1 days (range: 5-30 days). All of them are alive and free of symptoms in follow-up. CONCLUSION: Surgery was found to be curative with good results for those patients with SCJ infection that did not respond to a full course of intravenous antibiotic therapy. Surgical options include incision and drainage, curettage or SCJ resection. The type of surgical procedure depends on the radiological findings, presentation, severity of the infection and intra-operative findings. In our experience, complex muscle flap reconstruction was not necessary following SCJ resection.
Asunto(s)
Artropatías/cirugía , Osteomielitis/cirugía , Articulación Esternoclavicular/cirugía , Adulto , Anciano , Algoritmos , Desbridamiento/métodos , Drenaje/métodos , Farmacorresistencia Bacteriana , Femenino , Humanos , Artropatías/diagnóstico , Artropatías/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Osteomielitis/diagnóstico , Osteomielitis/tratamiento farmacológico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/cirugía , Articulación Esternoclavicular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Cardiac tamponade is a life-threatening condition that demands prompt diagnosis and emergency intervention to prevent the sequelae of persistent low cardiac output, cardiopulmonary failure, and death. Cardiac tamponade due to pericardial collection of cerebrospinal fluid is a rare but recognized sequela associated with ventriculoatrial shunts used in the management of congenital hydrocephalus.Herein, we describe the treatment of an 8-month-old infant with multiple congenital anomalies who presented with cardiac tamponade. This condition was caused by cardiac perforation by the distal tip of a ventriculoatrial shunt catheter. Timely pericardiostomy and repair of the cardiac perforation through a left anterior thoracotomy resulted in an uneventful recovery.