RESUMEN
Caustic ingestion in adults is a rare but potentially life-threatening problem. It remains controversial whether endoscopic findings and mortality differ between acid and alkali ingestion. We compared ingestion of these agents and evaluated prediction parameters for survival and complications.Adult patients who presented with caustic ingestion were analyzed from 2005 to 2016. Mucosal injury was graded endoscopically by Zargar's score. Age, gender, intent of ingestion, caustic agents, comorbidities, management, complications, and mortality were examined.Thirty-one patients met inclusion criteria and were divided into acid (nâ=â10) and alkali group (nâ=â21). Ingestion of alkali resulted in higher grades (≥III) of esophageal (56% vs 24%, Pâ=â.01) and stomach injuries (43% vs 13%, Pâ=â.05) and was mostly done with suicidal intent (76% vs 30%, Pâ=â.003). Patients in the alkali group received more often surgical interventions, mechanical ventilation and tracheotomy. Overall complications including Zargar's-score ≥ grade III, mediastinitis, and aspiration pneumonia were higher in alkali group but all showed no statistical significance (Pâ=â.73). Mortality (acid: 1 (10%), alkali: 4 (19%), Pâ=â.52), age, gender, comorbidities, and intensive care management did not differ significantly between the groups. Chronic renal failure and mediastinitis were promising prediction parameters for mortality but did not reach statistical significance. No independent risk factors for the development of esophageal stenosis were identified.Alkaline agents caused a higher mucosal injury severity and were more often used in suicidal intent. Mediastinitis and chronic renal failure might be potential prediction parameters for survival but need to be evaluated in larger studies.
Asunto(s)
Quemaduras Químicas/complicaciones , Cáusticos/toxicidad , Estenosis Esofágica/diagnóstico , Fallo Renal Crónico/diagnóstico , Mediastinitis/diagnóstico , Estómago/lesiones , Ácidos/toxicidad , Adulto , Anciano , Álcalis/toxicidad , Quemaduras Químicas/diagnóstico , Endoscopía del Sistema Digestivo , Estenosis Esofágica/inducido químicamente , Femenino , Humanos , Fallo Renal Crónico/inducido químicamente , Masculino , Mediastinitis/inducido químicamente , Persona de Mediana Edad , Estudios Retrospectivos , Estómago/patología , Intento de Suicidio/estadística & datos numéricos , Análisis de SupervivenciaAsunto(s)
Hipertensión Pulmonar/inducido químicamente , Mediastinitis/inducido químicamente , Sarcoidosis Pulmonar/inducido químicamente , Esclerosis/inducido químicamente , Dióxido de Silicio/efectos adversos , Corticoesteroides/uso terapéutico , Anciano , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Polvo , Humanos , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/tratamiento farmacológico , Hipertensión Pulmonar/fisiopatología , Exposición por Inhalación/efectos adversos , Masculino , Mediastinitis/diagnóstico por imagen , Mediastinitis/tratamiento farmacológico , Mediastinitis/fisiopatología , Exposición Profesional/efectos adversos , Imagen de Perfusión/métodos , Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Sarcoidosis Pulmonar/diagnóstico por imagen , Sarcoidosis Pulmonar/tratamiento farmacológico , Sarcoidosis Pulmonar/fisiopatología , Esclerosis/diagnóstico por imagen , Esclerosis/tratamiento farmacológico , Esclerosis/fisiopatología , Resultado del TratamientoAsunto(s)
Humanos , Femenino , Persona de Mediana Edad , Mediastinitis/inducido químicamente , Mediastinitis/complicaciones , Mediastinitis/diagnóstico , Divertículo de Zenker/complicaciones , Divertículo de Zenker , Mediastinitis/fisiopatología , Mediastinitis , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias , Tomografía Computarizada de Emisión , Nutrición Parenteral/instrumentación , Nutrición Parenteral/métodosRESUMEN
Propolis is a resinous substance collected by bees as a sealant for their hives. It is also used in traditional medicine as an antioxidant and antiinflammatory agent to treat ulcers, superficial burns, and microbial diseases. In this report, a 40-year-old woman who took liquid propolis for relief of her common cold experienced severe sore throat, dysphagia, and easy choking followed by fever and chills. Descending necrotizing mediastinitis and concomitant aspiration pneumonia were evident on the image studies. We performed video-assisted thoracoscopic surgery to achieve immediate and adequate drainage, and the patient resumed normal deglutition 2 months later. Early diagnosis and prompt video-assisted thoracoscopic surgery intervention are paramount to manage this life-threatening situation.
Asunto(s)
Mediastinitis/inducido químicamente , Mediastino/patología , Neumonía por Aspiración/inducido químicamente , Própolis/efectos adversos , Adulto , Antibacterianos/uso terapéutico , Antiinfecciosos/efectos adversos , Antiinfecciosos/uso terapéutico , Drenaje/métodos , Femenino , Humanos , Mediastinitis/diagnóstico , Mediastinitis/terapia , Necrosis/inducido químicamente , Necrosis/diagnóstico , Faringitis/tratamiento farmacológico , Neumonía por Aspiración/diagnóstico , Neumonía por Aspiración/terapia , Própolis/uso terapéutico , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos XAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Extravasación de Materiales Terapéuticos y Diagnósticos , Mediastinitis/inducido químicamente , Compuestos Organoplatinos/efectos adversos , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Carcinoma de Células Escamosas/tratamiento farmacológico , Catéteres Venosos Centrales , Neoplasias Esofágicas/tratamiento farmacológico , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Enfermedad Iatrogénica , Leucovorina/administración & dosificación , Leucovorina/efectos adversos , Masculino , Mediastino , Compuestos Organoplatinos/administración & dosificación , OxaliplatinoAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Extravasación de Materiales Terapéuticos y Diagnósticos , Mediastinitis/inducido químicamente , Compuestos Organoplatinos/efectos adversos , Fluorouracilo/efectos adversos , Humanos , Leucovorina/efectos adversos , Masculino , OxaliplatinoRESUMEN
BACKGROUND: A port-A catheter implantation for cancer patients is popular as a route for chemotherapy. Potential complications exist, such as perforation during chemotherapeutic agent infusion, especially when the port-A tip is incorrectly positioned or when it is in long-term use. CASE REPORT: We report on a patient who presented with hoarseness as a result of port-A catheter perforation-related mediastinitis subsequent to chemotherapeutic agent infusion through the catheter. CONCLUSIONS: Hoarseness is a rare complication of port-A perforation and extravasation. To avoid perforation, the tip of the catheter should be located in a high-flow vessel, such as the distal superior vena cava rather than higher in the caval vein, to prevent a locally increased concentration of drugs. We also recommend that a venogram be arranged if extravasation is suspected.
Asunto(s)
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Catéteres de Permanencia/efectos adversos , Falla de Equipo , Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico , Ronquera/etiología , Mediastinitis/inducido químicamente , Mediastinitis/diagnóstico , Neoplasias del Colon Sigmoide/terapia , Vena Subclavia/lesiones , Parálisis de los Pliegues Vocales/inducido químicamente , Quimioradioterapia , Terapia Combinada , Progresión de la Enfermedad , Esquema de Medicación , Femenino , Humanos , Infusiones Intravenosas , Flebografía , Tomografía Computarizada por Rayos X , Parálisis de los Pliegues Vocales/diagnóstico , Adulto JovenRESUMEN
A 16-year-old woman deliberately drank 4.5% sodium hypochlorite bleach. She was transferred to the emergency department after gastric lavage was performed at a local clinic. She experienced chest pain and fever after several vomiting episodes and esophagoscopy. Chest computerized tomography (CT) revealed air bubbles and abnormal soft tissue density at the right lateral aspect of the mid esophagus, a small amount of complicated pleural effusion, and pneumothorax. Barium esophagography revealed abnormal leakage of contrast media at the right wall of the mid esophagus, which indicated acute mediastinitis. The patient received intensive care and underwent delayed esophageal repair and colonic transplant. She was discharged 12 weeks after admission. Sodium hypochlorite is found in household bleaching agents used to disinfect dishes and bleach laundry. Poisoning due to ingestion of sodium hypochlorite bleach usually follows a benign clinical course. Few studies report severe complications such as esophageal stenosis or perforation.
Asunto(s)
Blanqueadores/envenenamiento , Perforación del Esófago/inducido químicamente , Mediastinitis/inducido químicamente , Hipoclorito de Sodio/envenenamiento , Intento de Suicidio , Adolescente , Perforación del Esófago/diagnóstico , Perforación del Esófago/cirugía , Femenino , Humanos , Mediastinitis/diagnóstico , Mediastinitis/cirugía , Resultado del TratamientoAsunto(s)
Esófago , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/terapia , Estómago , Administración Oral , Algoritmos , Catárticos/uso terapéutico , Preescolar , Suministros de Energía Eléctrica/efectos adversos , Endoscopía del Sistema Digestivo , Esófago/diagnóstico por imagen , Esófago/lesiones , Cuerpos Extraños/complicaciones , Cuerpos Extraños/diagnóstico , Reacción a Cuerpo Extraño , Humanos , Lactante , Mediastinitis/inducido químicamente , Mediastinitis/terapia , Polietilenglicoles/uso terapéutico , Radiografía , Estudios Retrospectivos , Estómago/diagnóstico por imagen , Fístula Traqueoesofágica/inducido químicamente , Fístula Traqueoesofágica/terapiaRESUMEN
BACKGROUND: A 62-year-old obese, diabetic female underwent endoscopic esophageal injection of botulinum toxin type A (Botox; Allergan, Irvine, CA) for achalasia. The patient presented to her gastroenterologist with chest pain 4 days after the procedure, but no thoracic or gastrointestinal pathologies were identified and the patient was sent home. She presented again the next day with continuing chest pain and newly developed fever. Esophagoduodenoscopy revealed no esophageal leak and a CT scan revealed only mild paraesophageal inflammation. The patient was sent home the same day with antibiotics after a urinalysis suggested presence of a urinary tract infection. The patient presented again 9 days after the procedure with continuing chest pain and fever. INVESTIGATIONS: Chest radiography, electrocardiography, complete blood count, cardiac enzyme levels, basic metabolic panel, urinalysis, Gastrografin (Bracco Diagnostics Inc, Princeton, New Jersey) and barium swallow study, endoscopy, abdominal and chest CT scans, blood culture and wound culture. DIAGNOSIS: Ulceration without perforation of the esophageal mucosa in the area of Botox injections. Unilateral pleural effusion and mediastinitis without abscess formation. MANAGEMENT: Pantoprazole and clonazepam for suspected gastroesophageal reflux and esophageal spasm. Levofloxacin for urinary tract infection. Intravenous antibiotic therapy and acute surgical exploration for possible esophageal rupture. Paraesophageal drain placement, nasogastric tube placement, and parenteral and enteral feeding.
Asunto(s)
Toxinas Botulínicas Tipo A/efectos adversos , Toxinas Botulínicas Tipo A/uso terapéutico , Acalasia del Esófago/tratamiento farmacológico , Mediastinitis/inducido químicamente , Diagnóstico Diferencial , Enfermedades del Esófago/inducido químicamente , Enfermedades del Esófago/diagnóstico , Femenino , Humanos , Mediastinitis/diagnóstico , Persona de Mediana Edad , Úlcera/inducido químicamente , Úlcera/diagnósticoRESUMEN
Se presenta el caso de un suicidio por ingesta masiva de ácido clorhídrico (Salfuman). La intensa causticación del estómago permitió el vertido del líquido a las cavidades torácica y abdominal, lo que originó mediastinitis y peritonitis químicas con extensa necrosis de coagulación que afectó prácticamente a la totalidad de las vísceras en ambas cavidades (AU)
We present a case of suicide by hydrochloric acid (Salfuman) massive ingestión. The intense caustic injury to the stomach allowed the pouring of the liquid into both thoracic and abdominal cavities, which caused chemical mediastinitis and peritonitis with extensive coagulating necrosis that practically affected all visceras (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Ácido Clorhídrico/envenenamiento , Peritonitis/inducido químicamente , Mediastinitis/inducido químicamente , Suicidio , NecrosisRESUMEN
This article presents three planned complex suicide cases. The first case was a 46-year-old man, who had taken some antidepressant and antipsychotic drugs before cutting his right wrist and ingesting a large amount of concentrated hydrochloric acid. In the second case, a 34-year-old man was found dead in his home, hanging by his neck, with a suicidal stab wound on the left side of the chest. In the third case, a 22-year-old woman was found dead, hanging by her neck from a ceiling beam of her grandmother's a storage room, after taking of a solid rodenticide. The histories revealed psychiatric problems in all cases. The investigation of scene, the method employed, the autopsy findings and the interview with their relatives altogether pointed toward a suicidal etiology.
Asunto(s)
Ácido Clorhídrico/envenenamiento , Traumatismos del Cuello/patología , Rodenticidas/envenenamiento , Suicidio , Heridas Punzantes/patología , Administración Oral , Adulto , Antidepresivos de Segunda Generación/efectos adversos , Antipsicóticos/efectos adversos , Sobredosis de Droga , Femenino , Humanos , Ácido Clorhídrico/administración & dosificación , Masculino , Mediastinitis/inducido químicamente , Métodos , Mianserina/efectos adversos , Persona de Mediana Edad , Insuficiencia Respiratoria/inducido químicamente , Tioridazina/efectos adversos , Traumatismos Torácicos/patología , Traumatismos de la Muñeca/patologíaRESUMEN
This study was designed to ascertain, in a rabbit model, extrapleural talc deposition and the related inflammatory response after talc slurry pleurodesis with two clinical doses, 200 and 50 mg/kg. Histopathologic evaluations revealed that whereas numerous rabbits receiving a high dose had talc in the ipsilateral (70%) and contralateral (55%) lung, mediastinum (90%), pericardium (30%), and liver (25%), a small number of animals treated with a low dose showed talc in the ipsilateral lung (10%) and mediastinum (20%) and none in the contralateral lung, pericardium, or liver. Hematologic and immunocytochemical analyses showed that a systemic inflammatory response develops shortly after pleurodesis with a high talc dose involving massive accumulation of neutrophils and macrophages in lung tissue. Zymography also revealed that the pulmonary expression of matrix metalloproteinases 2 and 9 was up-regulated in both lungs in a dose-dependent manner soon after talc instillation. Furthermore, microscopic examination of lung specimens revealed that the higher the dose of talc, the greater the development of both fibrotic visceral pleural thickening and foreign-body granulomas. These findings show pleurodesis with a high talc dose to be associated with an increased risk of extrapleural talc deposition, which may originate undesirable acute and chronic inflammatory responses.
Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Relación Dosis-Respuesta a Droga , Mediastinitis/inducido químicamente , Pericarditis/inducido químicamente , Pleuresia/inducido químicamente , Pleurodesia/efectos adversos , Neumonía/inducido químicamente , Talco/administración & dosificación , Talco/efectos adversos , Enfermedad Aguda , Animales , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Modelos Animales de Enfermedad , Masculino , Mediastinitis/patología , Pericarditis/patología , Pleuresia/patología , Neumonía/patología , Conejos , Talco/farmacocinética , Factores de TiempoRESUMEN
Sternal infections and mediastinitis following coronary bypass grafting are rare, but the treatment for infection remains difficult and the mortality of these complications is reported high. We reviewed our experiences in treating two patients in whom post-sternotomy mediastinitis had developed after coronary bypass grafting. Sternal infections and mediastinitis were treated with debridement of the infected sternum, supra-sternal omental transfer with an open sternal technique, and a primary skin closure.
Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Mediastinitis/inducido químicamente , Mediastinitis/terapia , Epiplón , Complicaciones Posoperatorias , Esternón/cirugía , Anciano , Humanos , Esternón/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Adjuvant chemotherapy for breast cancer, although generally safe and of proven benefit, can have severe complications. Central venous catheter (CVC) complications are relatively common forms of treatment-related morbidity in this setting. We report a rare type of CVC-related complication, that of chemotherapy-induced mediastinitis from central venous extravasation of the drug vinblastine, in a women undergoing adjuvant chemotherapy. The patient presented with signs and symptoms consistent with mediastinitis, but the diagnosis was delayed because the initial findings were nonspecific and there was little suspicion for a CVC-related problem. A radionuclide venous flow study was misleading, but a computed tomographic study of the chest and contrast venography confirmed the diagnosis. Conservative treatment with CVC removal, systemic anticoagulation, antibiotics, and pain controlled to gradual improvement in the patient's clinical status. More aggressive strategies, such as thrombolytic therapy and surgical intervention, were considered, but these approaches have not been used in this particular setting. The complication reported here is the first described in the literature in an adult patient. Two similar cases have been reported in pediatric patients. It is likely that this clinical problem is underreported. Patients with CVCs actively undergoing chemotherapy with vesicant agents should be watched carefully for early signs of CVC disruption and subsequent extravasation, as it is likely that early intervention will be of benefit.
Asunto(s)
Antineoplásicos Fitogénicos/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Extravasación de Materiales Terapéuticos y Diagnósticos/complicaciones , Mediastinitis/inducido químicamente , Vinblastina/efectos adversos , Amoxicilina/uso terapéutico , Combinación Amoxicilina-Clavulanato de Potasio , Analgésicos Opioides/uso terapéutico , Anticoagulantes/uso terapéutico , Cateterismo Venoso Central/efectos adversos , Quimioterapia Adyuvante , Ácidos Clavulánicos/uso terapéutico , Medios de Contraste , Dextropropoxifeno/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Cintigrafía , Vena Subclavia/diagnóstico por imagen , Trombosis/inducido químicamente , Tomografía Computarizada por Rayos X , Warfarina/uso terapéuticoRESUMEN
Arterial infusion of cis-diamminedichloroplatinum (CDDP) is an effective therapy for malignant neoplasms. Severe complications after this therapy in 298 patients with malignant tumors were reviewed in our institute from March 1982 to August 1989. Arteries infused with CDDP and the number of infusions were as follows: bronchial artery (a.) 277, hepatic a. 153, internal iliac a. 51, femoral or popliteal a. 15, lumbar a. 6, pulmonary a. 5, esophageal a. 3 and intercostal a. 3. Eight cases of severe complications were encountered: 3 of esophageal ulcer, 3 of spinal paralysis, and one each of mediastinitis and toe necrosis. The arteries responsible for complications were the bronchial a. in 3 cases of esophageal ulcer and 2 of spinal paralysis, intercostal a. in one of spinal paralysis, esophageal a. in one of mediastinitis and popliteal a. in toe necrosis. Complication rates were 2.7% (8/298 cases) and 1.5% (8/518 infusions). Angiotensin II was infused in 6 of 8 of the cases with complications. The complication rate was 2.9% (6/209 infusions) in the group with CDDP and angiotensin II and 0.6% (2/309 infusions) in the group with CDDP only. Arterial infusion of CDDP, especially combined with angiotensin II, should be done in consideration of the arteries responsible for such complications.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Cisplatino/efectos adversos , Enfermedades del Esófago/inducido químicamente , Infusiones Intraarteriales/efectos adversos , Neoplasias Pulmonares/tratamiento farmacológico , Parálisis/inducido químicamente , Adolescente , Adulto , Anciano , Angiotensina II/administración & dosificación , Arterias Bronquiales , Neoplasias Esofágicas/tratamiento farmacológico , Femenino , Humanos , Masculino , Mediastinitis/inducido químicamente , Persona de Mediana Edad , Necrosis , Dedos del Pie/patología , Úlcera/inducido químicamenteRESUMEN
Postero-anterior and lateral chest radiographs of patients undergoing endoscopic injection sclerotherapy of esophageal varices were reviewed. Radiographs were obtained prior to and within 48 hours of treatment. Following sclerotherapy, pleural effusions and densities were commonly seen at the azygoesophageal reflection and the posterior wall of the bronchus intermedius; however, on follow-up they had resolved. Most patients were asymptomatic, and morbidity was low. These findings suggest that inflammation developing after endoscopic injection sclerotherapy extends beyond the esophageal wall into the mediastinum and pleural space.