Cervical Drainage Research Articles

Low temperature plasma minimally invasive treatment of children piriform fossa fistula

Objective: To observe the clinical efficacy of lowtemperature plasma minimally invasive treatment of piriform fossa fistula in children at the infection stage and non-infection stage. Method: Twenty-five pediatric patients of piriform fovea fistula were treated with low-temperature plasma minimally invasive treatment. These patients were divided into the infection stage group(16 cases) and the non-infection stage group(9 cases). In both groups, low-temperature plasma ablation was performed to close the piriform fossa fistula under laryngoscope supported by endotracheal intubation under general anesthesia. For patients in infection stage, simultaneous cervical abscess incision and drainage were performed. The efficacy, postoperative recurrence rate and complications of the two groups were compared. Result: In the non-infection stage group, 7 cases were cured by 1 operation, and 2 cases were cured by the reoperation. In the infection stage group, 10 cases were cured by 1 operation, 5 cases were cured by the reoperation, and 1 case was cured by external fistula resection due to repeated purulent discharge of neck infection. No recurrent laryngeal nerve injury, massive hemorrhage or other complications occurred in these patients. Conclusion: Low temperature plasma minimally invasive treatment is safe and effective for pediatric patients of piriform fossa fistula.

Application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer

Objective To investigate the application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer. Methods The retrospective and descriptive study was conducted. The clinical data of a 49-year-old male patient with esophageal cancer who was admitted to the Fujian Medical University Union Hospital in November 2018 were collected. The patient underwent closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection. In the thoracic part, esophageal separation and thoracic lymph node dissection were performed with closed pneumothorax, semi-lateral position and multi suspension methods. In the abdominal part, gastric separation and lymph node dissection were accomplished with lifting of liver lobe and respective separation of greater curvature and lesser curvature of stomach. The operation time, volume of intraoperative blood loss, time for out-of-bed activities, time of postoperative drainage tube removal, volume of thoracic drainage fluid, postoperative complications, postoperative pathological examination results, time for discharge from hospital and results of follow-up were observed. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis of patients after operation up to February 2019. Count data were described as absolute number. Results The patient underwent successfully closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection. The operation time and volume of intraoperative blood loss was 310 minutes and 120 mL. The patient resumed out-of-bed activities at 2 days after operation. The abdominal drainage tube, thoracic closed drainage tube and right cervical drainage tube were removed at 2 days after operation with fasting, acid suppression, nutritional support. The thoracic Abel drainage tube and the left cervical drainage tube were removed at 5 days after operation. The volume of thoracic drainage fluid was 550 mL. No obvious sign of anastomotic leakage was found on esophageal angiography at 5 days after operation. The patient recovered well after operation without hoarseness, pulmonary infection and chylothorax. The postoperative examination result of the patient showed mid-thoracic esophageal squamous cell carcinoma (pT3N1M0G3 ⅢB stage). The patient was discharged at 8 days after operation. The patient was followed up for 3 months, and was able to engage in light physical activity. CT reexamination showed no sign of local recurrence or distant metastasis of the tumor. Conclusion Closed single-port thoracoscopic and laparoscopic radical esopahgectomy for esophageal cancer is safe and feasible, with good short-term efficacy. Key words: Esophageal neoplasms; Esophageal cancer; Radical surgery; Thoracoscopy; Laparoscopy; Single port

Parotidectomy in patients with head and neck cutaneous melanoma with cervical lymph node involvement.

Parotidectomy in melanoma of the coronal scalp and face with clinically involved cervical lymph node metastasis is based on predicted cervical lymphatic drainage described by O'Brien. In total, 40 parotidectomies with en bloc therapeutic neck dissection were retrospectively analyzed. Lymphatic spread of melanoma to the parotid lymph nodes was observed in 10 of 40 specimens (25%). Eight of the 10 parotid-positive patients developed a recurrence vs 17 of the 30 parotid-negative patients (P = 0.28). There were no differences in overall survival, melanoma-specific survival, and disease-free survival between the parotid-positive and parotid-negative patients. Although in this series no survival differences were found, parotidectomy still merits a sustained role in therapeutic neck dissection procedures to improve regional control and to prevent facial nerve damage after surgery for a second relapse from occult metastases in the parotid.

Clinical analysis of 234 esophageal foreign bodies

Objective: To explore the clinical characteristics and treatment methods of esophageal foreign body. Method: The clinical data of 234 patients with esophageal foreign bodies admitted to our department from January 2015 to August 2018 were retrospectively analyzed, including course time, foreign body types, surgical methods, imaging manifestations and treatment related complications. Result: The diagnosis of esophageal foreign bodies was confirmed by esophageal CT or esophageal barium meal X-ray examination before operation in 234 patients. Course time varied from 3 hours to 7 days, and the jujube nucleus was the most common food-borne foreign body.223 patients underwent esophagoscopic exploration and foreign body removal under general intravenous anesthesia, 11 of them had no definite esophageal foreign body, 22 had esophageal perforation and periesophagitis. After removal of foreign body, the nasogastric feeding tube was inserted. About 10 days later, the nasogastric feeding tube was removed when they got healthy. Nine cases underwent cervical abscess incision and drainage under general anesthesia. The average postoperative hospital day was 11 days. Conclusion: The rigid esophagoscopy is a safe and effective method for the esophageal foreign bodies. And neck abscess incision must be necessary,when they suffered from esophageal perforation with neck abscess and other serious complications.

Drainage During Endoscopic Thyroidectomy.

Background:Conventional cervical drainage tubes are placed crossing the suprasternal fossa during endoscopic thyroidectomy. In our clinical experience, some patients show shallow or absent suprasternal fossa, which affects the cosmetic outcome in the patient. Therefore, this study aimed to assess the feasibility and significance of restoring the suprasternal fossa by changing the position of neck drainage tubes.Methods and Materials:A total of 117 female patients were enrolled and divided into 2 groups, including 59 and 58 individuals in the Conventional (conventional anterior neck region negative pressure drainage) and Improvement (improved method with a negative pressure drainage) groups. Then, restoration of the suprasternal fossa in all subjects was observed at 1 day postsurgery, the day of extubation, and 3 months postoperatively. In addition, drainage volume, the time to extubation, and abnormal neck sensations were compared between the groups.Results:Compared with the Conventional group, the Improvement group showed improved restoration of the suprasternal fossa, with the patients more satisfied with the cosmetic outcome. However, operation time, postoperative drainage volume, and extubation time were not significantly different between the 2 groups.Conclusions:In endoscopic thyroidectomy via the chest and breast approach, using the new drainage technique described here could yield improved restoration of the suprasternal fossa, ameliorating the cosmetic outcome and patient satisfaction.

An analysis of perioperative outcomes following cervical abscess drainage in children under 2 years

ObjectiveTo identify risk factors and determine perioperative morbidity of children under 2 years of age undergoing cervical abscess drainage. MethodsPatients who underwent cervical abscess drainage 1–18 years of age were queried via the ACS-National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012–2015). Analyzed outcomes include length of stay, operative time, readmission/reoperation rate, and postoperative complications. ResultsA total of 2181 children were identified, 858 were <2 (51.5% male) and 1323 were >2 years (57.1% male) (p = 0.011). The younger cohort was found to undergo more lateral approaches for cervical abscess drainage whereas the older cohort was found to undergo more intraoral approaches for pharyngeal abscess drainage (p < 0.001), suggesting a difference in abscess location related to age at clinical presentation. The younger cohort was also found to have a higher preoperative white blood cell count (20.7 vs. 17.5, p < 0.001) but no significant difference in preoperative fulminant sepsis was observed. Younger children were found to have both a longer wait-time until surgery (1.4 vs. 1.1 days, p = 0.003) and a prolonged length of stay (LOS) (4.3 vs. 3.4 days, p < 0.001). Operative time was found to be lower in the younger cohort (18.4 vs. 21.5 min, p = 0.003), Finally, the younger cohort was found to have an increased incidence and duration of postoperative mechanical ventilation (63 vs. 41, and 0.4 vs. 0.1 days, respectively, p < 0.001.). There were no differences in post-op complications (wound infection, dehiscence, pneumonia, reintubation, and reoperation/readmission). Linear regression for LOS showed that major contributors were operative time, days of postop ventilation, and days from admission to surgery with R = 0.700. ConclusionChildren under 2 years of age have longer LOS that may in part be due to a greater likelihood of postoperative ventilation and a delay in operative intervention, despite having surgical approaches associated with a shorter LOS. They are no more prone to complications than are older children. Recognition of these critical factors plays a role in optimizing perioperative risk assessment and procedural planning within this patient population.

Making Maiken Nedergaard

Making Maiken Nedergaard

High IL-6 and VEGF-A levels correlate with delayed wound healing in cervical lymph node tuberculosis patients

A high proportion of tuberculosis (TB) patients experience delayed wound healing after surgery, and the specific reasons for this phenomenon are not yet clear. To analyse cytokine and growth factors at surgical sites to determine their contribution to delayed wound healing in patients with cervical lymph node TB (CLNT). We measured levels of interleukin (IL) 1β, IL-6, IL-10, IL-22, epidermal growth factor, fibroblast growth factor-2, interferon-gamma, tumour necrosis factor alpha and vascular endothelial growth factor A (VEGF-A) in cervical wound drainage fluid from 36 CLNT patients who underwent lymphadenectomy and in 24 thyroidectomy patients. Wound drainage fluid from CLNT patients showed higher IL-6 (P = 0.007) and VEGF-A (P < 0.001) levels than control thyroidectomy patients (P < 0.05). CLNT patients with a delayed healing time (>5 days; n = 18) showed higher IL-6 (P = 0.002) and VEGF-A (P < 0.001) levels in wound drainage fluid than CLNT patients with normal healing times (5 days; n = 18). IL-6 (OR 11.280, 95%CI 1.413-90.028; P = 0.022) and VEGF-A (OR 13.510, 95%CI 2.168-84.182; P = 0.005) can independently and significantly predict wound healing time in CLNT patients. These findings demonstrate that high IL-6 and VEGF-A levels in the post-operative wound fluid of CLNT patients correlate with delayed wound healing.

Incidence and Distribution of Nodal Metastases in Sinonasal Malignancy

Cervical lymph node drainage pathways of sinonasal malignancies (SNM) have not yet been well-established in the literature. We present the largest population-based cohort of SNM to investigate the frequency and pattern of cervical node involvement. The Surveillance, Epidemiology, and End Results registry was queried from 2004 to 2014, identifying patients with sinonasal squamous cell carcinoma (SCC), adenocarcinoma, adenoid cystic carcinoma (ACC), sinonasal undifferentiated carcinoma (SNUC), mucosal melanoma, and esthesioneuroblastoma. Cases were assessed by frequency of cervical lymph node level, distant metastasis, and primary subsite. A total of 4,171 SNM cases were identified, 527 of which presented with cervical nodal disease (12.6%). Level II and level I diseases were most commonly identified (36.1 and 29.5%). This finding was consistent despite histology and primary subsite involved. Regional disease was most commonly seen in SNUC (22.4%) and SCC (15.2%), and least commonly in ACC (4.1%). Malignancies of the maxillary sinus demonstrated the highest rate of nodal disease (19.6%), followed by the sphenoid sinus (15.9%). No cases of nodal disease were identified amongst frontal sinus malignancies. The parotid and level I/level II nodes were least involved in cases with distant metastasis (6% and 10%). Conversely, suboccipital/retroauricular and level VII (mediastinal) nodes most frequently presented with distant metastasis (67% and 33%). Although cervical node involvement in SNM is infrequent compared to other head and neck sites, levels II and I were overwhelmingly involved when present. Knowledge of these sinonasal drainage patterns will ultimately help guide the treatment of the neck in select cases.

Long-term follow-up of patients with early-stage diffuse large B-cell lymphoma of Waldeyer’s ring treated with intensity-modulated radiotherapy

Objective To evaluate the treatment outcome, prognostic factors, radiation dose, and toxicities in patients with early-stage primary diffuse large B-cell lymphoma of Waldeyer’s ring (WR-DLBCL) treated with intensity-modulated radiotherapy (IMRT). Methods This study included 80 patients with a confirmed diagnosis of stage Ⅰ—Ⅱ primary WR-DLBCL who were admitted to our hospital from 2008 to 2015. Only 3 patients received radiotherapy alone, and the other patients received radiotherapy and chemotherapy. After chemotherapy, 24 patients achieved complete remission (CR), and 53 patients achieved partial remission (PR). IMRT was given to the primary lesion and cervical lymphatic drainage region. Survival analysis was performed using the Kaplan-Meier method and log-rank test. The Cox model was used for analysis of prognostic factors. The toxicities were scored using the RTOG criteria. Results The median follow-up was 64 months. The 5-year locoregional control (LRC), overall survival (OS), and progression-free survival (PFS) rates were 94%, 88%, and 84%, respectively. The dose-volume histogram showed that the maximum, mean, and minimum doses to primary gross tumor volume were 54.47 Gy, 52.27 Gy, and 38.83 Gy, respectively. Prognostic analysis showed that age>60 years and increased lactate dehydrogenase (LDH) were influencing factors for OS (P=0.009 and 0.002), and that aged>60 years, IPI ≥2, and increased LDH were influencing factors for PFS (P=0.001, 0.035, and 0.007). Among all patients, 12, 53, and 8 experienced grade 1-3 radiation-induced acute oral mucositis, respectively, and 16 and 13 experienced grade 1 and 2 xerostomia as the late toxicity, respectively. Conclusions For patients with early-stage primary WR-DLBCL, IMRT results in satisfactory OS, PFS, and LRC and has tolerable early or late radiation-induced toxicities. Key words: Lymphoma/intensity modulated radiotherapy; Lymphoma, Waldeyer’s ring; Lymphoma, diffuse large B-cell; Treatment outcome

Use of a tubular retractor for transoral odontoidectomy of upper cervical epidural phlegmon extraction and abscess drainage

Anterior epidural abscess of the superior cervical cord with odontoid osteomyelitis is a rare but potentially devastating condition due to the potential for severe and irreversible neurological injury. Early and aggressive neurosurgical intervention and medical management is usually indicated in cases with symptomatic spinal cord compression and may be associated with superior clinical outcomes. Access to the craniovertebral junction for decompression of the upper cervical cord is complicated by the proximity of critical anatomical structures. The transoral approach is considered to be the standard for treating lesions of the odontoid and anterior epidural space of the superior cervical spine. The use of a tubular retractor for procedures of the craniovertebral junction has been described for several approaches to this region but its use has yet to be described for the transoral approach in a live patient. This report describes the novel use of a tubular retractor for cervicomedullary decompression via transoral odontoidectomy for abscess drainage and phlegmon resection in a patient with progressive cervical myelopathy. The tubular retractor serves to retract the pharyngeal wall flaps and expose the anterior arch of C1, odontoid, and inferior clivus. This variation of the transoral approach eliminates the need for stay sutures for these purposes and may be used for lesions of the odontoid and anterior epidural space of the superior cervical spine.

Cervical chylous leakage following esophagectomy that was successfully treated by intranodal lipiodol lymphangiography: a case report

BackgroundChylous leakage is a well-known complication after esophagectomy, but cervical chylous leakage is relatively rare, and considerable controversy remains regarding the appropriate management strategies. We herein report a case of cervical chylous leakage treated successfully by lipiodol lymphangiography.Case presentationThe patient, a 70-year-old man with middle thoracic esophageal cancer, underwent radical esophagectomy with 3-field lymph node dissection and subsequently developed cervical chylous leakage. From the second postoperative day (POD2), the amount of fluid in the cervical drainage tube increased by 200–300 ml/day. We started octreotide (300 μg/day) on POD5 and etilefrine (120 mg/day) on the POD6. However, the amount of cervical discharge did not decrease. We performed lipiodol lymphangiography on POD8. Thereafter, the amount of cervical discharge finally began to decrease. We removed the drainage tube on POD13, and the patient was discharged from the hospital on POD23.ConclusionsOur case suggests the clinical efficacy of lipiodol lymphangiography for cervical chylous leakage after esophagectomy.

Intraocular Pressure-Lowering Effect of Latanoprost Is Hampered by Defective Cervical Lymphatic Drainage.

PurposeTo evaluate whether defects in cervical lymphatic drainage influence the intraocular pressure (IOP)-lowering effect of latanoprost in patients with primary open-angle glaucoma (POAG) who have undergone unilateral radical neck dissection (uRND).MethodsWe enrolled (1) bilateral POAG patients who had started (bilateral) latanoprost (0.005%) monotherapy prior to their uRND and (2) treatment-naïve, bilateral glaucoma suspects (GSs) who had undergone the same surgery. We compared the eyes ipsilateral to the uRND with their fellow eyes in terms of the changes in IOP between the baseline (prior to the uRND) and the follow-up visits (1, 3, and 6 months after the uRND).ResultsThe study involved 22 eyes of 11 POAG patients and 14 eyes of 7 GSs. In the POAG patients, IOP had increased significantly after surgery in the eyes ipsilateral to the uRND (from 14.7±1.4mmHg to 17.1±2.2mmHg; P = 0.007). Interestingly, in the eyes contralateral to the uRND, IOP had not changed significantly after surgery (from 14.2±1.8mmHg to 14.4±2.0mmHg; P = 0.826). In GSs, the eyes ipsilateral to the uRND did not differ significantly from their fellow eyes in terms of post-operative IOP change (ipsilateral value: 0.3±0.5mmHg, fellow eyes: -0.1±0.7mmHg; P = 0.242).ConclusionIn the POAG patients, IOP had increased significantly in the eyes ipsilateral to the uRND. However, it had not changed significantly in the eyes contralateral to the surgery or in the eyes of the GSs. These findings suggest that, latanoprost works, at least in part, by enhancing outflow from the aqueous humor via the uveolymphatic pathway.

Descending Necrotising Mediastinitis Due to Thinner Injection in a Suicide Attempt: Case Report

Descending Necrotising Mediastinitis (DNM) is a serious complication caused by infection of mediastinal organs and mediastinal connective tissues. We report a case of DNM caused by thinner injection. The case is a 23 years old woman who transfered to a health institution after injecting thinner into cervical area in a suicide attempt. Her CT scans showed air artefacts on the left side of the cervical region and mediastinal enlargement. Cervical drainage, bilateral thoracotomy were performed. In follow-up CT scans, collapse on the cervical vascular structures, widespread air artefacts in the tissues were identified. Following the CT results, the patient underwent cervical fasciotomy, right rethoracotomy.

First-Pass Contrast-Enhanced MR Angiography in Evaluation of Treated Spinal Arteriovenous Fistulas: Is Catheter Angiography Necessary?

Catheter angiography is typically used for follow-up of treated spinal AVFs. The purpose of this study was to determine the diagnostic performance and utility of first-pass contrast-enhanced MRA in the posttreatment evaluation of spinal AVFs compared with DSA. A retrospective review was performed of all patients at our tertiary referral hospital (from January 2000 to April 2015) who underwent spine MR imaging, first-pass contrast-enhanced MRA, and DSA after surgical and/or endovascular treatment of a spinal AVF. Presence of recurrent or residual fistula on MRA, including vertebral level of the recurrent/residual fistula, was evaluated by 2 experienced neuroradiologists blinded to DSA findings. Posttreatment conventional MR imaging findings were also evaluated, including presence of intramedullary T2 hyperintensity, perimedullary serpentine flow voids, and cord enhancement. The performance of MRA and MR imaging findings for diagnosis of recurrent/residual fistula was determined by using DSA as the criterion standard. In total, 28 posttreatment paired MR imaging/MRA and DSA studies were evaluated in 22 patients with prior spinal AVF and 1 patient with intracranial AVF with prior cervical perimedullary venous drainage. Six image sets of 5 patients demonstrated recurrent/residual disease at DSA. MRA correctly identified all cases with recurrent/residual disease with 1 false-positive (sensitivity, 100%; specificity 95%; P < .001), with correct localization in all cases without interobserver disagreement. Conventional MR imaging parameters were not significantly associated with recurrent/residual spinal AVF. First-pass MRA demonstrates high sensitivity and specificity for identifying recurrent/residual spinal AVFs and may potentially substitute for DSA in the posttreatment follow-up of patients with spinal AVFs.

The clinical analysis of infection of the deep neck space with superior mediastinal abscess

Objective:To study the etiology, presentation, diagnosis and treatment of infection of deep neck space with superior mediastinal infection in order to accumulate experience in clinical diagnosis and treatment.Method:We reviewed medical records of 15 patients who were diagnosed with deep neck infection with superior mediastinal infection and those who were hospitalized in Guizhou provincial people's hospital from Janurary 2011 to July 2015.The patients were screened retrospectively for demographic characteristics, presenting symptoms, laboratory examinations, imaging features, bacteriologies and etiologies. The treatment and outcomes of the patients were investigated.Result:In 15 patients, 7 cases（46.67%) were related to foreign body in esophagus, 3（20%) cases were related to peritonsillar abscess, 2（13.33%) cases who had diabetes with poor blood glucose control were related to exodontias, 3（20%) cases were related to unknown reasons. The serum CRP［(151.82±22.12)mg/L］ at the time of admission had a positive correlation with the time of hospitalization. The time of CRP decreased to normal range after admission ［(15.3±2.1)d］ were apparently related to the hospitalization time［(23.8±4.1)d］(r=0.79, P<0.01). The results of bacteria culture of 7 cases was positive(46.67%), 2 cases were infected by Klebsiella pneumoniae and 1 case was mixed with Escherichia coli, 2 cases were infected by the Streptococcus viridans infection, 2 cases were infected by Hemolytic streptococcus A group and B group, 1 case was infected by Staphylococcus Aureus. Appropriate antibiotics for organisms were given based on the results of culture identification and empiric therapy. The patients with abscesses were treated with cervical and superior mediastinal drainage. In 15 patients who were complex treatment, 4 patients including 2 patients with diabetes were succumbed to the disease （mortality is 26.67%）,11 patients were healed up(effective rate is 73.33%).Conclusion:The patients with deep neck space infection with superior mediastinal infection had rapid onset, rapid development and the patients with diabetes had high mortality. The patients should be analyzed in detail the history and clinical manifestations combined with imaging examination, bacterial culture and drug sensitive test and so on in order to determine the diagnosis. The patients should be cured with effective antibiotics and active surgical intervention.

Determination of radiotherapeutic target zones for thoracic esophageal squamous cellcancer with lower cervical lymph node metastasis according to CT-images.

Esophageal squamous cell carcinoma (ESCC) is a leading cause of cancer-related deaths worldwide. And radical synchronized chemoradiotherapy has become an important treatment measures for this disease. It is necessary to define the therapeutic target zone based on computer tomography(CT)-images for precise radiotherapy. Therefore, we retrospectively analyzed the regularity of lymph node metastasis in lower cervical section of thoracic esophageal cancer based on CT-images and discussed the range of radiotherapy in supraclavicular zone. The lower cervical lymphatic drainage area was divided into cervical tracheoesophageal groove (CTG), medial supraclavicular zone (MSC zone) and lateral supraclavicular zone (LSC zone) based on CT-images. We found that the rate of lymph node metastasis to medial CTG and MSC zone was relatively high. And rate of lymph node metastasis to the above two zones from middle thoracic section was on an increasing trend with the progress of T stage. Patients at stage T3 and T4 with lymph node metastasis in tracheoesophageal groove in middle thoracic section showed a higher rate of lymph node metastasis in MSC zone. These results demonstrated that the CTG and MSC zone should be clinically included in the supraclavicular target zone for radical radiotherapy, and the T-stage and tumor location should be considered simultaneously.

Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description

ABSTRACTBackgroundDescending necrotizing mediastinitis is a serious infection involving the neck and the chest, in which an odontogenic, pharyngeal, or cervical infection spreads rapidly to the thoracic cavity, with a high death rate by sepsis and organic failure if not treated quickly and properly.MethodsA systematic search in the electronic database PubMed was conducted using the keywords “mediastinitis” and “descending necrotizing mediastinitis” resulting in 2560 items, filters were activated (systematic review, meta‐analysis, and clinical trial) resulting in 60 articles, from which we selected relevant articles on the topic.ResultsThe best available evidence we could obtain was from 26 case series with evidence level III. The overall mortality in this period was 17.5%.ConclusionFor mediastinitis limited to the upper part of the mediastinum, transcervical drainage may be sufficient; cases that extended below the tracheal carina may require cervical and transthoracic drainage. A multidisciplinary therapeutic approach has allowed a reduction in its mortality. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2275–E2283, 2016

Ultrasound-guided percutaneous drainage of pyometra in cervical cancer patients on radiotherapy

Background: Pyometra is a gynecological emergency in cervical cancer patients receiving radiotherapy because it can be complicated by perforation, sepsis, and death. It can delay initiation and continuation of treatment. For certain select patients who may not be able to undergo drainage of the lesion under anesthesia via cervical dilatation and drainage, ultrasound-guided percutaneous drainage is a good alternative. We report the successes recorded in using an alternative route for pyometra drainage in cervical cancer patients on radiotherapy when the conventional examination under anesthesia and cervical drainage was not possible. Patients and Methods: Following institutional ethical approval, a prospective study was conducted from January 2014 to January 2016 on selected patients referred from the radio-oncology unit of Ahmadu Bello University Teaching Hospital, Zaria to the Gynecologic Oncology Unit with pyometra complicating advanced cervical cancer on radiotherapy. Initial attempts at cervical dilatation and drainage under anesthesia were unsuccessful necessitating this approach of percutaneous drainage under ultrasound guidance with mild sedation after obtaining informed consent. Results: Six patients were managed with a mean age of 58.5 years, who were diagnosed with advanced cervical cancers clinical stages 2B to 3A on radiotherapy. An average of 200 ml of pus was drained, and culture revealed mixed infections with predominant anaerobes strongly sensitive to metronidazole. There was recurrence in 1 case (16.7%) after 1 month of follow-up requiring a repeat procedure. Conclusion: The procedure is relatively cheap, safe, and effective in selected patients.

Thoracic duct lesions in thyroid surgery: An update on diagnosis, treatment and prevention based on a cohort study

IntroductionThoracic duct fistula at the cervical level is a severe but rare complication following thyroid surgery, particularly associated to lateral dissection of the neck and to mediastinal goiter. Methodswe retrospectively analyzed chylous fistulas observed in a cohort of 13.224 patients underwent surgery for thyroid disease since 1986 to 2014, in the Unit of Endocrine Surgery, S. Maria University Hospital, Terni, Italy. ResultsWe observed 20 cases of chylous fistula. Thirteen patients underwent primary surgery in our institution while the remaining 7 cases had been referred to our Department from other hospitals for an already diagnosed lymphatic leak. Surgical procedures carried out included total thyroidectomy for mediastinal goiter in 4 patients, total thyroidectomy for cancer in 2 patients, unilateral functional lymphadenectomy in 11 patients and bilateral in 3. Intraoperative repair was carried out in 4 cases. Of the remaining 16 cases, 4 of the 6 fistulas with low flow leakage healed in about 30 days of conservative treatment, 2 cases instead required surgical repair. All 10 patients with “high-flow” fistula underwent surgery.Despite surgery was performed later, postoperative course in patients with late surgical repair is similar to what observed in those patients with early surgical repair. Both groups underwent cervical drainage removal in post-operative day 4. ConclusionHealing of a cervical chylous fistula can be achieved by conservative medical therapy (nutritional and pharmacological) but in case of therapeutic failure with rapid decrease of general condition, the surgical approach is necessary. In our experience, duct ligation after unsuccessful conservative treatment, is the only resolutive treatment.