Pharyngeal Abscess Research Articles

Pharyngo‐oesophageal fistula as a consequence of nasogastric tube placement

SummaryComplications associated with nasogastric tube placement are infrequent and usually not severe. This article details a case of a pharyngo‐oesophageal fistula in a 6‐year‐old Arabian racing gelding initially presenting with recurrent oesophageal obstruction and dysphagia 5 months after recovering from a medically treated colic. Initially, a suspected diverticulum was diagnosed using a combination of endoscopic examinations and barium‐contrast radiography. Its occurrence was believed to be secondary to a pharyngeal abscess occurring as a consequence of repeated or long‐term nasogastric tube placement during the previous treatment for colic. Continuing, and unresolvable, oesophageal obstruction and dysphagia resulted in the gelding being euthanised. Post‐mortem examination revealed the presence of a pharyngo‐oesophageal fistula.

Clinical manifestations of scarlet fever in children in the megalopolis at the present stage.

BACKGROUND: according to the literature, an increase in severe forms of scarlet fever among children was noted in a number of foreign countries in 2022-2023. AIMS: to identify the current clinical features of scarlet fever in children in a large metropolis of Russia. MATERIALS AND METHODS: an observational descriptive retrospective continuous study of the clinical features of the course of scarlet fever in children was conducted according to 295 case histories of patients diagnosed with Scarlet fever from 2020 to 2022 on the basis of the GBUZ "DGKB named after Z.A. Bashlyaeva DZM", GBUZ "DGKB No. 9 named after G.N. Speransky DZM" in Moscow. The statistical processing of the material uses traditional methods for calculating extensive and intensive indicators (p1 and p2), errors of extensive indicators (m1 and m2) and standard deviations (rmax↔rmip), taking into account the confidence interval (t) and confidence probability (P=95%), a method for comparing indicators using a well-known formula, where at t ≥ 2.0 P ≥ 95% p ≤ 0.05, the definition of standard deviations, taking into account the confidence interval (t) and the confidence probability P = 95%. The comparison of percentages in the analysis of four-field conjugacy tables was performed using the exact Fisher criterion. The differences were considered statistically significant at p 0.05. RESULTS: as a result of the study, it was revealed that the abolition of strict anti-epidemic restrictions on COVID-19 in 2022 led not only to an increase in the incidence of scarlet fever among children from 0 to 18 years of age by 3.6 times in 2022 compared with 2021, but, as a result, to an increase in hospitalization of children in hospitals in Moscow. Thus, the number of hospitalized children with scarlet fever in 2022 increased by 18.0 times compared to 2020. The majority of those hospitalized (83.4%) were children from organized groups, including those aged 3 to 7 years (52.9%) and from 7 to 14 years (39.3%), with an average severity of the disease (93.6%). It was noted that that among the examined children, 53 children (18%) had a history of COVID-19, and among this group of children, one in five children had severe scarlet fever, while among children who did not have a history of COVID-19, these were significantly (p 0.001) 8.4 times less (respectively, 20.7% versus 2.5%). It was revealed that every 8-9 patients (12.2%) had various complications, mainly of a septic nature and those that arose in the first week of the disease, including otitis media, sinusitis, community-acquired pneumonia, parathonsillar and lateral pharyngeal abscesses and toxic shock syndrome. In the second week and later, complications of an infectious and allergic nature were reported, including tubulointerstitial nephritis, acute renal injury, post-infectious cardiomyopathy, acute post-streptococcal glomerulonephritis, toxic allergic vasculitis, post-streptococcal arthritis. Beta-lactam antibiotics remain the etiotropic drugs of choice. Antibiotics of the cephalosporin 53.6% and penicillin 46.4% series were used to treat scarlet fever. CONCLUSIONS: in modern conditions of the megalopolis, scarlet fever occurs with a typical clinical picture. The majority of those hospitalized were children of preschool and school age, only 12.2% of children were diagnosed with various complications of scarlet fever and the vast majority of children (93.6%) had a moderate severity of scarlet fever. It was noted that against the background of an increase in the number of hospitalized patients, the number of patients with severe scarlet fever decreases, while the incidence of complications in patients does not change (12.3% - 12.8%). It was shown that among patients who had suffered from COVID-19, scarlet fever was 8.3 times more likely to occur in severe form compared with children who had no history of COVID-19 disease (respectively, 20.7% vs. 2.5, p 0.0001).

Translocation of a fish spike from the pharynx to the thyroid gland: A case report

BACKGROUND A fish spike stuck in the throat is a common ear, nose, and throat (ENT) emergency. However, it is very rare for a fish spike to reach the thyroid tissue through the throat, which is very dangerous and can lead to pharyngeal fistula, cervical abscess, mediastinal abscess, and thyroid abscess. Proper and timely management can help reduce complications, especially in elderly patients. CASE SUMMARY In the case presented here, the causative factor was dentures, but improper management aggravated the condition. In the case presented here, an elderly woman with a history of accidentally swallowing fish bones for 20 d had a sensation of foreign bodies in her throat. Eventually, computed tomography (CT) of the neck showed that the left side of the thyroid gland had a dense shadow in the form of a stripe. CONCLUSION If a fishbone foreign body is not visible during endoscopic examination but the patient has significant symptoms, the surgeon should be aware that the fishbone may be lodged in the thyroid. To avoid a misdiagnosis, ultrasound, CT, and other tests can be used to clarify the diagnosis. T The first step in treating a fish bone in the thyroid gland is to determine the position of the foreign body and the extent of the infection, and to develop a personalized surgical plan for its removal. At the same time, scientific information should be made available to the general public so that people know that if a fish bone is accidentally lodged, they should not force it to be swallowed or be spit out by inducing vomiting, which are incorrect methods and may aggravate the condition or even cause it to migrate outside the cavity, leading to serious complications, as in this reported case.

CHARACTERIZATION AND ANALYSIS OF PATIENT UNDER GOING COVID 19 RTPCR AT TERTIARY CARE CENTER

INTRODUCTION RT- PCR testing (Reverse transcriptase polymerase chain reaction) is most reliable diagnostic procedure for covid 19 screening.In the absence of effective treatments or preventive measures, all attempts to control the pandemic were based on RT-PCR testing of upper respiratory specimens, which is considered the diagnostic gold standard [1]RT-PCR COVID-19 testing is a generally safe and well-tolerated procedure, but numerous complications have been reported during this procedure. MATERIAL AND METHOD Retrospective study of 1524 Patients for RT-PCR testing were carried out from 1st February 2021 to 30th June 2021 and complications of testing were studied. RESULT Most common complication was broken swab in nasal cavity seen in 0.33% individuals. Second most common complication was epistaxis seen in 0.26% individuals.Least common complications were fainting and foreign body in throat seen in 0.13% and 0.07% of individuals respectively. Complications like CSF leak, septal abscess and pharyngeal abscess were not seen. CONCLUSION Our study reviewed the complications during COVID 19 RT-PCR testing. Sufficient anatomical and clinical knowledge of nasopharyngeal anatomical structures are required to lower the incidence of adverse events and also to protect patients from preventable but often underestimated risks.

Associations Between Findings of Fusobacterium necrophorum or β-Hemolytic Streptococci and Complications in Pharyngotonsillitis-A Registry-Based Study in Southern Sweden.

Most pharyngotonsillitis guidelines focus on the identification of group A streptococci (GAS), guided by clinical scores determining whom to test with a rapid antigen detection test. Nevertheless, many patients testing negative with this test are evaluated for group C/G streptococci (GCS/GGS) and Fusobacterium necrophorum, yet their importance remains debated. Our primary aim was to evaluate associations between complications and findings of F. necrophorum, GAS, or GCS/GGS in pharyngotonsillitis. This was a retrospective, registry-based study of pharyngotonsillitis cases tested for F. necrophorum (polymerase chain reaction) and β-hemolytic streptococci (culture) in the Skåne Region, Sweden, in 2013-2020. Patients with prior complications or antibiotics (within 30 days) were excluded. Data were retrieved from registries and electronic charts. Logistic regression analyses were performed with a dichotomous composite outcome of complications as primary outcome, based on International Classification of Diseases, Tenth Revision, codes. Cases with negative results (polymerase chain reaction and culture) were set as reference category. Complications within 30 days were defined as peritonsillar or pharyngeal abscess, otitis, sinusitis, sepsis or septic complications, recurrence of pharyngotonsillitis (after 15-30 days) or hospitalization. Of 3700 registered cases, 28% had F. necrophorum, 13% had GCS/GGS, 10% had GAS, and 54% had negative results. The 30-day complication rates were high (20%). F. necrophorum (odds ratio, 1.8; 95% confidence interval, 1.5-2.1) and GAS (1.9; 1.5-2.5) were positively associated with complications, whereas GCS/GGS were negatively associated (0.7; 0.4-0.98). Our results indicate that F. necrophorum is a relevant pathogen in pharyngotonsillitis, whereas the relevance of testing for GCS/GGS is questioned. However, which patient to test and treat for F. necrophorum remains to be defined.

An Autopsy Case of Posterior Pharyngeal Abscesses Caused by Periodontal Bacteria

A woman in her seventies living alone was found dead on the floor of her living room. A blue-green swelling was found from her right cheek to her anterior neck and an autopsy was performed. The autopsy revealed subcutaneous abscesses from the right cheek to the anterior neck, posterior pharyngeal abscesses, mediastinal abscesses, pleuritis, and pericarditis. The cause of death was diagnosed as sepsis due to a retropharyngeal abscess caused by extensive severe periodontitis. The presence of a dentist at the autopsy allowed for a rapid diagnosis of periodontal disease, which was the cause of the posterior pharyngeal abscesses and septic shock. Therefore, the participation of a dentist in a forensic autopsy is important not only for personal identification but also for the rapid diagnosis of the cause of death.

A case of adult-onset Grisel’s syndrome

Aim: Grisel’s syndrome is a non-traumatic subluxation of the atlanto-axial joint that occurs after infection or inflammation in the otolaryngological area, primarily in children. Method: This report describes the clinical characteristics of an extremely rare case of adult-onset Grisel’s syndrome. Result: A 77-year-old woman presented with neck and bilateral shoulder pain and stiffness. Her temperature was 37.6 °C. Blood testing revealed a mildly elevated inflammatory response, although blood cultures were negative. Computed tomography (CT) showed atlanto-axial subluxation and joint destruction. T2-weighted magnetic resonance imaging (MRI) displayed high signals in the soft tissues in the anterior space of the atlas and axis, posterior wall of the pharynx, and interspinous ligament, indicating spinal cord compression at the C1 level. Differential diagnoses of inflammation and diseases causing atlanto-axial subluxation included rheumatoid arthritis, amyloidosis, pyogenic spondylitis due to posterior pharyngeal abscess, and crowned dens syndrome. After the systematic elimination of each condition, we considered Grisel’s syndrome and began non-surgical treatment with intravenous antibiotics and a Philadelphia neck collar. Her inflammatory response and neck pain gradually decreased. Six months later, there was no progression of instability. She was able to walk unaided and live normally with the use of a neck collar as needed. Conclusion: Grisel’s syndrome occurs predominantly in children, but can also afflict adults. Since early diagnosis and treatment can improve symptoms in some cases and prevent progressive atlanto-axial instability, prompt evaluation of the atlanto-axial joint using CT or MRI is advised in patients with neck pain and limited range of motion.

Phlegmonous esophagitis with mediastinal abscess caused by pharyngeal abscess: a case description.

Phlegmonous esophagitis with mediastinal abscess caused by pharyngeal abscess: a case description.

Isolated oropharyngeal abscess with hypopharyngeal extension recurring 12 years after initial surgical management: A case report and review of the literature

Pharyngeal abscesses require urgent management as they have the propensity to cause severe and life-threatening complications. The introduction of antibiotics has led to a dramatic decline in the incidence of these infections. Regardless, abscess formation continues to be observed in the peritonsillar, parapharyngeal, and retropharyngeal spaces. Oropharyngeal and hypopharyngeal abscesses that cause airway obstruction are scarcely reported and tend to be secondary to other processes. Herein, we describe the case of an 83-year-old man presenting with an idiopathic, obstructive, oropharyngeal wall abscess, extending from the infratonsillar region to the hypopharynx, which recurred after initial surgical management 12 years prior for the same process. He required reintervention during both episodes for rapid reaccumulation. A detailed electronic literature search of PubMed and MedLine was performed for studies reporting on recurrent pharyngeal abscesses and their management. Results were limited to articles published in English from inception to August 2021. The timely management of pharyngeal infections acutely obstructing the airway is crucial. Physicians should adopt close and frequent monitoring and have a low threshold for reimaging should symptoms worsen or fail to improve after the initial surgical intervention.

Клинический случай острого аденотонзиллита и гнойного тиреоидита, осложненного флегмоной шеи, у больного с нераспознанным раком щитовидной железы

Phlegmon of the neck is one of the most severe variants of soft tissue suppurations encountered in the practice of otorhinolaryngologists, maxillofacial and thoracic surgeons. Currently, the clinical course of purulent-inflammatory processes in the neck has changed markedly. According to many authors, the number of patients with atypical course of purulent-inflammatory diseases has increased. Along with the appearance of sluggish forms leading to a chronic process, the number of locally advanced cases of the disease has increased. Among the purulent complications of inflammatory diseases, phlegmonous processes of the pharynx and neck occupy a special place. Unlike paratonsillar and pharyngeal abscesses, the diagnosis and treatment of which do not cause any particular difficulties, recognition of these processes in the initial stage is not always possible, and their localization in the vicinity of the larynx, great vessels of the neck, and mediastinum poses a danger to the life of patients. We present our own clinical observation of acute adenotonsillitis and purulent thyroiditis complicated by neck phlegmon with unrecognized thyroid cancer in a 33-year-old young man.

Differential diagnosis of parapharyngeal abscess with multisystem inflammatory syndrome in children associated with COVID-19

The pandemic of the new coronavirus infection (COVID-19) has identified new diagnostic and medical tasks before different doctors. As observations show, children have the flow of infection easier than adults. However, in some cases, COVID-19 in children proceeds extremely difficult, with fever and multisystem inflammation, possibly requiring treatment in the resuscitation department. In domestic practice, the term "Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19" is used to indicate the disease. Among the local symptoms of MIS are inflammations of the skin and mucous membranes, as well as various lymphadenopathy. The article presents the results of our clinic's observation of 205 patients with MIS for the period from May 2020 to May 2021. In some patients, the clinical manifestations of MIS-C required differential diagnosis with parapharyngeal abscesses (PPA). For this purpose, the children were consulted by an otorhinolaryngologist and a CT scan of the neck with contrast enhancement was performed. Despite the striking clinical manifestations similar to PPA, in no case was a pharyngeal abscess revealed. Both of these diseases are potentially fatal if treatment is not started on time, and therefore we believe that the awareness of otorhinolaryngologists about the manifestations of MIS-C will be useful in modern clinical practice.

Grade 4 Neutropenia Secondary to Immune Checkpoint Inhibition - A Descriptive Observational Retrospective Multicenter Analysis.

IntroductionImmune checkpoint inhibitors (ICI) are increasingly being used to treat numerous cancer types. Together with improved recognition of toxicities, this has led to more frequent identification of rare immune-related adverse events (irAE), for which specific treatment strategies are needed. Neutropenia is a rare hematological irAE that has a potential for a high mortality rate because of its associated risk of sepsis. Prompt recognition and timely treatment of this life-threatening irAE are therefore critical to the outcome of patients with immune-related neutropenia.MethodsThis multicenter international retrospective study was conducted at 17 melanoma centers to evaluate the clinical characteristics, diagnostics, treatment, and outcomes of melanoma patients with grade 4 neutropenia (<500 neutrophils/µl blood) treated with ICI between 2014 and 2020. Some of these patients received metamizole in addition to ICI (ICI+/met+). Bone marrow biopsies (BMB) of these patients were compared to BMB from non-ICI treated patients with metamizole-induced grade 4 neutropenia (ICI-/met+).ResultsIn total, 10 patients (median age at neutropenia onset: 66 years; seven men) with neutropenia were identified, equating to an incidence of 0.14%. Median onset of neutropenia was 6.4 weeks after starting ICI (range 1.4–49.1 weeks). Six patients showed inflammatory symptoms, including fever (n=3), erysipelas (n=1), pharyngeal abscess (n=1), and mucositis (n=1). Neutropenia was diagnosed in all patients by a differential blood count and additionally performed procedures including BMB (n=5). Nine of 10 patients received granulocyte colony-stimulating factors (G-CSF) to treat their grade 4 neutropenia. Four patients received systemic steroids (including two in combination with G-CSF, and one in combination with G-CSF and additional ciclosporin A). Four patients were treated with one or more antibiotic treatment lines, two with antimycotic treatment, and one with additional antiviral therapy. Five patients received metamizole concomitantly with ICI. One fatal outcome was reported. BMB indicated a numerically lower CD4+ to CD8+ T cells ratio in patients with irNeutropenia than in those with metamizole-induced neutropenia.ConclusionGrade 4 neutropenia is a rare but potentially life-threatening side effect of ICI treatment. Most cases were sufficiently managed using G-CSF; however, adequate empiric antibiotic, antiviral, and antimycotic treatments should be administered if neutropenic infections are suspected. Immunosuppression using corticosteroids may be considered after other causes of neutropenia have been excluded.

Transoral versus Transcervical Drainage of Pharyngeal Abscesses in Children: Post-Operative Complications

The objective of this study was to compare complications and other perioperative outcomes between intraoral and transcervical drainage of both retropharyngeal and parapharyngeal abscesses. This was a retrospective study that analyzed data from the 2012 to 2016 National Surgical Quality Improvement Program (NSQIP)-Pediatric public use files. Baseline characteristics and perioperative outcomes including postoperative complications and length of hospital stay (LOS) were compared between intraoral and transcervical drainage groups. Multivariable logistic regression was performed to inspect predictors of having an extended LOS, defined as LOS greater than 3 days. A total of 1174 patients were included. Mean age was 5.1 ± 3.8 years in the intraoral group (N = 1063) and 4.2 ± 4.3 years in the transcervical group (N = 111, P < .001). There was no significant difference in the rate of post-operative complications between groups (5.7% intraoral vs 8.1% transcervical, P = .316). LOS was significantly longer in the transcervical group (>3 days in 36.2% of intraoral vs 49.5% of transcervical, P = .006). Patients in the transcervical group had 1.59 times the odds of extended LOS, after adjusting for age, pre-operative ventilator support, asthma, structural pulmonary disease, hematologic disorders, and all post-operative complications (P = .024). There does not appear to be a significant difference in the rate of post-operative complications after intraoral versus transcervical drainage for pharyngeal abscesses in children. However, transcervical drainage was associated with an extended hospital stay. Further prospective studies will be needed to determine the reasons for this.

Pharyngeal abscess: a rare complication of repeated nasopharyngeal swabs.

Pharyngeal abscess: a rare complication of repeated nasopharyngeal swabs.

Features of the clinic, diagnosis and treatment of parapharyngeal abscesses in children: analysis of 121 observations

To analyze the features of the clinic, diagnosis and treatment of PPA in children. According to the hospital database, a retrospective analysis of the medical histories of children discharged from the clinic with a diagnosis of "J39.0 Retropharyngeal and parapharyngeal abscess" was carried out in the period from 01.01.14 to 31.12.19. In all cases, the diagnosis was confirmed by computed tomography (CT) data with contrast enhancement. Complaints at the time of treatment, anamnesis and instrumental diagnosis data, clinical features of the course of the disease and the effectiveness of treatment were analyzed. 121 children were treated for PPA (average age 73±41 months; Me=52.5 months), which is 0.4% of all hospitalized in the otorhinolaryngological department, 0.7% of the number of emergency hospitalizations, 0.8% of the number of hospitalized children with pharyngeal diseases, and 8.3% of the number of patients with pharyngeal abscess. Abscesses were more often localized in the upper pharynx, at the level of the I-II cervical vertebrae (49.6% of all observations); abscesses were found least often in the pharyngeal space (5.8%), there was no statistically significant difference between the right-sided and left-sided location: 47.9% and 46.2%, respectively. Surgical treatment was performed in 98 (81%) patients in the presence of an abscess capsule or an abscess diameter of more than 2 cm according to CT; the remaining 23 (19%) children were treated conservatively. The opening of the abscess was performed endopharyngeal, in the case of a pronounced deep lateral location of the abscess and its proximity to large blood vessels - with access through the tonsillar niche after preliminary tonsillectomy (19.4% of those operated). The final diagnosis of parapharyngeal and retropharyngeal abscess can be established by contrast-enhanced computed tomography. Conservative treatment is indicated for a limited group of patients at the initial stages of the disease, most patients need surgical treatment.

Anticipated difficult intubation in a septic shock patient

Difficult intubation can be a real challenge for any anesthesiologist. It is particularly hazardous and much more difficult to manage in an emergency situation.&#x0D; We present a case of a 72 years old male patient who was brought to ER with stridor and increasing shortness of breath. He was unstable hemodynamically on presentation, so was managed with adrenaline/salbutamol nebs, I/V fluids and intermittent boluses of vasopressors in the ER. ENT referral was also sought who tried a quick nasal scope, but couldn’t come to any conclusion. During neck examination they could feel a mass in the upper part of the neck and made a provisional diagnosis of a pharyngeal abscess. Portable chest x-ray was unremarkable and there was no time to do a CT neck to confirm the diagnosis due to the patient’s worsening condition. It was decided to rush the patient to OR for an awake fibre-optic intubation in the presence of ENT team in case if there was a need to do an emergency tracheostomy. The OR was prepared accordingly and the patient’s upper airway was sprayed and nebulized with lignocaine. A very small dose of remifentanil infusion was started for better tolerance of the procedure. Patient remained in an extremely critical condition with a systolic blood pressure 60-70 mmHg, despite of I/V fluids and metaraminol infusion. He also required intermittent boluses of 25 mics of adrenaline. There was no time for central venous access.

Laser ablation and management of a retropharyngeal abscess caused by Corynebacterium pseudotuberculosis in a ram

A one-year-old crossbred ram presented for acute respiratory distress. Initial diagnostics revealed compression of the pharynx by a spherical, avascular mass. The ram was initially managed with a tracheostomy, antimicrobials...

Establishment of Pediatric Bone Marrow Transplant Unit in Public Sector Hospital, a Dream Accomplished.

<h3>Background</h3> Bone Marrow Transplant (BMT) is a highly sophisticated curative treatment of many Hematological, immunological, metabolic and Oncological conditions. Pakistan is a Lower middle income country. The treatment facilities are very limited as compared to the need of the region. Our Pediatric Hematology/Oncology unit is in one of the busy center of the country. We decided to start the First ever Public sector Pediatric Bone Marrow Transplant. <h3>Objective</h3> This study was done to know & enlighten the hurdles in establishment of BMT unit in Public Sector Hospitals in LMIC. The task to start BMT was taken as a challenge in collaboration with NIBD & BMT, Karachi, Pakistan in 2016. The Physicians and other supportive Team were sent for short term training.On return the Team started renovation of old building. In next step arrangement of instrumentation was done step by step, includes Cell separators, Platelet Aphresis Machines, HEPA Filters, CBC Analyzer, Handy Electrolyte Machine, Fridge (-80C⁰) for Cryopreservations & Plasma Storage, PRBC storage fridge and Blood grouping/Cross matching reagents and Gel Cards arranged. Then two patients with Beta Thalassemia Major were selected who had full matched sibling donors. The standard Conditioning Protocol of BU/Cy/ATG with GVHD prophylaxis Steroids/MTx and Cyclosporine started after saving the Autologus Bone Marrow Harvest. The Bone Marrow Harvest was done on both donors on same day and Infusion was done. The MNC and CD34 count were appropriate. The senior team members of Pediatric Hem/Onco department were involved and senior most staff nurses had taken care of the patients along with mothers of the patients. But unfortunately one patient died of Severe Pneumonia along with Pharyngeal abscess on day +11 and the second on +25 due to Primary engraftment Failure and severe Pulmonary Hemorrhage. The initial two patient's mortality depressed the Hospital administration as well as the Treating Team. We decided to review the supportive care techniques, restricted the entry and limited the Treating staff. After getting these improvements we again decided to start the BMT unit again in March 2018 and selected Aplastic Anemia patient of 8 years who had 6/6 matched sibling donor.The five days conditioning was done with Fludarabine, Cyclophsphamide and GVHD prophylaxis with Cyclosporin, MTX and steroids. PBSC was done on cell separator and stem cell infusion done. Patient engrafted Neutrophil on +10, Platelets on +18 and RBC on +45. Th immnunosupression was tapered off 6 months post BMT and now free of medication. Since then we have done so far total 23 patients including Aplastic Anemia, Thalassemia, Fanconi Anemia.Our success rate is 60%. I know it is far behind the international data but we are thriving to improve it day by day. <h3>Conclusion</h3> The persistent struggle is needed for establishment of BMT units in LMICs. <h3>Recommendation</h3> When there is a will, there is a way.

PURULENT MEDIASTINITIS: 24 HOURS FOR SUCCESSFUL DIAGNOSIS AND INITIATION OF THERAPY

Purulent mediastinitis can develop in patients of any age and are characterized by a severe, progressive course with a high mortality rate. The causes of mediastinitis can be: complications of inflammatory diseases of the lungs, pleura, trachea, neck, oral cavity, larynx, pharynx, esophagus, heart. Primary mediastinitis occurs as a result of trauma and exogenous infection with open gunshot injuries of the mediastinum, with instrumental manipulations (esophageal esophageal surgery, esophagoscopy, tracheal intubation, tracheostomy, gastric probing, cardio-dilatation, and often injuries occur from foreign bodies of the esophagus, trachea, burns, tumors, perfora, perfora spontaneous rupture Primary mediastinitis can develop after operations on the organs of the chest, with anasto failure brains of the esophagus, trachea, bronchi, after cardiosurgical operations and infection of the mediastinal fiber.The primary source of infection can be phlegmon of the upper and lower extremities, frostbite, osteomyelitis of the lower jaw, pharyngeal abscess, phlegmonous mumps, purulent lymphadenitis, sepsis. Microfl ra in mediastin is presented mixed infection. Anaerobes (bacterioids, peptostreptococci, fusobacteria, Prevotella, etc.) can be combined with aerobes (staphylococci, streptococci, Klebsiella), their synergism is determined malignant course of mediastinitis and high mortality.

Effects of remifentanil preconditioning on factors related to uterine contraction in WISH cells.

BackgroundPreterm labor and miscarriage may occur in stressful situations, such as a surgical operation or infection during pregnancy. Pharyngeal and buccal abscess and facial bone fractures are inevitable dental surgeries in pregnant patients. Remifentanil is an opioid analgesic that is commonly used for general anesthesia and sedation. Nonetheless, no study has investigated the effects of remifentanil on amniotic epithelial cells. This study evaluated the effects of remifentanil on the factors related to uterine contraction and its mechanism of action on amniotic epithelial cells.MethodsAmniotic epithelial cells were preconditioned at various concentrations of remifentanil for 1 h, followed by 24-h lipopolysaccharide (LPS) exposure. MTT assays were performed to assess the cell viability in each group. The effects of remifentanil on factors related to uterine contractions in amniotic epithelial cells were assessed using a nitric oxide (NO) assay, western blot examinations of the expression of nuclear factor-kappa B (NF-κB), cyclooxygenase 2 (COX2), and prostaglandin E2 (PGE2), and RT-PCR examinations of the expression of the proinflammatory cytokines interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α).ResultsRemifentanil did not affect viability and nitric oxide production of amniotic epithelial cells. Western blot analysis revealed that remifentanil preconditioning resulted in decreased expressions of NF-κB and PGE2 in the cells in LPS-induced inflammation, and a tendency of decreased COX2 expression. The results were statistically significant only at high concentration. RT-PCR revealed reduced expressions of IL-1β and TNF-α.ConclusionsPreconditioning with remifentanil does not affect the viability of amniotic epithelial cells but reduces the expression of factors related to uterine contractions in situations where cell inflammation is induced by LPS, which is an important inducer of preterm labor. These findings provide evidence that remifentanil may inhibit preterm labor in clinical settings.