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Your search keyword '"Descending necrotizing mediastinitis (DNM)"' showing total 2 results
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2 results on '"Descending necrotizing mediastinitis (DNM)"'

1. Update on Necrotizing Mediastinitis: Causes, Approaches to Management, and Outcomes.

Author

Sandner, Annett and Börgermann, Jochen

Abstract

Descending necrotizing mediastinitis (DNM) is one of the most feared and fatal forms of mediastinitis, occurring as a complication after odontogenic or cervicofascial infections or after cervical trauma. Delayed recognition, underestimation of the extent of disease, and insufficient therapy promote spread of infection. Primary treatment of DNM includes surgical eradication of the pharyngeal or odontogenic infection focus, and a concomitant major drainage applied to the neck and the mediastinum. However, the mortality rate of DNM remains high, even with the routine use of CT scanning, antibiotics, advancements in anesthesia and intensive care, and immediate surgical drainage. The present state of the optimal management of DNM is discussed controversially, in particular the question of whether thoracotomy should be performed routinely or if minimally invasive procedures (eg, video-assisted thoracoscopy) may be introduced. This review reports on the incidence and course of this disease and discusses management approaches to DNM. [ABSTRACT FROM AUTHOR]

Published
2011
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2. Descending necrotizing mediastinitis associated with Lactobacillus plantarum

Author

Takahito Nei, Iwao Mikami, Akira Sato, Munenaga Nakamizo, Junichi Okamoto, Ryoichi Saito, Kazuhiko Yokoshima, Shunta Inai, Kazunari Sonobe, and Shuji Haraguchi

Subjects
Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Antibiotics, Case Report, Meropenem, Thoracoscopic surgery, Laryngeal cancer, Case fatality rate, medicine, Humans, Abscess, Aged, Past medical history, business.industry, Neck dissection, medicine.disease, Mediastinitis, Surgery, Anti-Bacterial Agents, Descending necrotizing mediastinitis (DNM), Infectious Diseases, Lactobacilli, Oral microbiology, business, medicine.drug, Lactobacillus plantarum
Abstract

Background: Descending necrotizing mediastinitis (DNM), a severe infection with a high fatality rate, develops in mediastinal spaces due mainly to deep cervical abscesses. The majority of causative microbes of DNM are Streptococci and oral anaerobes. DNM associated with Lactobacillus-infection is rather rare. Case presentation: A 69-year-old male with an unremarkable past medical history was referred to our hospital for surgical resection of advanced laryngeal cancer. Full examination revealed a neck abscess and DNM with a background of untreated diabetes mellitus. Initially, he was treated with meropenem. However, Lactobacillus plantarum was isolated from surgical drainage of a mediastinal abscess. Despite using antibiotics capable of eradicating all isolates with susceptibilities not differing significantly from those of the neck and mediastinal abscesses, we attributed DNM to the L. plantarum detected only in the mediastinal abscess. After DNM treatment, he underwent total pharyngolaryngectomy with bilateral neck dissection followed by reconstruction using free jejunum. He was discharged fully recovered. Conclusion: We concluded that L. plantarum as the sole cause of the mediastinal abscess in the present case cannot be ruled out. As the number of immunocompromised patients increases, we should be cautious regarding this “familiar” microbe.

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