Mediastinitis descendente necrosante de origen orofaríngeo
Thoracic drainage in descending necrotizing mediastinitis
F. González Aragoneses*, N. Moreno Mata, E. Orusco Palomino, J.C. Vázquez Pelillo, E. Peña González, E. Folque Gómez
Servicio de Cirugía Torácica. Hospital General Universitario Gregorio Marañón. Madrid
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"apellidos" => "Díaz-Agero Álvarez" ] 4 => array:2 [ "nombre" => "J.L." "apellidos" => "Gil Alonso" ] 5 => array:2 [ "nombre" => "J.J." "apellidos" => "Mafé Madueño" ] 6 => array:2 [ "nombre" => "F.J." "apellidos" => "de la Cruz Lozano" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615307213?idApp=UINPBA00003Z" "url" => "/03002896/0000003200000008/v1_201506230038/S0300289615307213/v1_201506230038/es/main.assets" ] "es" => array:14 [ "idiomaDefecto" => true "titulo" => "Mediastinitis descendente necrosante de origen orofaríngeo" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "394" "paginaFinal" => "396" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. González Aragoneses, N. Moreno Mata, E. Orusco Palomino, J.C. Vázquez Pelillo, E. Peña González, E. Folque Gómez" "autores" => array:6 [ 0 => array:3 [ "nombre" => "F." "apellidos" => "González Aragoneses" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Moreno Mata" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Orusco Palomino" ] 3 => array:2 [ "nombre" => "J.C." "apellidos" => "Vázquez Pelillo" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Peña González" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Folque Gómez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Torácica. Hospital General Universitario Gregorio Marañón. Madrid" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Sirio. 4. 28007 Madrid." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Thoracic drainage in descending necrotizing mediastinitis" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1995-11-21" "fechaAceptado" => "1996-03-09" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec546082" "palabras" => array:3 [ 0 => "Mediastinitis" 1 => "Mediastinitis descendente" 2 => "Mediastinitis descendente necrosante" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec546083" "palabras" => array:3 [ 0 => "Mediastinitis" 1 => "Descending mediastinitis" 2 => "Descending necrotizing mediastinitis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La diseminación al mediastino de las infecciones orofaríngeas puede dar lugar a una mediastinitis descendente necrosante (MDN) de elevada mortalidad (alrededor del 40%), favorecida por un diagnóstico tardío y un drenaje insuficiente. En 2 casos tratados se procedió, en el primero, al drenaje mediastínico por vía transcervical, subxifoidea y por toracotomía, con éxito, y en el segundo sólo por vía transcervical ante el estado de la paciente, que fue insuficiente. Es de enorme importancia la rápida instauración del drenaje mediastínico apropiado. El drenaje cervical, que puede ser suficiente en casos de perforación del esófago cervical, no lo es en la MDN, que requiere un drenaje más extenso y temprano, lo que se consigue mejor a través de una toracotomía. La tomografía axial computarizada (TAC) torácica es fundamental para un rápido diagnóstico, planteamiento del abordaje quirúrgico más apropiado y valoración en el seguimiento de la efectividad de los drenaje efectuados.</p></span>" ] "en" => array:1 [ "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The spread of oropharyngeal infections to the mediastinum can give rise to descending necrotizing mediastinitis (DNM), which causes a high rate of mortality (around 40%), particularly when diagnosis is late and drainage inadequate. In the first case we report, successful drainage of the mediastinum was achieved at the cervical and sub-xiphisternum levels and by thoracotomy. Given the condition of the second patient, transcervical drainage alone was considered the best option, but this treatment was inadequate. Rapid start of appropriate drainage of the mediastinum is of great importance. Cervical drains, which may be adequate when there is perforation of the cervical esophagus, is insufficient in DNM, which calls for more aggressive, early drainage, such as can be achieved by thoracotomy. Computerized axial tomography of the chest is essential for rapid diagnosis, to plan the most appropriate surgical approach and for follow-up and evaluation of drainage.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Descending necrotizing mediastinitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.S. Estrera" 1 => "M.J. Landay" 2 => "J. Grisham" 3 => "D.P. Sinn" 4 => "M.R. 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