{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,4,2]],"date-time":"2022-04-02T18:56:52Z","timestamp":1648925812656},"reference-count":12,"publisher":"Akademiai Kiado Zrt.","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MaSeb"],"published-print":{"date-parts":[[2012,10,1]]},"abstract":"<jats:title>Absztrakt<\/jats:title><jats:p><jats:italic>Bevezet\u00e9s:<\/jats:italic>Az acut descend\u00e1l\u00f3 necrotiz\u00e1l\u00f3 mediastinitis (DNM) s\u00falyos, a g\u00e1tor\u00fcreg gyorsan progredi\u00e1l\u00f3, sz\u00e9tes\u0151 gyullad\u00e1s\u00e1val j\u00e1r\u00f3 septicus folyamat, mely megfelel\u0151 seb\u00e9szi kezel\u00e9s n\u00e9lk\u00fcl, illetve a fel nem ismert esetekben ak\u00e1r 80%-os hal\u00e1loz\u00e1ssal j\u00e1r.<jats:italic>Beteganyag, m\u00f3dszer:<\/jats:italic>1999 \u00e9s 2012 k\u00f6z\u00f6tt az Orsz\u00e1gos Kor\u00e1nyi Int\u00e9zet \u00e9s a Semmelweis Egyetem Mellkasseb\u00e9szeti Oszt\u00e1ly\u00e1n 17 beteget kezelt\u00fcnk a fenti k\u00f3rk\u00e9p miatt. A fej-nyaki els\u0151dleges septicus folyamat 8 esetben fog\u00e1szati g\u00f3c, 4 betegn\u00e9l retro\/parapharyngealis abscessus, 1 ismeretlen eredet\u0171 nyaki phlegmone, 2 tonsillaris t\u00e1lyog talaj\u00e1n alakult ki. 1 esetben az el\u0151zm\u00e9nyben m\u0171t\u00e9t (mediastinoscopia), 1 betegn\u00e9l hasi m\u0171t\u00e9t sor\u00e1n \u201eneh\u00e9z intubatio\u201d (fel nem ismert tracheas\u00e9r\u00fcl\u00e9s) szerepel. Az els\u0151 felt\u00e1r\u00e1s 9 esetben t\u00f6rt\u00e9nt nyaki, 4 esetben nyaki \u00e9s thoracotomi\u00e1s, 1 esetben csak thoracotomi\u00e1s, 3 betegn\u00e9l pedig az orofacialis r\u00e9gi\u00f3ban t\u00f6rt\u00e9n\u0151 behatol\u00e1sb\u00f3l. A folyamat kiterjedts\u00e9ge s\u00fcrg\u0151s CT-vizsg\u00e1lattal volt meg\u00edt\u00e9lhet\u0151, ezt k\u00f6vet\u0151en azonnali m\u0171t\u00e9t t\u00f6rt\u00e9nt.<jats:italic>Eredm\u00e9nyek:<\/jats:italic>N\u00e9gy beteg ig\u00e9nyelt k\u00e9tszeri felt\u00e1r\u00e1st, 5 betegn\u00e9l h\u00e1romszor, 3 betegn\u00e9l n\u00e9gyszer t\u00f6rt\u00e9nt exploratio. A m\u0171t\u00e9tek 70%-\u00e1ban kombin\u00e1lt, t\u00f6bb r\u00e9gi\u00f3t \u00e9rint\u0151 felt\u00e1r\u00e1st v\u00e9gezt\u00fcnk. Tapasztalataink alapj\u00e1n a progn\u00f3zist befoly\u00e1solja az els\u0151 orvosi \u00e9szlel\u00e9s \u00e9s a seb\u00e9szi beavatkoz\u00e1s k\u00f6z\u00f6tt eltelt id\u0151, a beteg kora \u00e9s diabetes mellitus t\u00e1rsbetegs\u00e9ge. Kilenc beteget vesztett\u00fcnk el (53%), nyolc beteg gy\u00f3gyult, t\u00fcnetmentes (47%).<jats:italic>K\u00f6vetkeztet\u00e9sek:<\/jats:italic>A sikeres kezel\u00e9s alapfelt\u00e9tele a k\u00f3rfolyamat id\u0151ben t\u00f6rt\u00e9n\u0151 felismer\u00e9se, a primer ok s\u00fcrg\u0151s megsz\u00fcntet\u00e9se, a cervicofacialis r\u00e9gi\u00f3 id\u0151ben t\u00f6rt\u00e9n\u0151 adekv\u00e1t felt\u00e1r\u00e1sa, debridement, nyaki \u00e9s fels\u0151 mediastinalis drainage. Ha a folyamat az azygos vena, illetve az aorta\u00edv szintje al\u00e1 terjed, jobb oldali thoracotomi\u00e1t kell v\u00e9gezni mediastinalis felt\u00e1r\u00e1ssal, kiterjesztett debridementtel, mellkasi sz\u00edv\u00f3-\u00f6bl\u00edt\u0151 drainek korrekt behelyez\u00e9s\u00e9vel, sz\u00e9les spektrum\u00fa, illetve c\u00e9lzott antibiotikumok ad\u00e1s\u00e1val, a septico-toxicus \u00e1llapot kezel\u00e9s\u00e9vel. Gyors \u00e9s agressz\u00edv ter\u00e1pi\u00e1val n\u00f6velhet\u0151 a gy\u00f3gyult betegek ar\u00e1nya.<\/jats:p>","DOI":"10.1556\/maseb.65.2012.5.9","type":"journal-article","created":{"date-parts":[[2012,10,20]],"date-time":"2012-10-20T01:00:50Z","timestamp":1350694850000},"page":"383-387","source":"Crossref","is-referenced-by-count":1,"title":["Az acut descend\u00e1l\u00f3 necrotiz\u00e1l\u00f3 mediastinitis seb\u00e9szi kezel\u00e9se"],"prefix":"10.1556","volume":"65","author":[{"given":"Attila","family":"V\u00e1gv\u00f6lgyi","sequence":"first","affiliation":[{"name":"1 Orsz\u00e1gos Kor\u00e1nyi Tbc \u00e9s Pulmonol\u00f3giai Int\u00e9zet, Mellkasseb\u00e9szeti Oszt\u00e1ly \u00e9s Semmelweis Egyetem, \u00c1ltal\u00e1nos Orvostudom\u00e1nyi Kar, Mellkasseb\u00e9szeti Tansz\u00e9ki Csoport, Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e1l","family":"Vad\u00e1sz","sequence":"additional","affiliation":[{"name":"1 Orsz\u00e1gos Kor\u00e1nyi Tbc \u00e9s Pulmonol\u00f3giai Int\u00e9zet, Mellkasseb\u00e9szeti Oszt\u00e1ly \u00e9s Semmelweis Egyetem, \u00c1ltal\u00e1nos Orvostudom\u00e1nyi Kar, Mellkasseb\u00e9szeti Tansz\u00e9ki Csoport, Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zolt\u00e1n","family":"Heiler","sequence":"additional","affiliation":[{"name":"1 Orsz\u00e1gos Kor\u00e1nyi Tbc \u00e9s Pulmonol\u00f3giai Int\u00e9zet, Mellkasseb\u00e9szeti Oszt\u00e1ly \u00e9s Semmelweis Egyetem, \u00c1ltal\u00e1nos Orvostudom\u00e1nyi Kar, Mellkasseb\u00e9szeti Tansz\u00e9ki Csoport, Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f3zsef","family":"Kas","sequence":"additional","affiliation":[{"name":"1 Orsz\u00e1gos Kor\u00e1nyi Tbc \u00e9s Pulmonol\u00f3giai Int\u00e9zet, Mellkasseb\u00e9szeti Oszt\u00e1ly \u00e9s Semmelweis Egyetem, \u00c1ltal\u00e1nos Orvostudom\u00e1nyi Kar, Mellkasseb\u00e9szeti Tansz\u00e9ki Csoport, Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Csaba","family":"Feh\u00e9r","sequence":"additional","affiliation":[{"name":"1 Orsz\u00e1gos Kor\u00e1nyi Tbc \u00e9s Pulmonol\u00f3giai Int\u00e9zet, Mellkasseb\u00e9szeti Oszt\u00e1ly \u00e9s Semmelweis Egyetem, \u00c1ltal\u00e1nos Orvostudom\u00e1nyi Kar, Mellkasseb\u00e9szeti Tansz\u00e9ki Csoport, Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Attila","family":"Cseke\u0151","sequence":"additional","affiliation":[{"name":"1 Orsz\u00e1gos Kor\u00e1nyi Tbc \u00e9s Pulmonol\u00f3giai Int\u00e9zet, Mellkasseb\u00e9szeti Oszt\u00e1ly \u00e9s Semmelweis Egyetem, \u00c1ltal\u00e1nos Orvostudom\u00e1nyi Kar, Mellkasseb\u00e9szeti Tansz\u00e9ki Csoport, Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katalin","family":"Zsikla","sequence":"additional","affiliation":[{"name":"2 Intenz\u00edv Oszt\u00e1ly, Orsz\u00e1gos Kor\u00e1nyi Tbc \u00e9s Pulmonol\u00f3giai Int\u00e9zet, Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zsolt","family":"Rozgonyi","sequence":"additional","affiliation":[{"name":"2 Intenz\u00edv Oszt\u00e1ly, Orsz\u00e1gos Kor\u00e1nyi Tbc \u00e9s Pulmonol\u00f3giai Int\u00e9zet, Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"1","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1097\/00000658-193810000-00009","article-title":"Mediastinitis following cervical suppuration","volume":"108","author":"Pearse HE","year":"1938","journal-title":"Ann Surg"},{"key":"2","first-page":"545","article-title":"Descending necrotizing mediastinitis","volume":"157","author":"Estrera AS","year":"1983","journal-title":"Surg Gynecol Obstet"},{"key":"3","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S1010-7940(05)80067-3","article-title":"Descending necrotising mediastinitis: a case report and review of the literature","volume":"9","author":"Al-Ebrahim KE","year":"1995","journal-title":"Eur J Cardiothorac Surg"},{"key":"4","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/0003-4975(90)90022-X","article-title":"Descending necrotizing mediastinitis: transcervical drainage is not enough","volume":"49","author":"Wheatley MJ","year":"1990","journal-title":"Ann Thorac Surg"},{"key":"5","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1136\/thx.52.8.702","article-title":"Optimal treatment of descending necrotising mediastinitis","volume":"52","author":"Corsten MJ","year":"1997","journal-title":"Thorax"},{"key":"6","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/S0022-5223(94)70453-8","article-title":"Descending necrotizing mediastinitis. 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