Effectiveness and Therapeutic Impact of CT-Guided Percutaneous Drainage for Deep Neck Abscesses

Objective: The purpose of this study is to evaluate the effectiveness and safety of CT-guided percutaneous drainage (CPD) in the management of deep neck abscesses. Factors associated with successful treatment in patients with DNA will be identified. Methods: We retrospectively studied 29 patients who presented to the department of otolaryngology with deep neck abscesses between April 2011 and April 2015. These 29 patients were managed with CPD after antibiotic therapy or needle aspiration failed. Data on patient demographics, location of infection, existing comorbidity, duration of hospitalization, treatment received, and complications were reviewed. Results: The average age of 29 patients, including 18 men and 11 women, was 56 years old. Abscess was found in parapharyngeal space (n = 16), submandibular space (n = 7), retropharyngeal space (n = 5) and pretracheal space (n = 1). The maximum transverse diameter of abscess ranged from 4.8 cm to 8.0 cm (mean 6.03 cm). Positive cultures were found in 24 cases and the most common pathogen found was Streptococcus viridans. Average hospital stay was 6.7 days. Deep neck abscesses were completely removed without residual in all patients. No one had complications and no one died during and after CPD. Conclusion: CPD is a safe and highly effective procedure for treating patients with deep neck abscesses who do not respond to antibiotics therapy. This technique can also provide reliable evidence on pathogens responsible for deep neck abscesses and help otolaryngologists choose effective treatment to achieve better clinical success rate. We recommend that most deep neck abscesses should be managed initially by CPD before resorting to open surgery.

Deep neck infections mortal complications:Intrathoracic complications and necrotising fasciitis

BACKGROUND We planned this study considering that complications of deep neck infections can be seriously life threatening.AIM To raise awareness that introthoracic complications and necrotizing fasciitis are causes of serious mortality and morbidity.METHODS This study was carried out with the participation of 188 patients who were treated at Mersin University Department of Otorhinolaryngology and Head and Neck Surgery at January 1,2024.When the patient files were retrospectively examined,16 of 188 patients(8.5%)were included in the study because they were observed to have necrotizing fasciitis and/or intrathoracic complications.RESULTS There were a total of 16 patients in this study,9 males(56.25%)and 7 females(43.75%).All patients were adults(>18 years)and the mean age was 50.37 years±15.37 years.Female patients had a mean age of 40.42 years±13.38 years,whereas for male patients was 58.11 years±12.44 years.CONCLUSION Patients with necrotizing fasciitis and/or intrathoracic complications require more complicated and serious surgeries,intensive care unit monitoring,and mechanical ventilator support.Higher rates of morbidity and mortality should be expected in Bal KK et al.Deep neck infections mortal complications WJCC https://www.wjgnet.com 6384 October 26,2024 Volume 12 Issue 30 these patients who are hospitalized for longer periods of time.

Application of Negative Pressure Manual Dressing Change Combined with Mupirocin Ointment in the Treatment of a Case of a Patient with Cirrhosis Complicated with Deep Thigh Abscess

Objective: To explore the treatment and nursing characteristics for pressure injury on the inside of the thigh caused by forced posture in patients with cirrhosis and diabetes mellitus. Methods: A patient with cirrhosis and diabetes mellitus complicated with abscess of right inner thigh pressure injury was selected as the study object, who was admitted to Xuzhou Medical University Hospital on June 29, 2019. The analysis of the clinical diagnosis, treatment and nursing process were applied to explore the prognosis of the patient with cirrhosis and diabetes mellitus complicated with deep abscess of the thigh. Results: The traditional treatment including incision and drainage was not allowed, as the general treatment was not effective for the patients with cirrhosis and diabetes mellitus complicated with deep abscess in the inner thigh. After 8 days of negative pressure manual dressing change combined with mupirocin ointment treatment, the local skin condition returned to normal. Conclusion: After literature search, it was found that the above-mentioned cirrhosis combined with diabetes and deep abscess cases in the inner thigh were rare clinically. When the traditional treatment of incision and drainage is limited, negative pressure manual dressing change combined with antibiotics is an effective method, which is worthy of clinical application and promotion.

Recurrent interface abscess secondary to Acanthamoeba keratitis treated by deep anterior lamellar keratoplasty

Dear Sir,I am Dr. Yan-Long Bi, from the Department of Ophthalmology of the Tongji Hospital affiliated to Tongji University School of Medicine, Shanghai, China. I write to present a case report of recurrent amoebic corneal abscess

Kawasaki disease with peritonsillar abscess as the first symptom:A case report

BACKGROUND Kawasaki disease(KD),also known as mucocutaneous lymph node syndrome,is an acute,self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications,with a 25%incidence of coronary artery aneurysms.Periton–Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.CASE SUMMARY A 5-year-old boy who presented to a community hospital with a 3-d fever,difficulty in opening his mouth,and neck pain and was originally treated for throat infection without improvement.On the basis of laboratory tests,ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck,the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy.On the fifth day of admission,the child developed conjunctival congestion,prune tongue,perianal congestion and desquamation,and slightly stiff and swollen bunions on both feet.A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.CONCLUSION Children with neck pain,lymph node enlargement,or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics.Clinicians should not rush invasive operations such as neck puncture,incision,and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.

Traumatic Retropharyngeal Abscess of Insidious Onset—A Case Report and Literature Review

Retropharyngeal abscess is an abscess of the deep spaces in the neck which if not treated urgently can be life-threatening as a result of airway compromise. It is important to detect and treat very early. It may arise in pediatrics from direct neck trauma which is not very common and fishbone impaction. Direct anterior neck trauma resulting in insidious retropharyngeal abscess has not been widely reported.

Management of pediatric peritonsillar and deep neck infections-cross-sectional retrospective analysis

Objective:Deep neck infections(DNI)are responsible for significant morbidity in children and healthcare expenditures.Few studies exist specifically addressing the clinical and epidemiologic characterization and management of DNI's in the pediatric population.Our goal was to analyse the demographic characteristics,clinical presentation,diagnostic and therapeutic approaches of peritonsillar and DNI in pediatric patients.Methods:The medical records of patients,aged up to 18 years,admitted for peritonsillar and DNI at our department,from 2011 to 2016,were retrospectively reviewed and compared with the literature available.Ninety-eight patients were enrolled.Results:The mean age was higher in patients with peritonsillar abscess and lower in patients with retropharyngeal and parapharyngeal infections.Admissions have significantly increased from 2011.There was a seasonal variation for DNI incidence,with a peak incidence in Summer and Spring.All patients included were treated as inpatient and received empirical intravenous antibiotic therapy and steroids regardless of drainage procedures.Incision and drainage was performed in 72 patients.The hospital length of stay was higher among patients with retropharyngeal abscess and in the group with complications.Only 2 patients developed complications during hospital stay.The most common microbiological pattern was monomicrobial and the most commonly isolated pathogens were Streptococcus Pyogenes,Streptococcus Mitisand anaerobic bacteria.Conclusions:Surgical incision and drainage followed by intravenous antibiotic and steroids proved to be successfull with low morbidity related to surgical approach.However,in selected cases,medical therapy may be an alternative to surgical management in uncomplicated infections.

Deep neck space infection e A retrospective study of 270 cases at tertiary care center

Objective:To review the clinical findings in deep neck infections and identification predisposing factors of these complications. Methods:In this study, 270 patients with deep neck infections were studied retrospectively, study conducted in the Department of Ear, Nose and Throat, Dr. Shankarrao Chavan Govern-ment Medical College, Nanded, Maharashtra, India, from March 2013 to March 2016. Results:Analysis showed that males are most likely to have deep neck space infections (DNSI). Odontogenic and tonsillar causes were the more frequent ones. Staphylococcus aureus and Streptococcus species were the microorganisms more commonly isolated. Conclusion:DNSI remains a common and challenging disease for otorhinolaryngologists, and should be treated on emergency basis. In developing countries, lack of adequate nutrition, poor oral hygiene, tobacco chewing, smoking and beetle nut chewing has led to an increased prevalence of dental and periodontal diseases. In present study, Odontogenic infections were the most common etiological factor for DNSI.

Individual Differences in Cognitive Performance Regulated by Deep-Brain Activity during Mild Passive Hyperthermia and Neck Cooling

Hyperthermia-induced decline in cognitive performance is a moderate complication that poses challenges to the maintenance of safety. Although the underlying mechanism can be attributed to the disruption of brain networks, the propensity remains unclear. This study aimed to test the hypothesis that the extent of the alterations in cognitive performance is governed by the activity of deep brain structures, including monoaminergic neural systems. A decline in cognitive performance during mild hyperthermia and the beneficial effects of neck cooling were demonstrated using the Continuous Performance Test as a battery of cognitive tasks. Aspects of cognitive performance were characterized using the deep-brain activity (DBA) index as a neural activity parameter and the State-Trait Anxiety Inventory to assess the extent of alterations in cognitive performance as an individual measure. It was found that a higher average DBA index during tasks is essential for high cognitive performance in the heat. This beneficial effect of DBA is governed by the upper brainstem. This DBA benefit is more significant for individuals with higher average DBA indices at rest in a normal environment. Individual differences in cognitive performance in the heat are governed by differences in DBA. In addition, the beneficial effect of DBA on cognitive performance in heat only applies under conditions including neck cooling. This limited neck-cooling effect is attributed to anti-homeostatic thermoregulatory responses to cognitive tasks regulated by DBA.

Effect of canulate compression bone screws and iliac bone flap with deep iliac circumflex vessel on functional restoration of hip joint after femoral neck fracture of young people

Objective To retrospect therapeutic effects of iliac flap with deep iliac circumflex vessel with canulate compression bone screws internal fixation on femoral neck fracture of young people. Method 34 cases of femoral neck fracture had been treated with pedicle bone flap with deep iliac circumflex artery and canulate bone screws internal fixation. Result By follow up for 1 to 1.5 years, 32 cases were healing by first intention, and patients obtained satisfactory joint function. Conclusion Femoral neck fracture can be treated by transplanting pedicle bone flap with deep iliac circumflex vessel and canulate bone screws internal fixation.

磁共振图像利用深度学习进行腮腺肿瘤病理亚型识别的可行性分析

目的 探讨基于MRI T_(2)WI、DWI、增强T_(1)WI的多模态图像,利用深度学习自动识别腮腺肿瘤病理类型,通过与病理结果对照评判机器学习的效能。方法 选取经病理证实的39例腮腺肿瘤患者,其中多形性腺瘤9例,Warthin瘤13例,恶性肿瘤6例,其他非肿瘤病变11例。MRI经标准化处理后通过2D U-NET网络对肿瘤类型进行鉴别,对比单通道T_(2)图像、多通道T_(2)、DWI和增强T_(1)图像输入对肿瘤亚型的分类效果。其中29例的434层图像为训练集,10例的156层图像为测试集。采用准确率、敏感度、特异度、F1分数、准确度等指标评估病理分类效能。结果 采用T_(2)单通道输入训练时,对Warthin瘤的鉴别具有最高的F1分数59.2%、敏感度为51.1%和准确度为70.3%,多形性腺瘤次之。通过常规T_(2)、DWI和增强T_(1)图像对Warthin瘤鉴别的敏感度、准确度、F1分数分别为79.5%、70.0%、74.5%,而判断多形性腺瘤的敏感度、特异度分别为46.2%、81.5%。结论 通过腮腺肿瘤MRI,利用深度学习能有效识别Warthin瘤,多模态图像结合能提高Warthin瘤、多形性腺瘤识别的敏感度。

深度学习重建算法联合低管电压在头颈部CT血管成像中的应用

目的探讨深度学习图像重建(DLIR)算法联合低管电压(70 kVp)在头颈部CT血管成像中的应用价值。资料与方法回顾性收集2021年11月—2022年11月宁夏回族自治区人民医院行头颈部CT血管成像检查的40例患者,管电压70 kVp,管电流智能调控SmartmA模式。对原始数据进行自适应统计迭代重建(ASiR-V60%、ASiR-V90%)及DLIR(DLIR-L、DLIR-M、DLIR-H),比较不同算法及水平重建图像的主观及客观评价指标。结果颈部及颅内动脉不同水平ASiR-V及DLIR重建图像CT值差异均无统计学意义(P>0.05)。随着ASIR-V及DLIR重建水平增加,颈部及颅内图像噪声均减低,DLIR-H与ASiRV60%差异均有统计学意义(P<0.05),分别减低24.30%、29.42%;颈部及颅内图像信噪比(SNR)、对比噪声比(CNR)均升高,DLIR-H重建图像SNR、CNR最高。颈总动脉分叉部、颈内动脉C4段、椎动脉V4段SNR、CNR与ASiR-V60%差异均有统计学意义(P<0.05),SNR分别提高55.60%、43.90%、44.66%,CNR分别提高55.57%、44.24%、45.10%;大脑中动脉SNR、CNR较ASiR-V60%提高45.39%、45.89%,差异有统计学意义(P<0.05)。ASiR-V90%主观评分较ASiR-V60%降低,差异无统计学意义(P>0.05)。DLIR主观评分随重建水平升高而升高,DLIR-H较DLIR-M、DLIR-L差异有统计学意义(P均<0.05),DLIR-H及DLIR-M的主观评分高于ASiR-V60%与ASiR-V90%,差异有统计学意义(P均<0.05)。结论在低管电压头颈部CT血管成像中,与ASiR-V相比,DLIR可以进一步降低图像噪声,提升图像质量和诊断信心,其中DLIR-H表现最佳。

196例颈深部感染患者临床特征分析:一项多中心15年回顾性研究

目的:调查评估颈深部感染(deep neck infection,DNI)患者影响预后的危险因素。方法:回顾性分析新疆地区2010年1月~2024年8月因DNI住院治疗的196例患者的临床资料。除评价患者人口学特征外,还通过单因素及多因素Logistic回归分析确定影响严重并发症及长期住院的DNI患者预后的独立危险因子。结果:多因素Logistic回归分析结果显示存在合并症(P 1=0.013,P 2<0.001)、中性粒细胞与淋巴细胞比率(neutrophil-to-lymphocyte ratio,NLR)(P 1=0.005,P 2=0.008)分别是患严重并发症及长期住院的DNI患者的独立危险因子。存在合并症对DNI患者发生严重并发症且长期住院的诊断价值较好,受试者工作特征曲线下面积(area under curve,AUC)分别为:AUC_(合并症)=0.77及AUC_(合并症)=0.82。NLR值也显示了较好的评价效能,分别为AUC NLR=0.81及AUC_(NLR)=0.82。另外,白细胞计数(white blood cell counts,WBC)诊断预测严重并发症的AUC WBC=0.90;不同感染来源、C反应蛋白(C-reactive protein,CRP)及降钙素原(procalcitonin,PCT)水平预测患者长期住院(>10 d)的AUC值分别为0.69、0.73、0.71。结论:本研究发现存在合并症、不同感染来源、WBC、NLR、CRP及PCT为预测DNI患者发生严重并发症且长期住院的危险因素。

股骨颈骨折影像人工智能快速诊断方法研究

目的 旨在构建人体股骨颈骨折影像人工智能(artificial intelligence,AI)快速诊断方法,从而实现股骨颈骨折的自动化评估。方法 采集1 018例股骨颈骨折的病例作为研究样本,分为训练集(676例)、验证集(112例)和测试集(230例)。应用训练集和验证集样本通过自动化影像预处理、骨折诊断模型构建和模型评估三个步骤进行股骨颈骨折评估模型构建,应用测试集对模型进行测试。结果 建立了1 018例股骨颈骨折样本数据库。建立的智能评估模型识别股骨颈骨折精准率达到78.7%。结论 该模型将为股骨颈骨折自动化评估软件的研发提供技术支撑。

头颈部恶性肿瘤根治术后下肢深静脉血栓形成的风险预测模型构建

目的构建头颈部恶性肿瘤根治术后下肢深静脉血栓形成(lower extremity deep venous thrombosis,LDVT)的风险预测模型并探讨其临床价值。方法回顾性纳入2017年1月—2022年12月于徐州市中心医院口腔颌面外科就诊的224例头颈部恶性肿瘤患者,均接受根治手术。根据LDVT发生情况分为发生组(n=24)和未发生组(n=200)。统计两组患者临床信息,通过单因素及多元Logistic回归筛选入组患者围手术期LDVT的独立危险因素,并构建风险预测列线图模型,采用受试者工作特征曲线(receiver operating characteristic,ROC)验证列线图模型的预测效能。结果两组在是否患有高血压、术前是否抗凝治疗、D-二聚体(D-dimer)水平、术后卧床时间和血小板与淋巴细胞比值(platelet/lymphocyte ratio,PLR)有明显差异(P<0.05)。将多元Logistic回归获取的危险因素构建风险预测模型,R语言软件计算模型的曲线下面积(area under curve,AUC)为0.814(95%可信区间0.778~0.849),提示其具有良好的判别和校准效果。决策曲线分析证实,在10%~75%的阈值概率区间内,预测模型的净收益较高。结论基于高血压病史、术前预防性抗凝治疗、D-二聚体水平≥0.5 mg/L、术后卧床≥3 d、血小板与淋巴细胞比值(PLR)≥176来构建的风险预测模型,对头颈部恶性肿瘤并接受根治手术的患者围手术期发生LDVT有良好的风险预测性,可用于提供个体化LDVT风险评估,指导治疗决策,减少LDVT并发症的发生。

颈部迁移性异物误诊分析及文献复习

目的探讨颈部迁移性异物的误诊原因、治疗方法及防范措施。方法回顾性分析2023年收治的1例误诊的颈部迁移性异物并感染患者的临床资料。结果患者10 d前误咽鱼骨后出现持续颈部肿痛,首次于外院就诊未明确诊断,第2次于外院就诊考虑感染,并给予抗感染治疗后效果不佳。入院后经相关检查后行颈部探查+异物取出术明确诊断为颈部迁移性异物并感染。误诊时间8 d。确诊后给予颈外入路取出异物、脓肿引流、抗感染及鼻饲饮食等处理后患者痊愈。结论临床医生应提高对颈部迁移性异物的认识。对于有误咽异物史,内镜检查阴性,但有持续颈部症状者,应高度怀疑异物迁移,及时行CT扫描或超声检查可以防止误诊及严重并发症发生。

颈深部脓肿的临床特征及预后影响因素分析

目的回顾分析颈深部脓肿患者的临床特征及预后影响因素。方法回顾性分析2014年10月至2023年8月中国医科大学附属第一医院耳鼻咽喉科急诊手术治疗的166例颈深部脓肿患者的病历资料,按照预后分为预后良好组和预后不良组,根据临床资料总结其临床特征,结合计算年龄校正Charlson共病指数(aCCI)评分,采用多因素logistic回归分析2组患者各项指标对预后的影响。结果2组性别、年龄、纵隔感染、脓毒症、糖尿病、高血压、C反应蛋白(CRP)、降钙素原(PCT)、aCCI评分比较,有统计学差异(P<0.05),表明以上因素对颈深部脓肿患者预后有显著影响。多因素回归分析结果表明纵隔感染、高血压、aCCI评分是颈深部脓肿患者预后的独立危险因素(P<0.05)。结论纵隔感染、高血压以及aCCI评分是影响颈深部脓肿患者预后的独立危险因素,可初步评估颈深部脓肿患者的预后。

基于深度学习算法的自动勾画系统在头颈部危及器官勾画精度的研究

目的:评估和分析3种基于深度学习技术的自动勾画系统在勾画头颈部危及器官(OAR)中的准确度。方法:以放疗医师手工勾画的OAR为标准,通过体积相似性系数(DSC)、豪斯多夫距离(HD)、感兴趣区域质心偏差(COMD)、过分割率(FNR)、欠分割率(FPR)、Jaccard系数(JC)、灵敏度指数(SI)及包容性系数(II)等参数评估PV-iCurve、RT-Mind和AccuContour自动勾画系统在头颈部OAR勾画的精度。结果:脑的FNR、JC、SI值,脑干的FPR、II值,左眼的FPR、FNR、JC、SI值,下颌骨的FPR、FNR、SI、II值,左腮腺的FPR、FNR、SI、II值及脊髓的DSC、FPR、JC、II值均显示3种勾画系统间存在统计学差异(P<0.05),只有脑干的HD、FNR、SI值和脊髓的HD值显示3种自动勾画系统勾画结果无统计学差异(P>0.05)。结论:通过多个参数的比较,发现3种软件在不同OAR勾画中的勾画精度不同,难以进行整体横向比较,因此这些参数仅作为参考,不能用于评估勾画结果作为临床治疗的标准,虽然3种软件都有较好的勾画结果,但仍需医师仔细审核和做必要的修改。

肛周深间隙脓肿不同手术入路选择及疗效的研究

目的:探讨不同手术入路治疗肛周深间隙脓肿的疗效。方法:回顾性收集2021年1月至2021年12月于新疆医科大学第一附属医院肛肠科住院治疗的患者并按照接受手术入路不同分为经外括约肌外手术入路组(25例)、经括约肌间手术入路组(30例)进行对照研究。两组患者术前均行肛周超声或核磁共振检查确诊为肛周深间隙脓肿。分析比较两组患者临床疗效、手术时间、术中出血量、脓肿深度、术后VAS评分、创面渗液、白细胞计数、C-反应蛋白、降钙素原、术后换药时间、创面愈合时间、并发症情况、脓肿复发率、肛瘘形成率等情况,采用t检验和χ2检验进行组间比较。结果:经外括约肌外组与经括约肌间组患者在治愈率、手术时间、术中出血量、术后1d疼痛评分、C-反应蛋白、术后并发症、脓肿复发率、肛瘘形成率等方面差异无统计学意义(P>0.05)。经外括约肌外组在创面愈合时间、术后换药时间、住院天数等方面均小于经括约肌间组(P<0.05)。经括约肌间组在术后1d创面渗液量、术后3d疼痛评分、术后白细胞计数下降程度、降钙素原水平、创面瘢痕长度等方面均优于经外括约肌外组(均P<0.05)。结论:经外括约肌外、经括约肌间手术入路在术中、术后多方面因素中各有利弊,但均能有效治疗肛周深间隙脓肿,降低脓肿复发及成瘘率,提高患者满意度,值得进一步推广。

人工智能在儿童耳鼻咽喉头颈外科中应用的系统综述

目的系统综述国内外儿童耳鼻咽喉头颈外科领域人工智能的应用情况,重点分析其进展,以期为未来发展与临床实践提供参考。方法在PubMed、Web of Science、Embase数据库中检索人工智能应用于儿童耳鼻咽喉头颈外科的相关文献,检索日期为2024年6月,检索范围不受研究类型、发表日期以及手稿原始语言的限制。依据国家心肺血液研究所研究质量评估工具(NHI-SQAT)和2011版牛津循证医学证据分级(LOE)对文章质量施行评估,遴选出真实有效的文献。提取文献内容并对人工智能在该领域的应用现状与发展前景进行系统综述。结果经过初步筛选摘要与标题、阅读全文、追溯补充检索、筛除质量不符合标准的文献后,最终纳入38篇文献。人工智能被广泛应用于儿童耳鼻咽喉头颈外科疾病的诊疗中,其形式不一,通过机器学习和大数据处理等方法,实现了手术辅助、诊疗模型建立等,在临床应用方面具有巨大潜力。其中,儿童中耳炎的诊疗、儿童听力损伤测定、术前规划与术后指导、远程医疗等成为近年来人工智能探索及应用的主要方向。结论人工智能在国内外儿童耳鼻咽喉头颈外科中的应用越来越广泛,人工智能的疾病辅助诊疗已逐渐被医患群体所接受,未来人工智能的应用形式将更为多元化。