[HSF] anaerobic late mediastinitis

[psimha]

Well I did make your blood curdle with Yoghurt !!
There is ample literature about the use of non antibiotic methods - 
biological control with the use of things like vinegar _ for 
pseudomonas, Honey for a wide variety of organisms and curds - again for 
a wide variety as topical applications. In fact with emerging antibiotic 
resistance there has been a resurgence of these including usage of 
maggots (Popular in the UK for diabetic feet etc).
I have seen usage of omentum / muscle flaps after local debridement in 
these cases being successful. If not then a homograft may have to be used .
I first started using Yoghurt in  my oncosurgery training (in the 80's) 
where it was extremely useful in cleaning up infected and fungating 
tumors prior to surgery and also topically to control infections in 
these immunocompromised patients. I was also initially surprised seeing 
its use but  was shown literature and seeing the wonderful results I 
have used it extensively with no regrets. It has proved useful even in 
plastic surgery where we used it  to deal with infected meshes etc too.
Prasanna
Ajit Damle wrote:
> I am too stunned to comment on "Yogurt in mediastinum".
>
> To my unsophisticated mind it seems that infection (leading to eventual
> death) will not be controlled unless the prosthetic graft is replaced with a
> homograft, if it does.
>
> Does anyone know if infection in a vascular graft in such a situation can be
> controlled without replacing it?
>
> Ajit Damle
>
>
>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Friday, March 23, 2007 11:04 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] anaerobic late mediastinitis
>
> Keep chest open and I will tell something that will make your blood 
> curdle but has worked well.
> Apply fresh curds (Yoghurt) to the wound. This will displace the E coli 
> and the colonized lactobacillus is nonpathogenic ansd will get 
> eliminated. Later you can mobilize flaps/ close with drains.
> IV antibiotics after mediastinal cultures etc etc are obvious.
> Look for diverticulitis especially if a meat eater.
> erdinç naseri wrote:
>   
>> Dear forum members,
>> Opinion requested in the following case:
>> 76 y/o male applied for CABG and ascending aortic aneurysm(6.5 cmm at 
>> STJ ),No AI.Supracoronary  ascending aortic replacement with tubular 
>> graft and CABG X 1 one month ago.Had abdominal distention at postop 
>> 5.th day. No fever.Diagnosed as paralytic ileus. stoped oral intake 
>> and followed by general surgery guys for one week conservatively.WBC 
>> 4000 considered normal by them but I told them that this is relative 
>> neutropenia in open heart surgery ( ususally 12-20000 in postop 
>> period).After one week started oral feeding and discharged.Applied 2 
>> days ago with anemia, weakness and abdominal distention.Hospitalized 
>> by my colleagues and followed medicaly( Genaral surgeons agreed on 
>> medical follow up),I saw the patient yesterday.No fever with Partial 
>> dehiscence and wound was dirty( oozing bad smelly fluid).Immediately 
>> taken to ICU and monitorized.Started inotropics for low cardiac out 
>> put and took the patient to the operation room.Opened the sternum 
>> .Very fetid odor and semiclear fluid.Grafts intact ,coronary graft 
>> open.Deep bradycardia and hypotension and arrest followed by mannual 
>> massage.Cardiac activity returned but with maximum inotropic 
>> agents.Opened both pleura and put a tube in each and one in 
>> suprasternal notch for irrigation.He is in ICU  with unremitting fever 
>> (39-40)and Culture revealed E.coli.
>> erdinc
>>
>>
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