[HSF] anaerobic late mediastinitis

[prasannasimha]

All I can say is you have a bunch of very ungrateful patients and I 
would add - Greedy. They seem to be trying to hit a lottery all the 
time. Is this true of the majority of the patients or are only some like 
this ? This lottery seems to be as if they are begging to get something 
wrong so that they cans sue.
Prasanna
Edward Bender wrote:
> As an anecdote, I performed an aorto bifemoral bypass on a 75 year old 
> patient who, 2 weeks post-op developed an ischemic and perforated left 
> colon.  At the time of re-exploration he had stool coming out of his 
> wound and poop all over the graft.  He was alive without infection 8 
> years after this event. I know this because I saw him in court when he 
> sued me (and lost).  Yes, you can control a graft infection, but I 
> don't know if you can cure it.
>
> Ed Bender, MD
>
>
> On Mar 23, 2007, at 2:42 PM, 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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