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Przypadek pacjenta z ciężką, zębopochodną ropowicą szyi (wywołaną przez Streptococcus anginosus oraz Prevotella intermedia), towarzyszącym mieszanym zakażeniem ogólnoustrojowym (sepsą) i zapaleniem płuc

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Hrydnova V., Stępiński M. J.
Polski Przegląd Otorynolaryngologiczny
|
2023
|
vol. 12
|
issue 3
42-47
PL
Wstęp: Wśród wielu ostrych procesów zapalnych narządów i struktur szyi szczególną uwagę zwraca ropowica szyi (łac. phlegmone), która jest rozlanym ropnym zakażeniem tkanek miękkich szyi i stanowi poważne zagrożenie dla życia chorego. Opis przypadku: W pracy zawarto studium przypadku pacjenta z ciężką, zębopochodną ropowicą szyi oraz towarzyszącym mieszanym zakażeniem ogólnoustrojowym (sepsą) i zapaleniem płuc. Chorego kilkukrotnie poddawano leczeniu chirurgicznemu. W warunkach oddziału intensywnej terapii, w analgosedacji prowadzono wspomaganie układów: oddechowego i krążenia oraz szerokospektralną antybiotykoterapię (początkowo empiryczną, a następnie celowaną). Po stabilizacji parametrów życiowych leczenie kontynuowano w oddziale laryngologii. Autorzy pracy dokonali przeglądu dostępnej literatury dotyczącej etiologii, diagnostyki, leczenia ciężkich, zębopochodnych zakażeń tkanek miękkich szyi, ze szczególnym uwzględnieniem infekcji wywołanych przez Streptococcus anginosus i Prevotella intermedia. Wnioski: Właściwy wybór taktyki postępowania w przypadku zaawansowanego procesu ropno-zapalnego okolicy szyjno-twarzowej odgrywa ważną rolę zarówno w leczeniu, jak i ratowaniu życia chorego. Piśmiennictwo podkreśla konieczność wczesnego wykrycia obecności Streptococcus anginosus oraz pilne leczenie chirurgiczne z uwagi na agresywny przebieg zakażenia niniejszym patogenem.
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A case of a patient with severe odontogenic phlegmon of the neck (as caused by Streptococcus anginosus and Prevotella intermedia) associated with mixed systemic infection (sepsis) and pneumonia

100%
Hrydnova V., Stępiński M. J.
Polski Przegląd Otorynolaryngologiczny
|
2023
|
vol. 12
|
issue 3
42-47
EN
Introduction: Among numerous acute inflammatory processes within the organs and structures of the neck, special attention is paid to the phlegmon, i.e. diffuse purulent infection of the soft tissues of the neck, which poses a serious threat to the life of the affected individual. Case report: Presented herein is a case study of a patient with severe odontogenic phlegmon accompanied by mixed systemic infection (sepsis) and pneumonia. The patient had undergone several surgical procedures. Respiratory and circulatory support with broad-spectrum antibiotic therapy (empirical followed by targeted) were administered in analgosedation within an ICU setting. Following the stabilization of vital signs, the treatment was continued within the Department of Laryngology. The authors have reviewed the available literature on the etiology, diagnostics, and treatment of severe, odontogenic infections of the soft tissues of the neck, with particular emphasis on infections caused by Streptococcus anginosus and Prevotella intermedia. Conclusions: The correct choice of management tactics in case of an advanced purulent inflammatory process within the cervicofacial region is of utmost importance for the treatment outcomes as well as for the saving of the patient’s life. Literature reports highlight the need for early detection and urgent surgical treatment of Streptococcus anginosus infections due to the aggressive course of infections caused by this pathogen species.
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Foreign body within the upper esophagus of a patient not consenting to surgical treatment – case report and legal proceedings in light of current case law

81%
Stępiński M. J., Tymiński R., Hrydnova V.
Polski Przegląd Otorynolaryngologiczny
|
2024
|
vol. 13
|
issue 1
54-60
EN
Introduction: Patients intentionally inserting foreign bodies into the lumen of their gastrointestinal tract usually aim at achieving certain benefits, such as postponement or avoidance of punishment. Aim: In view of the ever-increasing number of proceedings (including criminal proceedings) against health care professionals, the authors carried out a review of the available literature on: medical actions undertaken in cases of foreign bodies within the esophagus, current legislation and jurisprudence as practiced in the Republic of Poland within the context of model legal proceedings in cases involving patients raising doubts about being fully conscious and not consenting to necessary treatment. Case report: The article presents a case of a patient with an esophageal foreign body who had not consented to the proposed surgical treatment. Doubts as raised within the otorhinolaryngological team with regard to the patient’s state of consciousness were not dispelled as the result of psychiatric consultation. Following a meticulous analysis of the current jurisprudence of the Polish judicial system and obtaining a court’s permission to intervene, the procedure (esophagoscopy with removal of esophageal foreign body) was performed. After exclusion of any life-threatening complications, the patient was transferred to the Psychiatric Department. Conclusions: In the current state of the law, performing a procedure to remove a foreign body from the esophagus without prior court approval could qualify as a violation of patient’s rights. In such case, legal liability of the physician would arise regardless of the fact that the patient would have received care in accordance with the current medical knowledge and practice.
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