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Resistant cervical lymphadenitis in a 10-year-old child: case report
Zohreh Shalchi, Katayoun Borhani, Hamid Eshaghi, Mahmoud Khodabandeh,
Volume 79, Issue 2 (May 2021)
Abstract
Background: Purulent cervical lymphadenitis presents with different manifestations such as fever and Erythema of the skin at the site of infection. The appropriate treatment for purulent lymphadenitis are antibiotics. If there is no response to antibiotic treatment, other causes should be considered, including uncommon infectious causes (for example Mycobacterium infections or fungal infections), malignancy and Kawasaki diseases, etc. This study aimed to introduce a child with suspected purulent cervical lymphadenitis, who was initially presented with purulent lymphadenitis and was treated with broad-spectrum antibiotics. Due to the lack of response to treatment, further laboratory and clinical examinations were performed for him, then he was diagnosed with Kawasaki disease.
Case Presentation: A 10-year-old boy with fever and severe cervical lymphadenitis was referred to Tehran Children's Medical Center Hospital in May 2018. He had leukocytosis in his lab test and the acute reactant phase was high. He was diagnosed with purulent lymphadenitis and he was treated with broad-spectrum antibiotics. But no therapeutic response was observed, the patient's fever continued and erythrocyte sedimentation rate (ESR) increased in the laboratory tests. The patient's knee developed arthralgia, and Inflammation of the neck spread to the chest wall. Therefore echocardiography was performed. The patient's left anterior descending artery (LAD) had ectasia in echocardiography (LAD>2/5 SD). The patient was diagnosed with atypical Kawasaki disease, therefore the appropriate treatment was started for him and a dramatic clinical response was seen. His fever stopped and the patient's cervical lymphadenitis had completely improved. In the follow-up, the patient's left anterior descending artery (LAD) ectasia was resolved.
Conclusion: Kawasaki disease is one of the causes of cervical lymphadenitis in children. If a patient with suspected purulent lymphadenitis is treated with appropriate antibiotics but no adequate response is seen, Kawasaki disease should be considered and the patient must be re-evaluated for Kawasaki disease.
 

Comparison of the prevalence of pericardial effusion and cardiac tamponade after cardiac surgery with and without chest tube suction in patients referred to Chamran hospital, Isfahan
Mahmoud Saeidi, Zahra Eshaghian Dorcheh ,
Volume 79, Issue 10 (January 2022)
Abstract
Background: Pericardial effusion is one of the most important complications of cardiac surgeries. Administration of a low-power suction to the mediastinal or pleural chest tube of patients helps better and constant drainage of pericardial or pleural secretions after surgeries. This technique might change the secretion and discharges of patients and might change the outcomes of surgeries.
Methods: This clinical trial was performed in 2017-2018 from April to March in Chamran Hospital of Isfahan on 91 patients who were candidates of cardiac surgeries. Patients are selected according to inclusion and exclusion criteria and finally, the study population is formed. In all patients after cardiac surgery, two Chest tubes were inserted, either in pericardial space or one in pericardia space and the other in left or right pleural space. After inserting chest tubes in patients and after sutures, patients were divided into two groups. In the first group, their chest tube was attached to the low power suctioning device, which resulted in active blood withdrawal or discharge of the site of surgery, the second group was also treated normally without binding to the suction device. The diagnosis of pericardial effusion or tamponade in patients who were hospitalized was made by clinical symptoms, portable chest graph as well as echocardiography, and in patients who had been discharged it was diagnosed by being referred to a specialist, clinical symptoms, chest radiography as well as echocardiography. Data regarding surgery duration, intubation duration, the prevalence of pericardial effusion, and cardiac tamponade were collected and analyzed.
Results: Administration of a low-pressure suction to the chest tube of patients was associated with decreased frequency of pericardial effusion (P=0.01). The frequency of tamponade was also significantly lower in patients with suction on chest tubes (P=0.04). Duration of intubation after ICU admission of patients was significantly lower in patients with suctions (P<0.001).
Conclusion: Generally, we indicated that the use of suction in cardiac surgeries is associated with decreased intubation time and of course decreased recovery time and decreased pericardial effusion. Therefore, this method could be used in cardiac surgeries.

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