Methicillin resistant Staphylococcus aureus infection in descending necrotizing mediastinitis from retropharyngeal perforation: a rare event.

Background: Descending necrotizing mediastinitis is a rare but serious infection of the interpleural spaces and mediastinal connective tissue from the cervical region to the diaphragm that spreads rapidly along fascial planes.

Case: This report describes an unusual presentation of descending necrotizing mediastinitis in an otherwise healthy 25-year-old woman infected with methicillin-resistant Staphylococcus aureus, whose management required open sternotomy with frequent debridement.

Conclusion: The mainstays of descending necrotizing mediastinitis management are early diagnosis, aggressive surgical debridement and drainage, and appropriate antibiotic therapy.

Talk to your patients about breast disease.

You have been caring for a 32-year-old woman for the past several years. She presented to your office 2 years ago because she noticed a new breast nodule. You examined her and noted marked breast density at her area of concern without an obvious mass.

Vessel injury and capillary leak.

Objective: To understand the mechanism of pathologic capillary leak in the critically ill patient.

Design: Review of normal and altered physiology of the microvasculature. Review of recent literature describing pathogenesis, mediators, and interventions influencing capillary leak and microvascular repair.

Effect of supplemental ornithine on wound healing.

Background: Supplemental arginine has been shown to enhance wound healing, in particular collagen synthesis. Ornithine is the main metabolite of arginine in the urea cycle and shares many of the biopharmacologic effects of arginine. The present study examines the effect of ornithine supplementation on wound healing and attempts to describe its possible mechanism.