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Space infection of the head and neck.

Deep neck infection may be lethal, especially when life-threatening complications occur. We conducted a retrospective analysis of 184 patients with deep neck infection who were treated at Kaohsiung Medical University Hospital during the past 6 years. Factors such as age, sex, hospitalization days, clinical presentations, involved spaces, imaging studies, microbiology, and treatment method were analyzed. There were 122 men and 62 women with a mean age of 41.7 years. The average hospitalization was 8.4 days. The involved spaces, determined by physical examination and radiologic findings, were the peritonsillar space (59 patients), parapharyngeal space (77 patients), submandibular space (55 patients), and retropharyngeal space (20 patients). Of the 49 patients for whom the origin of infection was identified, 29 were infected via the upper respiratory tract and 13 had infection of odontogenic origin. The most common isolated organism was Klebsiella pneumoniae. One hundred and thirty-seven patients (74.5%) underwent surgery, including repeated needle aspiration (87 patients) and surgical drainage (50 patients). The remaining 47 patients recovered uneventfully with antibiotic therapy alone. Eighteen patients developed life-threatening complications, such as descending mediastinitis, sepsis, airway obstruction, and jugular vein thrombosis. Two patients died of septic shock. The combination of accurate diagnosis, effective antibiotic therapy, airway maintenance, and intensive surgical debridement for those who fail to respond to conservative treatment will lead to a good prognosis.

Adolescent↗

[The fundamental and clinical studies on clindamycin-2-phosphate in the otorhinolaryngologic field (author's transl)].

Fundamental and clinical investigation with a new antibiotic, clindamycin-2-phosphate, were performed with the results which may lead to following conclusions. 1) Concentration in blood: The blood level of clindamycin-2-phosphate in healthy adults who were given 300 mg by intramuscular injection reached a peak level of 4.3 mug/ml one hour after injection. Even after 6 hours, clinically effective serum concentration of 0.5 mug/ml was still demonstrable. 2) Concentration in tissues: Clindamycin-2-phosphate activity was demonstrable at the concentrations of 1.6 approximately 2.3 mug/g in human palatine and mucous membrane of maxillary specimen one hour after the intramuscular injection of 300 mg. Further the concentration was 2.9 approximately 5.4 mug/ml. 3) Results of clinical treatment: When clindamycin-2-phosphate was injected intramuscularly in 30 cases of representative infections in the otorhinolaryngolgic field, it was excellent in 12 cases, good in 12 cases, fair in 4 cases and poor in 2 cases. Excellent and good results were obtained in 24 cases, being the effectiveness 80 per cent. 4) Side effect: No side effect was shown with the intramuscular injection of clindamycin-2-phosphate. The comparative examination of hepatic function, electrolyte and auditory acuity before and after injection showed no significant disturbance.

Acute Disease↗

[Fundamental and clinical investigation of clindamycin-2-phosphate in otorhinolaryngological field (author's transl)].

Some laboratory examinations were made with clindamycin-2-phosphate (CLDM-2-phos.). The drug was applied clinically to several otorhinolaryngological infections and the good results were obtained as follows. 1) Observing by biophotometer, the growth of Staphbylococcus aureus FDA 209P was inhibited well by the serum (diluted 10-fold) 30 minutes, 1, 2, 4 hours after 300 mg of CLDM-2-PHOS. were injected intramuscularly. 2) Serum concentration was determined by thin-layer method with Sarcina lutea ATCC 9341 as the test organism. The peak of serum level was obtained at 1 hour after a single intramuscular injection of 5 mg/kg or 10 mg/kg dosis of CLDM-2-phosphate. The peak of blood concentration was 5.4 mug/ml, 5.6 mug/ml respectively. 3) CLDM-2-phosphate concentration in tissues was estimated one hour after intramuscular injection of CLDM-2-Phosphate. The concentrations in blood and palatine tonsilla were 5.0 mug/ml and 2.9 mug/ml respectively after the intramuscular injection of 10 mg/kg. The concentrations in blood and mucous membrane of maxillar sinusitis were 4.1 mug/ml and 2.5 mug/ml respectively after the intramuscular injection of 10 mg/kg. 4) CLDM-2-phosphate was administered by intramuscular injection into 30 cases with various infections in otorhinolaryngological field. The clinical results were excellent in 22 cases (73.3%), effective in 3 cases (10.0%) and ineffective in 5 cases (16.7%). The effectiveness was 83.3%. 5) No side effects were observed in 30 cases.

Acute Disease↗