Extended pterional orbital decompression in severe orbital cellulitis

BACKGROUND: Bacterial orbital cellulitis is a relatively uncommon infective process, which can threaten the function of orbital structures. Apart from antibiotic therapy, sinus surgery with or without abscess drainage via an orbito-otorhinolaryngological approach might be necessary. CASE DESCRIPTION: We present three cases of severe orbital cellulitis, leading to increasing loss of vision, proptosis, afferent pupillary disturbances and restriction of extra-ocular movements, despite antibiotic therapy. After extended pterional orbital decompression and reducing the orbital pressure by removal of the lateral and superolateral orbital walls, all patients showed distinct improvement of initial symptoms, without any complications related to the operation. INTERPRETATION: Extended pterional orbital decompression represents an effective treatment alternative and supplement in cases of a severe, threat to ocular function due to orbital cellulitis, where acute reduction of pressure on orbital, neural and vascular structures is intended.     

Catastrophic acute retinal necrosis syndrome associated with diffuse orbital cellulitis: a case report

Background To report a case of severe acute retinal necrosis syndrome (ARN) associated with initial features of orbital cellulitis.Methods A 49-year-old immunocompetent woman presented with unilateral painful orbital inflammation associated with deep visual loss due to ARN. Polymerase chain reaction (PCR) for detection of viral DNA was applied to ocular fluids. Immunohistochemistry for detection of viral antigens and histopathologic studies were performed on orbital biopsy specimens.Results HSV-2 DNA was detected by PCR in ocular fluids. Orbital biopsy disclosed non-specific inflammation without viral replication. Orbital inflammation resolved rapidly after the initiation of antiviral drugs, whereas intraocular inflammation worsened. Final ophthalmic examination disclosed no light perception due to optic atrophy.Conclusion ARN and cellulitis may be associated. Consequently, ARN should be investigated in all patients with orbital inflammation, in order to initiate immediately an appropriate antiviral strategy.     

Diagnosis and management of eosinophilic cellulitis (Wells’ syndrome): A case series and literature review

INTRODUCTION:

Eosinophilic cellulitis (Wells’ syndrome) is an inflammatory dermatitis that is often misdiagnosed as infectious cellulitis due to its similarity in presentation. Misdiagnosis leads to delay of correct treatment and inappropriate use of antibiotics.

METHODS:

A case series of eosinophilic cellulitis and a literature review are presented.

RESULTS:

Patients with Wells’ syndrome may present with a variety of nonspecific symptoms, such as fever, arthralgia and malaise, as well as myriad cutaneous lesions with associated erythema, presenting as blisters, bullae, papules and/or nodules. Several treatment modalities have been used to treat eosinophilic cellulitis and have been met with variable success rates; these include systemic corticosteroids, topical corticosteroids and antihistamines, with success rates of 91.7%, 50% and 25%, respectively.

CONCLUSIONS:

A high degree of clinical suspicion must be exercised to diagnose this rare condition. Cellulitis with an atypical presentation or not responding to appropriate antibiotic treatment should trigger suspicion of Wells’ syndrome. To date, the most successful treatment method is a short course of systemic corticosteroids.     

A Healthier Future for Tissue Viability - An initiative to improve outcomes for patients with lower limb issues

Reducing unwarranted variation in clinical care and access to care was a central goal of the Five Year Forward View, and the later Long Term Plan. Variation in provision and access to lower limb services in one Sustainability and Transformation Partnership were apparent. Through networking and collaboration of STP wide tissue viability and related specialist services a programme of service development was accepted as part of wider Frailty service provision.This led to a public health needs assessment of the problem being commissioned; 6 clinical pathways being produced; and clear recommendations for improvement in service provision being made. The public health needs assessment is believed to be the first of its kind considering the issues of leg ulceration, cellulitis of the lower limb, lymphoedema of the lower limb (excluding cancer related), chronic oedema of the lower limb, diabetic foot ulceration and foot ulceration.Data from local hospital episode statistics, community services data and extrapolation from national data sources has been used to understand the local impact. This provided an idea of the numbers of the population affected, the costs to the local health economy and a baseline for improvement outcome measurement in the future. It also prompted widespread service provision changes to meet the needs of those living with lymphoedema and chronic oedema and pathways for skin tear and leg ulceration have been designed for implementation.The public health needs assessment is fully published and freely accessible elsewhere. This article describes the process followed to undertake the work.     

肝硬化合并皮肤软组织感染研究进展

肝硬化患者因其免疫力低下、下肢水肿等原因是皮肤软组织感染的高危人群,常见的皮肤软组织感染部位为下肢,常见的感染类型为蜂窝织炎。与一般人群不同,肝硬化患者合并皮肤软组织感染的病原体以革兰阴性杆菌为主。血清肌酐值和MELD评分为肝硬化患者合并皮肤软组织感染预后不良的预测因素。我国肝硬化患者合并皮肤软组织的病原学与临床特征尚需进一步明确,旨在为优化此类患者的优化管理提供一定的依据。     

儿童面部蜂窝织炎相关临床因素分析

目的研究儿童面部蜂窝织炎相关临床因素对病情评估的意义。方法收集社区获得性面部蜂窝织炎患儿49例。采用Pearson相关分析总病程、住院日及发热天数与年龄、最高体温、WBC、C反应蛋白（CRP）值、静脉抗菌药物起用时间的相关性；采用两独立样本t检验比较起病后48h内及72h内使用不同抗菌药物类型（普通β-内酰胺酶类抗菌药物和加β-内酰胺酶抑制剂抗菌药物或万古霉素）所对应的总病程、住院日及发热天数；以发热天数为因变量（Y），年龄（X1）、最高体温（X2）、WBC（X3）、CRP值（X4）、静脉抗菌药物起用时间（X5）为自变量进行多元线性回归分析。结果发热天数与最高体温、CRP值、静脉抗菌药物起用时间均呈正相关（r=0.755、0.455和0.351，均P＜0.05），与年龄呈负相关（r=-0.304，P=0.034），与WBC无相关性（r=0.094，P=0.522）；住院日与CRP值呈正相关（r=0.442，P=0.001），与其他指标无相关性（均P＞0.05）；总病程与临床指标均无相关性（均P＞0.05）。起病后48h内及72h内使用普通β-内酰胺酶类抗菌药物和使用加β-内酰胺酶抑制剂抗菌药物或万古霉素其总病程、住院日及发热天数比较差异均无统计学意义（均P＞0.05）。发热天数（Y）与最高体温（X2）及静脉抗菌药物起用时间（X5）具有线性回归关系，回归方程为：Y=-84.200+2.204X2+0.762X5。结论发热天数与年龄、最高体温、CRP值、静脉抗菌药物起用时间具有相关性，即该4项指标对病情评估具有临床意义；早期使用抗菌药物可缩短病程，而使用普通β-内酰胺酶类抗菌药物和使用加β-内酰胺酶抑制剂抗菌药物或万古霉素其疗效无明显差异；最高体温、静脉抗菌药物起用时间对发热病程具有预测意义。