Abdominal wall cellulitis and sepsis secondary to percutaneous cecostomy

We report 1 case of abdominal wall cellulitis and sepsis which developed following percutaneous placement of a Cope catheter for cecal decompression in a patient with Ogilvie's syndrome. This case highlights that further laboratory investigation and clinical evaluation are needed to determine the safest and most efficacious technique of percutaneous drainage.     

蒲公英软膏外敷治疗早期急性蜂窝组织炎50例疗效观察

目的观察蒲公英软膏外敷治疗早期急性蜂窝组织炎的临床疗效。方法选取100例早期急性蜂窝组织炎患者,随机分为两组：抗生素治疗组（对照组）和抗生素加蒲公英软膏外敷治疗组（治疗组）,每组各50例。在治疗过程中加强观察,比较两组的治疗效果。结果治疗组50例患者中48例取得显著效果,有效率为96％;2例患者局部组织坏死,行切开引流后获治愈。对照组50例患者中41例取得显著效果,有效率为82％;9例患者行切开引流后治愈。两组有效率比较差异有统计学意义（P〈0．05）。结论蒲公英软膏外敷是有效治疗早期急性蜂窝组织炎重要的辅助治疗方法,早期使用可提高治愈率,减少局部组织化脓坏死,避免切开引流,具有使用方便、经济、患者易于接受等优点。     

Correlation between lumbar lordosis angle and degree of gynoid lipodystrophy (cellulite) in asymptomatic women

INTRODUCTION: Gynoid lipodystrophy (cellulite) has been cited as a common dermatological alteration. It occurs mainly in adult women and tends to gather around the thighs and buttocks. Its presence and severity have been related to many factors, including biotype, age, sex, circulatory changes, and, as some authors have suggested, mechanical alterations such as lumbar hyperlordosis. OBJECTIVE: To correlate the degree of cellulite with the angle of lumbar lordosis in asymptomatic women. METHODS: Fifty volunteers were evaluated by digital photos, palpation, and thermograph. The degree of cellulite was classified on a scale of 1-4. Analyses were performed on the superior, inferior, right and left buttocks (SRB, IRB, SLB, ILB), and the superior right and left thighs (SRT, SLT). The volunteers underwent a lateral-view X-ray, and the angle of lumbar lordosis was measured using Cobb's method (inferior endplate of T12 and the superior endplate of S). The data were statistically analyzed using ANOVA and Spearman's correlation. A significance level of 5% was adopted. RESULTS: Volunteers had a mean age of 26.1+/-4.4 years and a mean body mass index of 20.7+/-1.9 kg/m(2). There was no significant difference in lumbar lordosis angle between those with cellulite classes 2 and 3 (p>or=0.297). There was also no correlation between lumbar lordosis angle and the degree of cellulite (p>or=0.085 and r>or=0.246). CONCLUSIONS: The analysis suggests that there is no correlation between the degree of cellulite and the angle of lumbar lordosis as measured using Cobb's method.     

Management of pediatric lateral neck infections: Does the adage "... never let the sun go down on undrained pus ..." hold true?

OBJECTIVES: Pediatric neck infections are frequently treated by Otolaryngologists, Head and Neck surgeons. The relative role of medical versus surgical treatment of pediatric neck infections is debated. The aims of this study are to analyze the management of pediatric neck infections with respect to clinical assessment, radiological assessment and treatment. METHODS: Medical records from January 1999 to June 2005 were reviewed and analyzed. RESULTS: Two hundred and five children with lateral neck infections were included in the study. The clinical diagnosis correlated with the radiology finding in 73.6% with a sensitivity of 28% and a specificity of 92% for lateral neck abscess recognition. The ultrasound finding correlated with the surgical finding in 65.2% with a sensitivity of 70% and a specificity of 33%. When an ultrasound scan was used it changed the intended treatment plan in 10.5% of children. CONCLUSIONS: Accurate clinical assessment of lateral neck infections is poor, generally under estimating suppuration. However, when an abscess is diagnosed clinically this correlates highly with the surgical finding. Radiological assessment has inaccuracy in identifying suppuration and this should be borne in mind when being used as a diagnostic tool for neck infections.     

Stenotrophomonas maltophilia infections of intact skin: a systematic review of the literature

To highlight the importance of intact skin infection syndromes caused by Stenotrophomonas maltophilia, we review 17 reported cases. Skin infection syndrome presentations included metastatic cellulitis (58%), primary cellulitis (23%), and ecthyma gangrenosum (17%). Associated risk factors were hematologic malignancies and chemotherapy (94%), neutropenia (94%), presence of central venous catheter (17%), and exposure to broad-spectrum antibiotics (84%). The diagnosis was supported by cultures of skin biopsy specimens (35%), blood cultures (24%), or both (41%). Trimethoprim–sulfamethoxazole was the treatment of choice (76%), and outcomes were favorable (71%).     

Helicobacter cinaedi bacteremia with cellulitis after ABO-incompatible living-donor liver transplantation: Case report

Helicobacter cinaedi (H. cinaedi), a Gram-negative spiral-shaped bacterium, is an enterohepatic non-Helicobacter pylori Helicobacter species. We report the first case of H. cinaedi bacteremia with cellulitis after liver transplantation. A 48-year-old male, who had been a dog breeder for 15 years, underwent ABO-incompatible living-donor liver transplantation for hepatitis C virus-induced decompensated cirrhosis using an anti-hepatitis B core antibody-positive graft. The patient was preoperatively administered rituximab and underwent plasma exchange twice to overcome blood type incompatibility. After discharge, he had been doing well with immunosuppression therapy comprising cyclosporine, mycophenolate mofetil, and steroid according to the ABO-incompatible protocol of our institution. However, 7 mo after transplantation, he was admitted to our hospital with a diagnosis of recurrent cellulitis on the left lower extremity, and H. cinaedi was detected by both blood culture and polymerase chain reaction analysis. Antibiotics improved his symptoms, and he was discharged at day 30 after admission. Clinicians should be more aware of H. cinaedi in immunocompromised patients, such as ABO-incompatible transplant recipients.     

Longitudinal evaluation of manual lymphatic drainage for the treatment of gynoid lipodystrophy

BACKGROUND

The gynoidlypodystrophy, known as cellulitis or cellulite, refers to a condition that gives the skin an undulating and uneven appearance, affecting 80-90% of women after puberty.

OBJECTIVES

to investigate the efficacy and safety of manual lymphatic drainage for cellulite management.

METHODS

this was an open, prospective, intervention study including 20 women aged from 20 to 40 years. Fourteen sessions of manual lymphatic drainage were performed once a week on lower limbs and buttocks.

RESULTS

Fifteen women completed the study. A significant improvement on quality of life was observed (p=0.018). A significant reduction (p=0.023), estimated at 0.3±0.8 cm, in hip circumference was found, but no difference was found in thighs circumference (p>0.05). A significant reduction elastic recuperation of skin on buttocks, which means skin elasticity worsening, was observed. All measures obtained by ultrasound images showed no changes (p>0.05).

CONCLUSION

manual lymphatic drainage was safe but not effective as an isolated approach for cellulite management. Further randomized, controlled or comparative studies about manual lymphatic drainage for cellulite control, as unique or combined therapeutic modality, are necessary.     

Urgencias no traumáticas de cabeza y cuello. Aproximación desde la clínica. Parte 1: tumefacción cervicofacial,disfagia y disnea

Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons: first, they affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known.Various publications focus on nontraumatic emergencies of the head and neck from the viewpoints of anatomic location or of particular diseases. However, these are not the most helpful viewpoints for dealing with patients in the emergency department, who present with particular signs and symptoms.We propose an analysis starting from the four most common clinical presentations of patients who come to the emergency department for nontraumatic head and neck emergencies: cervical swelling, dysphagia, dyspnea, and loss of vision. Starting from these entities, we develop an approach to the radiologic management and diagnosis of these patients.