Diagnosis and Conservative Management of Primary Lymphedema Resulting From Multiple Aplastic Lymphocenters in a Dog.

A 6-week-old 7.4-kg (16.3-lb) sexually intact male Great Dane with a history of severe peripheral edema within the head, neck, limbs, and tail since birth was referred for further evaluation. A whole-body computed tomography examination documented severe subcutaneous edema multifocally associated with numerous hypoplastic and aplastic lymphocenters, particularly the left axillary, iliosacral, inguinal, and popliteal lymphocenters bilaterally. A congenital anomaly of the lymphatic system resulting in lymphedema was strongly suspected. The dog was managed with a combination of low-fat diet, rutin, and furosemide initially. In addition, the owner used a combination of compression socks and therapeutic massage several times daily along with carprofen and gabapentin for pain and inflammation. The patient was hospitalized to receive supportive care several times over a 2-year period for treatment of fever associated with cellulitis resulting in secondary wounds and infections. To the author's knowledge, this report represents the first case of presumed congenital lymphedema diagnosed with computed tomography and successful long-term medical management without surgical intervention.

[Dynamics of clinical changes and healing of purulent wounds in application of nanocapsules of phosphatidylcholine in complex of treatment of patients, suffering the oral cavity floor phlegmon].

Substantiation of expediency for nanocapsules of phosphatidylcholine (lipin) application, owing antihypoxant, antioxydant and immunostimulating action in complex of treatment of patients, suffering odontogenic phlegmon of oral cavity floor (OPHOCF), is presented. The preparation application have promoted a trustworthy reduction of exudation of purulent content, as well as more rapid occurrence of granulations and the wound epithelization.

Implantable photonic devices for improved medical treatments.

An evolving area of biomedical research is related to the creation of implantable units that provide various possibilities for imaging, measurement, and the monitoring of a wide range of diseases and intrabody phototherapy. The units can be autonomic or built-in in some kind of clinically applicable implants. Because of specific working conditions in the live body, such implants must have a number of features requiring further development. This topic can cause wide interest among developers of optical, mechanical, and electronic solutions in biomedicine. We introduce preliminary clinical trials obtained with an implantable pill and devices that we have developed. The pill and devices are capable of applying in-body phototherapy, low-level laser therapy, blue light (450 nm) for sterilization, and controlled injection of chemicals. The pill is also capable of communicating with an external control box, including the transmission of images from inside the patient's body. In this work, our pill was utilized for illumination of the sinus-carotid zone in dog and red light influence on arterial pressure and heart rate was demonstrated. Intrabody liver tissue laser ablation and nanoparticle-assisted laser ablation was investigated. Sterilization effect of intrabody blue light illumination was applied during a maxillofacial phlegmon treatment.

[Head and neck cellulitis caused by a broken anesthesia needle]. / Cellulite cervicofaciale sur bris d'aiguille d'anesthésie.

INTRODUCTION: Third molar extraction is one of the most common surgical procedures in oral and maxillofacial surgery. Infectious complications can be estimated at 3.6% after local anesthesia. OBSERVATION: A 39-year-old female patient, presenting with important swelling of the face and neck after extraction of teeth 28 and 38 after local anesthesia. Clinical and radiographic data led to the diagnosis of facial cellulitis due to a foreign body on the sub angulo-mandibular region. Drainage under general anesthesia was performed and a fragment of anesthesia needle was removed. One month after surgery, the patient was considered cured. DISCUSSION: Breaking an anesthesia needle is a rare accident, which can occur during oral surgery under local anesthesia. Respecting the rules of good practice is essential in preventing this type of complication, especially since forensic rules for dental and oral surgery are becoming stricter.

Moxifloxacin in complicated skin and skin structure infections (cSSSIs): A prospective, international, non-interventional, observational study.

INTRODUCTION: ARTOS was an international, prospective, non-interventional, non-controlled observational study designed to determine the effectiveness, safety, and tolerability of moxifloxacin under daily-life conditions in patients with complicated skin and skin structure infections (cSSSIs) treated in Europe, the Middle East, and Asia-Pacific region. METHODS: Eligible patients included males and females who were hospitalized patients or outpatients requiring antibiotic therapy for cSSSIs and for whom the treating physician had elected to begin moxifloxacin therapy in accordance with its approved indications. Patients were assessed before therapy and then at one or two follow-up visits. Effectiveness was assessed with respect to improvement and resolution of signs and symptoms of cSSSIs and safety with respect to the nature and frequency of adverse events and adverse drug reactions. RESULTS: A total of 6,594 patients were enrolled of whom 5,444 had data available for analysis; 4,692 patients received sequential intravenous/oral (IV/PO) moxifloxacin and 752 exclusively IV therapy. A majority of patients were aged between 40 and 79 years and had one or more comorbid conditions. Post-surgical wound infection, skin abscess, and diabetic foot infection were the cSSSIs most frequently diagnosed and treated with moxifloxacin, with almost 90% of infections rated moderate or severe. Treating physicians chose sequential moxifloxacin 400 mg for most patients, switching from IV to PO after 3-4 days. On average, treatment was maintained for 10 days. Treatment with moxifloxacin was associated with rapid relief in symptoms, with 93.2% of patients experiencing either complete resolution of symptoms or improvement at follow-up. Moxifloxacin was well tolerated with adverse drug reactions occurring in only 2% of patients. CONCLUSIONS: This study, conducted in a 'real-world' setting, confirms the effectiveness and safety of moxifloxacin in the treatment of a wide spectrum of cSSSIs seen in routine clinical practice.

Inflammatory state of type II diabetic patients with chronic ulcers in response to herbal treatment.

BACKGROUND: Type II diabetic patients easily develop ulcers over their feet which heal with great difficulties and not infrequently, end up in amputations. In the quest for innovative means to avoid amputation, herbal medicine has been used in China to heal ulcers. METHOD: A randomized placebo controlled clinical trial involving 80 patients was conducted to test whether a herbal formula taken orally could help to preserve the ulcerated leg. Other parameters measured included granulation maturation time, skin temperature and circulation, and tumor necrosis factor alpha (TNF-α). RESULTS: showed a 85% limb rescue with the herbal treatment group showing superiority over placebo group. TNF-α decline was observed with gradual ulcer healing and the herbal supplement group showed a more impressive decline (p=0.037).

[Macrolane®: A severe case of calf cellulitis after modeling injection]. / Macrolane® : un cas grave de cellulite du mollet après injection modelante.

In recent years, the market for resorbable injectables has been steadily expanding. The European Community's seal of approval (CE) is a sufficient guaranty to get them distributed. These injectables do not require official approval because they are considered to be "implantable medical devices" and not medicines. Macrolane(®)is a hyaluronic acid in gel form (NASHA [non-animal stabilized hyaluronic acid]) and has been on the French market since 2007. It can be injected into all areas except the face. It is highly cross-linked which, while slowing its absorption into the body, can also leave long-lasting residues. We report the first case of cellulitis after injection into the calf by a practitioner in his office.

[The role of natural medicinal factors in federal and regional recreational zones in the rehabilitation of patients following surgical treatment of pathological periapical tissues and oral cavity phlegmonas].

The necessity of considering the problem with which this paper is concerned arises from the current scientific discussion of the actions of physicians working in municipal healthcare facilities and sanatoria directed toward rehabilitation of patients after surgical treatment of periapical tissues and oral cavity phlegmonas. The study elucidated the mechanism of action of mineral waters (alkaline, sodium hydrocarbonate or boron-containing water with elevated fluorine and chlorine content) extracted from natural deposits of the Belgorod Region and Krasnodar Krai (Territory). It was shown that drinking these waters contributed to the correction of the disturbed balance in the ratio of sodium and potassium ions excreted with urine and to the positive dynamics of serum phosphorus level in the patients included in this study.

[Descending necrotizing mediastinitis: a diagnosis not to miss]. / La cellulite cervico-médiastinale nécrosante: un diagnostic à ne pas méconnaître.

Descending necrotizing mediastinitis is a severe disease which occurs after a mild otorhinolaryngologic or dental infection. The diagnosis must be established rapidly with the help of clinical and computed tomography of the neck and chest data. Treatment is based on antibiotics, surgery and hyperbaric oxygen. The outcome is poor with high mortality. We report a case of septicemia complicating descending necrotizing mediastinitis after dental infection.

Psoas abscess and cellulitis of the right gluteal region resulting from carcinoma of the cecum.

Although retroperitoneal or psoas abscess is an unusual clinical problem, the insidious and occult characteristics of this abscess sometimes cause diagnostic delays, resulting in considerably high morbidity and mortality. In particular, psoas abscess caused by perforated colon carcinoma is uncommon. We report a case of psoas abscess caused by a carcinoma of the cecum. A 72-year-old Japanese woman was admitted to our hospital, with pain in the right groin and buttock. The pain had appeared 6 months before admission, and the symptoms had then been relieved by oral antibiotics. On March 25, 1999, inflammatory signs in the right buttock indicated localized cellulitis, and incision and drainage was performed at a local hospital. The patient was referred to our hospital on the same day. On admission to our hospital, computed tomography (CT) scan revealed a thick right-sided colonic wall and enlargement of the right ileopsoas muscle. Barium enema and colonofiberscopy revealed an ulcerated tumor occupying the entire circumference of the cecum. A retroperitoneal abscess and fistula had been formed by the retroperitoneal perforation of cecum carcinoma: surgical resection was performed after remission of the local inflammatory signs. Operative findings indicated that the cancerous lesion and its surrounding tissues were firmly attached to the right iliopsoas and major psoas muscle, and en-bloc resection, including adjacent muscular tissue, was performed. The fact that carcinoma of the colon could be a cause of psoas abscess and cellulitis in the gluteal region should be considered when an unexplained psoas abscess is diagnosed.

Anthrax as the cause of preseptal cellulitis and cicatricial ectropion.

A 54-year-old female farmer with anthrax infection of the eyelids is presented. She was initially managed with high dose intravenous penicillin G treatment. Following complete healing of the eyelid lesions, significant cicatricial ectropion resulted. Her right lower eyelid ectropion was corrected by surgical reconstruction using full thickness skin graft after a period of 6 months during which the cicatrization process stabilized. Satisfactory cosmetic and functional improvement was achieved. Anthrax of the eyelid must be considered in the differential diagnosis of preseptal or orbital cellulitis and any reconstructive procedure should be attempted only after the cessation of the healing process.

[Management of necrotizing cellulitis and fasciitis]. / Quelle prise en charge pour les cellulites et fasciites nécrosantes?

A literature review did not reveal any controlled study on the management of necrotizing fasciitis. Treatment protocol includes: - an immediate or early surgical management with debridement of all necrotic tissue and extensive fasciotomy followed by a surgical reexamination of the infected area in the following days; - an initial antibiotic therapy targeting aerobic Gram-positive and Gram-negative organisms and anaerobes (e.g: amoxicilline-clavulanic acid or vancomycin-metronidazole); - an adequate nutritional support, infusion, and resuscitation; - hyperbaric oxygen therapy may be considered as an associated treatment; but there is no randomized, controlled trial demonstrating its efficacy.

Atypical indications for OtoScan laser-assisted myringotomy.

OBJECTIVE: To describe the role of OtoScan laser-assisted myringotomy (OtoLAM) for indications other than chronic otitis media or recurrent acute otitis media. STUDY DESIGN: Cross-sectional review. METHODS: Twenty-seven office-based OtoLAM procedures were performed in 21 patients for "atypical" reasons. The indications included middle ear dysfunction with necessary air travel (n = 10) or hyperbaric oxygen treatment (n = 6), mastoiditis with postauricular cellulitis (n = 2), canal exostosis prohibiting tympanostomy (n = 1), acute otitis media accompanied by seizures (n = 1), and chronic middle ear effusion in a patient with hemophilia (n = 1). RESULTS: In each of the 20 cases available for follow-up, middle ear disease resolved with closure of the laser-assisted myringotomy. At a later date, two patients (10%) underwent another OtoLAM in the opposite ear and four patients (20%) required repeat OtoLAM in the same or both ears. Three patients (15%) ultimately underwent myringotomy tube placement because of recurrent middle ear dysfunction. CONCLUSIONS: Although this report contains preliminary data, the data suggest that OtoLAM may provide an additional option in the care of certain patients who have previously been treated with myringotomy tubes.

[The use of nitatsid and gipozol'-N in the combined treatment of acute inflammatory diseases of the maxillofacial area]. / Primenenie nitatsida i gipozolia-N v kompleksnom lechenii ostrykh vospalitel'nykh zabolevanii cheliustno-litsevoi oblasti.

Combined drugs with a hydrophilic base, nitacide and hyposol-n, were used in combined therapy of acute purulent inflammations of the maxillofacial area. Time course of clinical parameters and changes in microflora were studied in patients administered different local treatments with different inflammatory reactions. The data indicate a high efficiency of the drugs, which optimized local therapy of suppurative wounds and are recommended for wide practical use.

[The effect of ozone therapy on the dynamic spectrum of the peripheral blood proteins in patients with phlegmons of the face and neck]. / Vliianie ozonoterapii na dinamiku spektra belkov perifericheskoi krovi u bol'nykh s flegmonami litsa i shei.

The influence of ozone therapy (parenteral and local application of ozonized solutions) and conventionally used methods of treatment on spectrum dynamics of peripheral blood proteins of 59 patients with phlegmon of the face and the neck was studied. Application of ozone in combined treatment of the given pathology was found to contribute to correction of protein synthetic liver function. Manifested by the rise in albumin level and by decrease in globulin synthesis activity. The effect is explained by hepatocyte metabolism change because of activation of enzymatic intracellular processes.

[Surgical treatment of putrid neck phlegmon]. / Khirurgicheskoe lechenie gnilostnoi flegmony shei.

The experience of treatment of 236 patients with cervical phlegmon, in 7 of whom with putrefactive phlegmon, was summarized. The treatment difficulties are due to rapid infection spreading, the possibility absence of timely laboratory confirmation of diagnosis. Operative intervention was conducted during two hour period of time after the hospitalization moment. An adequate detoxication therapy, hyperbaric oxygenation, antibiotic therapy was conducted to all of the patients, metrogyl was administered without fail. Two patients died because of mediastinitis (1) and the pulmonary artery thromboembolism (1).

[Necrotizing cervico-mediastinal cellulitis. Apropos of 3 cases]. / Les cellulites cervico-médiastinales nécrosantes. A propos de 3 cas.

OBJECTIVE: To outline the most appropriate treatment of descending necrotizing mediastinitis. MATERIALS AND METHODS: Three adult patients had mediastinitis occurring from a descending odontogenic infection in one case and oropharynx infection in two cases. All patients underwent extensive surgical debridement and a cervicomediastinal drainage through a cervical incision. All patients survived. DISCUSSION: Soft-tissue infections of the neck with mediastinitis demand early diagnosis aided by CT scan in order to decrease their threat to life. Extensive surgical debridement and a cervico mediastinal drainage through a cervical incision is adequate when mediastinitis is limited to the upper mediastinum. Thoracotomy has to be performed when the process spread below the carina. Patients must be treated initially aggressively with the aid of multidisciplinary support team (intensive care physicians, thoracic and head and neck surgeons). Early surgery must treat both neck and mediastin. While usually associated with greater than 40% mortality, all the patients in this series survived.

Synergistic soft tissue infections of the perineum.

Seven patients with necrotizing soft tissue infections of the perineum are described. Predisposing factors related to infection were present in four patients (diabetes mellitus, multiple myeloma, HIV, and a poorly defined immunodeficiency syndrome). Anaerobic and facultative anaerobic bacteria were cultured in each case. Two patients required skin graft closure of the debrided wounds, with the remaining wounds closed by contracture and epithelialization. A diverting sigmoid colostomy to facilitate wound care was performed on one patient who had complete dissolution of all anal sphincters. The role of hyperbaric oxygen therapy in four patients was of uncertain value.