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Bone Dec 2021Fibrous dysplasia (FD) is a mosaic skeletal disorder in which the craniofacial bones are commonly affected. Normal structures are replaced by expansile, highly vascular,... (Review)
Review
Fibrous dysplasia (FD) is a mosaic skeletal disorder in which the craniofacial bones are commonly affected. Normal structures are replaced by expansile, highly vascular, fibro-osseous tissue. The typical clinical course is a gradual, asymptomatic expansion of the osseous structures. However, in the periorbital region, even minor structural changes may cause functional impairment, such as diplopia and hyposmia. Furthermore, rapidly evolving secondary lesions, such as fluid-filled cysts, can sometimes develop. In the midface and periorbital regions, such acute change may be associated with severe pain, vision loss, and, signs of inflammation. Here we describe three patients with craniofacial FD who presented with recurrent episodes of periorbital inflammation mimicking orbital cellulitis. All presented with pain, edema, erythema, and warmth, with varying degrees of functional impairment. On imaging, all had cystic changes in the FD lesion, including two with aneurysmal bone cysts (ABCs). Two were initially diagnosed with periorbital cellulitis and treated with antibiotics; in two, the radiographic findings were misdiagnosed as osteomyelitis. Recurrent episodes were recognized as not infectious and effectively managed with corticosteroids. Given the vascular nature of FD and the association of ABCs, it is likely the findings in these patients represent inflammation associated with vascular leak in the relatively confined space of the tissues overlying the periorbital bones. Recognition of this entity can lead to more rapid and appropriate treatment.
Topics: Bone and Bones; Craniofacial Fibrous Dysplasia; Fibrous Dysplasia of Bone; Humans; Inflammation; Osteomyelitis
PubMed: 34425287
DOI: 10.1016/j.bone.2021.116157 -
Indian Journal of Ophthalmology Sep 2023Ophthalmic dirofilariasis is an uncommon zoonotic parasitic infection caused by species of Dirofilaria, a dog tapeworm that is transmitted to human by mosquitoes. Man is...
BACKGROUND
Ophthalmic dirofilariasis is an uncommon zoonotic parasitic infection caused by species of Dirofilaria, a dog tapeworm that is transmitted to human by mosquitoes. Man is a dead-end host for the parasite. Ophthalmic involvement is rare and includes periorbital, subconjunctival, subtenon, and intra-ocular involvement. We report the removal of a subconjunctival worm and identification by light microscopy (LM) and scanning electron microscopy (SEM).
PURPOSE
: A 62-year-old female presented with complaints of redness, discharge, and foreign body sensation with difficulty in opening eyes in the left eye for the last 3 days. The patient is a non-vegetarian. On examination, her best corrected visual acuity in both eyes was 20/20. On slit lamp examination, there was a long, thin, round, coiled white subconjunctival live worm in the left eye superiorly. The rest of anterior segment evaluation, intra-ocular pressure, and fundus was normal in both eyes. The parasite was removed under local anesthesia from subconjunctival space [Video]. External surface morphology under LM revealed fine transverse cuticular striations with tapered cephalic and caudal ends. Uterus was long and coiled with indistinguishable masses inside. The finding was also confirmed by SEM.
SYNOPSIS
A subconjuctival parasite was removed and identified as Dirofilaria repens by characteristic LM and SEM findings.
HIGHLIGHT
Dirofilaria species may lodge in many tissues of human bodies including eye and adnexa. Dirofilaria is a natural parasite of carnivorous animals, mostly dogs, cats, and foxes. The most common mode of transmission to human is usually by bite of mosquitoes like Culex and Aedes, which are considered as vectors, and it is often thought that parasitemia is because of accidental conduction. Simple surgical removal of the worm is curative. After removal, the worm should be visualized directly under LM. All the internal structures of the transparent worm could be seen and compared with those under SEM.
Topics: Humans; Female; Male; Animals; Dogs; Middle Aged; Microscopy, Electron, Scanning; Parasites; Mosquito Vectors; Eye; Face
PubMed: 37602631
DOI: 10.4103/IJO.IJO_830_23 -
JPMA. the Journal of the Pakistan... Jun 2023Foreign bodies are amongst the commonest emergencies presenting to the otorhinolaryngologists. They can be remarkably difficult to see and remove. However,...
Foreign bodies are amongst the commonest emergencies presenting to the otorhinolaryngologists. They can be remarkably difficult to see and remove. However, nasopharyngeal foreign bodies are exceedingly rare. Foreign bodies can have disastrous complications, such as rhinolith formation, septal perforation, erosion into the surrounding structures, and infections including sinusitis, otitis media, periorbital cellulitis, diphtheria, meningitis, and tetanus. Imaging investigations, such as X-ray, CT scan and MRI, can be of great help in diagnosing and planning treatment in clinically equivocal cases, although they are rarely needed. Complete removal of the foreign body is of paramount importance in treating this entity. This unique case demonstrates the importance of a thorough clinical examination and history in patients presenting with vague complaints, especially in the paediatric population due to their usually non-specific symptoms and insufficient history.
Topics: Humans; Child; Child, Preschool; Foreign Bodies; Sinusitis; Tetanus; Tomography, X-Ray Computed; Magnetic Resonance Imaging
PubMed: 37427634
DOI: 10.47391/JPMA.5676 -
Genes Feb 2020Edelweiss () in the family is a wildflower that grows in rocky limestone places. Here, we investigated the efficacy of edelweiss callus culture extract ( callus culture...
Edelweiss () in the family is a wildflower that grows in rocky limestone places. Here, we investigated the efficacy of edelweiss callus culture extract ( callus culture extract; LACCE) using multiple assays from to as well as transcriptome profiling. Several assay results showed the strong antioxidant activity of LACCE in response to UVB treatment. Moreover, LACCE suppressed inflammation and wrinkling; however, moisturizing activity was increased by LACCE. The clinical test demonstrated that constant application of LACCE on the face and skin tissues improved anti-periorbital wrinkles, skin elasticity, dermal density, and skin thickness compared with the placebo. The RNA-Sequencing results showed at least 16.56% of human genes were expressed in keratinocyte cells. LACCE up-regulated genes encoding several KRT proteins; DDIT4, BNIP3, and IGFBP3 were involved in the positive regulation of the developmental process, programmed cell death, keratinization, and cornification forming skin barriers, which provide many advantages in the human skin. By contrast, down-regulated genes were stress-responsive genes, including metal, oxidation, wounding, hypoxia, and virus infection, suggesting LACCE did not cause any harmful stress on the skin. Our comprehensive study demonstrated LACCE is a promising agent for anti-aging cosmetics.
Topics: Aging; Antioxidants; Asteraceae; Callosities; Cell Culture Techniques; Gene Expression Profiling; Humans; Keratinocytes; Plant Extracts; Skin; Transcriptome
PubMed: 32098197
DOI: 10.3390/genes11020230 -
Cureus Jul 2023Mucormycosis is a fulminant angioinvasive fungal infection that occurs in an immunocompromised condition, most commonly in diabetic patients. Rhino-cerebral and...
Mucormycosis is a fulminant angioinvasive fungal infection that occurs in an immunocompromised condition, most commonly in diabetic patients. Rhino-cerebral and pulmonary infections are common but may also lead to disseminated disease associated with a high mortality rate (almost 100%). Here we report on an elderly diabetic lady presented with a headache and altered level of consciousness and peri-orbital swelling following coronavirus disease 2019 (COVID-19). Imaging studies revealed a single large space-occupying lesion in the frontal lobe extending to the left orbit and sinusitis. An excisional biopsy was taken from the middle meatus of the nasal cavity and histopathology findings were broad aseptate hyphae branching at the right angle which suggests mucormycosis. Liposomal amphotericin B was started but the patient developed acute kidney injury (AKI) and bi-cytopenia (thrombocytopenia and anemia) followed by sepsis resulting in death. Though this is a rapidly progressing disease with a high mortality rate, a strong level of suspicion and early diagnosis can save lives.
PubMed: 37644947
DOI: 10.7759/cureus.42652 -
International Journal of Pediatrics &... Sep 2019Sickle cell disease (SCD) affects millions worldwide. It has a spectrum of clinical manifestations. However, SCD is more prone to have invasive infection compared with...
INTRODUCTION
Sickle cell disease (SCD) affects millions worldwide. It has a spectrum of clinical manifestations. However, SCD is more prone to have invasive infection compared with normal individual, and one of the main pathogen of concern is salmonella, where the individual with SCD is more susceptible to salmonella infection. Furthermore, several distinct clinical syndromes can develop in children infected with salmonella, depending on both host factors and the specific serotype involved.
OBJECTIVES
We aim to describe the infection patterns and whole range of potential complications in children with SCD exposed to invasive salmonella infection.
METHOD
This is a retrospective observational cohort study which was conducted at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia between 2012 and 2018. All sickle cell patients who are exposed to invasive salmonella infections and treated in our hospital over the last 6 years were included in our study.
RESULTS
Six patients were enrolled in the study, five males and one female with ratio of (M: F) 5:1, age range from 20 months-14 years, and the diagnosis at admission were as follows: (three as vasooclusive crisis, three as infection) with different kind of infections (three sepsis, three septic arthritis, four osteomyelitis, one meningitis, one myositis, one periorbital cellulitis, one diskitis), where three (50%) suffered multiple sites of infections and the other three (50%) with one site of infection, two (50%) of osteomyelitis patients suffered multifocal infection. Species identification is as follows: (three group D, one group C, and two were not specified), only two occasions where resistant to ciprofloxacin while all others were pan sensitive. Fever was prolonged (take more than seven days to subside even with appropriate therapy and intervention) in five out of six.
CONCLUSIONS
Multiple site of infection, sever osteomylitis, and delay in fever response consolidated the fact of high virulence of salmonella in SCD patients. We did not encounter significant resistant rate to both quinolone and cephalosporin.
PubMed: 31700970
DOI: 10.1016/j.ijpam.2019.05.001 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jul 2020Trauma to the face caused by assault or impact may cause internal orbital fracture. Increased intraorbital pressure without disruption of soft tissue integrity or... (Comparative Study)
Comparative Study
BACKGROUND
Trauma to the face caused by assault or impact may cause internal orbital fracture. Increased intraorbital pressure without disruption of soft tissue integrity or causing a fracture line in orbital rims or orbital floor fractures described as 'orbital blow-out fracture'. Such fractures have been categorized as 'pure blow-out fractures' in which only the orbital floor is affected, and 'impure blow-out fractures' in which other maxillofacial bones such as zygoma, maxilla and nasoethmoid are also affected. Physical examination reveals periorbital edema and ecchymosis, subconjunctival hemorrhage, limitation of eye globe movements, diplopia, enophthalmos, dystopia, and infraorbital hypoesthesia. Reconstruction of the orbital bony structures is the most important issue to preserve the standard orbital functions and providing an aesthetic view. Although many surgical approaches have been defined in the literature regarding the attitude and timing of treatment, no consensus exists. In literature; many autogenous and alloplastic biomaterials have been recommended to correct orbital bone defects.
METHODS
This study aims to compare postoperative outcomes of patients presenting with pure and impure blow-out fractures repaired with cartilage, bone grafts, titanium mesh or porous polyethylene implant. Sixty-four orbital floor fractures of 62 cases were included in this research who admitted to our clinic with maxillofacial trauma between 2011 and 2018. All patients underwent maxillofacial radiological examination; Waters radiography and also axial-coronal plane maxillofacial and orbital computerized tomography.
RESULTS
Permanent, post-operative, vertical diplopia in extreme gazes was detected in 3 of 14 patients in whom the orbital floor was reconstructed with an iliac bone graft. Two of nineteen cases who underwent reconstruction using auricular conchal cartilage graft had vertical diplopia in extreme gazes four months after the operation. The implant extruded and became palpable in 2 of 15 patients in the porous polyethylene implant group. None of the patients in the iliac bone and conchal cartilage autograft groups was presented late postoperative enophthalmos according to the graft resorption. In titanium mesh group, 1 of eleven patients had permanent, post-operative vertical diplopia in extreme gazes. None of the patients in this group developed any donor area complications, infection, or implant extrusion.
CONCLUSION
Results show that the auricular conchal cartilage graft was the best biomaterial used to repair defects smaller than 4 cm², where as titanium mesh was a good option to repair defects larger than 4 cm². However, selection of the optimal biomaterial to be used to repair orbital blow-out fractures should be made according to patient characteristics and preoperative findings, the severity of the injury, the cost of the biomaterial to be used, and surgeon's expertise.
Topics: Bone Substitutes; Bone Transplantation; Diplopia; Humans; Orbital Fractures; Postoperative Complications; Plastic Surgery Procedures; Treatment Outcome
PubMed: 32589255
DOI: 10.14744/tjtes.2020.80552 -
Cureus Oct 2023Acute dacryocystitis and orbital cellulitis are conditions with serious implications, particularly among pediatric patients. The co-occurrence of these conditions in...
Acute dacryocystitis and orbital cellulitis are conditions with serious implications, particularly among pediatric patients. The co-occurrence of these conditions in children is rare, and their association with coronavirus disease 2019 (COVID-19) infection introduces a unique dimension. We present the case of a five-year-old boy who presented to the pediatric emergency department with left periorbital swelling, erythema, and excessive tearing. He had a history of low-grade fever and rhinorrhea, raising concerns about COVID-19. Upon physical examination, we observed significant periorbital swelling and erythema, accompanied by conjunctival injection and chemosis. The diagnosis encompassed acute dacryocystitis and cellulitis, with subsequent confirmation of COVID-19 through testing. Imaging confirmed the presence of post-septal cellulitis and ethmoid sinus opacification. The patient received intravenous antibiotics, leading to clinical improvement and eventual discharge for outpatient follow-up. This case underscores the importance of maintaining a high index of suspicion for unusual presentations in pediatric patients. Successful management involved a multidisciplinary approach, emphasizing the significance of promptly initiating antibiotic therapy and adopting conservative measures for nasolacrimal duct obstruction.
PubMed: 37933361
DOI: 10.7759/cureus.46559 -
Case Reports in Ophthalmology 2022Hematic pseudocysts are fibrous, nonepithelial lined capsules containing blood byproducts that typically present remotely following orbital fracture hardware...
Hematic pseudocysts are fibrous, nonepithelial lined capsules containing blood byproducts that typically present remotely following orbital fracture hardware implantation. Trauma, implant migration, and tissue erosion are believed to cause hemorrhage to pool within the capsular space. Risk factors include inadequate posterior fracture reduction and use of nonporous material which prevents fibrovascular ingrowth and stabilization. Mass effect from these lesions may cause patients to present with pain, lid swelling, hyperglobus, proptosis, lid retraction, motility restriction, or blurry vision. Pseudocysts associated with fracture hardware have been misdiagnosed as tumors or in one prior case as an infection. Herein we report a unique case of hematic pseudocyst masquerading as orbital cellulitis with maxillary sinusitis. A 59-year-old man presented with periorbital pain, hyperglobus, proptosis, and ptosis 2 years after repair of an orbital floor fracture. CT demonstrated a soft tissue collection adjacent to an implant as well as maxillary sinus opacification. He did not improve with antibiotics, at which point surgery revealed a pseudocyst and its contents were removed. This report describes a unique presentation of orbital pseudocyst and summarizes the literature on this entity.
PubMed: 35702518
DOI: 10.1159/000523890 -
Taiwan Journal of Ophthalmology 2022To describe the presentation of both new-onset and reactivation of thyroid eye disease (TED) following COVID-19 vaccination. Single-institution retrospective case series...
To describe the presentation of both new-onset and reactivation of thyroid eye disease (TED) following COVID-19 vaccination. Single-institution retrospective case series of patients presenting with symptoms and signs of new or reactivated TED coinciding with recent COVID-19 vaccination. Data collected included patient age, gender, presenting symptoms, ocular history, clinical signs, and interval duration between vaccination and onset of ocular symptoms. Three female patients were identified. All patients were over 18 years of age (range 45-66 years). Patients received either the Moderna or Pfizer COVID-19 vaccine and presented with symptoms of TED within 24 h to 21 days of receiving their first or second dose. None of the patients had previous infections with severe acute respiratory syndrome coronavirus 2. Two patients had a history of inactive TED with stable thyroid function tests: One of these patients had stable disease for at least 15 years and the other had stable disease for 5 years. The third patient had no previous history of thyroid dysfunction or TED and presented with low levels of thyroid-stimulating hormone. All three cases presented with proptosis. In two of three cases, periorbital edema, eyelid retraction, and diplopia were present. None were current smokers. One had prior facial hyaluronic acid filler injections. Symptoms in all cases were improving at 4 to 8 months. While the possibility of unrelated TED flaring concurrently with COVID-19 vaccination exists, questions remain on the effects of the COVID-19 vaccine in patients with autoimmune ophthalmic diseases. Physicians should be aware of this potential association and counsel patients appropriately.
PubMed: 35399967
DOI: 10.4103/tjo.tjo_61_21