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[Scrotal reconstruction after necrotizing cellulitis of the perineum and external genital organs. Apropos of 21 cases].

The author report twenty one cases of tissue reconstruction defects secondary to necrotizing cellulitis of perineum and external genital organs, treated at the burns and plastic surgery unit of CHU Ibn Rochd of Casablanca, between 1992 and 1994. Depending on the extent of the defect, the techniques used were gracilis musculocutaneous flap in 8 cases, thigh fasciocutaneous flap in 7 cases, groin flap in 4 cases, simple skin sutures and skin grafts in one case, respectively. The morphological results were satisfactory. The mean hospital stay after reconstruction was 15 days.

Adult↗

[The usage of light density heparin (fraxiparin) in the treatment of orbital phlegmonous cellulitis with orbital veins and thrombophlebitis of the cavernous sinus].

A case of 72 years old man, diabetic, suffering from phlegmonous cellulitis with orbital veins and sinus cavernous thrombophlebitis as a nasal vestibule furuncle complication is presented. Apart from the application of antibiotics and surgical procedure, the patient was treated from beginning with thrombolytics specimen, fraxiparine. The methods of treatment of cavernous sinus thrombosis with thrombolytic specimens evoke in the literature controversial opinions. In the author's opinion the early application of fraxiparine in presented case could be regarded as responsible for stopping the process orbital veins and sinus cavernous thrombosis and even causing it to recess. The complete cure without complications (e.g. blindness) is attributed by the authors to the anticoagulation treatment. The authors also stress that fraxiparine may by used for treatment of cavernous sinus thrombophlebitis even when the surgical procedure is planned.

Aged↗

Dissecting cellulitis of the scalp: response to isotretinoin.

We report three patients with dissecting cellulitis of the scalp. Prolonged treatment with oral isotretinoin was highly effective in all three patients. Furthermore, long-term post-treatment follow-up in two of the patients has shown a sustained therapeutic benefit.

Adult↗

Excessive mortality in market-age turkeys associated with cellulitis.

Between July, 1993, and October, 1994, seven cases were examined that consisted of increased mortality in commercial turkeys due to cellulitis. The condition started at 13-16 wk of age in toms and persisted until the birds were marketed. The mortality rate was 1-2% per week. Lesions began on the ventrum of the tail and consisted of swelling and the formation of vesiclelike structures. Most of the affected birds also had an accumulation of gelatinous fluid in the subcutis of the tail and breast areas. The underlying musculature was often darkened or petechiated. Clostridium perfringens type A was isolated from two of the cases. Lesions similar to those found in the field were reproduced experimentally in turkeys injected with the subcutaneous fluid obtained from birds in field cases.

Animals↗

Case report: scrotal cellulitis secondary to hot tub exposure.

Inflammatory disorders of the scrotum vary in their presentation and etiology. This may range from relatively minor cutaneous infections to scrotal gangrene. Herein presented is a case of scrotal cellulitis secondary to cutaneous inoculation from a hot tub.

Bacterial Infections↗

[Streptococcus cellulitis. Apropos of 3 clinical cases].

We report three cases of streptococci cellulitis of the hand. The characteristic clinical presentation suggested streptococcus infection; locoregional edema, rash, echymosis, phlyctena and signs of finger ischemia. Operative findings also suggested streptococcus infection: swelling of brownish subcutaneous tissue and local thrombus formation. There was no true pus formation. Streptococcus was identified in all 3 cases. Emergency surgical treatment is needed. The portal is opened, followed by extensive fasciotomy and debridement of all necrosed tissue. Partial suture is indicated. Antibiotics can be used as an adjunct but are not sufficient alone.

Adult↗

Sustained complete remission after incomplete chemoradiation complicated with pelvic cellulitis in a patient with recurrent cervical carcinoma.

We report on a 52-year-old female patient with a bulky, recurrent cervical carcinoma involving the vagina and bladder, who developed entero-recto-vesicovaginal fistulas and sepsis with pelvic cellulitis after external radiation of 40 Gy and 2 courses of concurrent chemotherapy. Chemoradiation was interrupted and an ileostomy was performed. After recovery, no residual tumor was detectable. Thirteen months after ceasation of chemoradiation, repair of vesicovaginal and rectovaginal fistulas via posterior sagittal approach was performed. Revision of double bowel ileostomy and ileo-T-colostomy was performed 17 months later. The patient enjoyed the restoration of enteral and urinary function only temporarily. She developed rectovesical fistula and underwent an ileostomy again 6 months later. She had another episode of peritonitis and upper gastrointestinal bleeding and expired at 4 years from initiation of salvage therapy. She had no evidence of cancer recurrence during a series of laparotomies and biopsies. The dramatic regression of the tumor may be attributed to its extraordinary radiosensitivity or chemosensitivity. The acute pelvic inflammatory complications may also contribute to the tumor cell killing. The prognosis of recurrent cervical carcinoma is invariably poor except in small tumors confined to vagina. This case gives support to the efficacy of chemoradiation and the potential role of biologic therapy in treatment of this dismal disease.

Antineoplastic Combined Chemotherapy Protocols↗

An adult case of retropharyngeal cellulitis; diagnosis by magnetic resonance imaging.

We experienced an adult case of cellulitis in the prevertebral space with retropharyngeal and danger space, and, which was suspected to be due to a fish bone stuck in the throat. Its lesion could not be demonstrated on plain radiograph, postcontrast computed tomography, or laryngoscopy, but noncontrast magnetic resonance imaging demonstrated the lesion and was useful in assessing the efficacy of medication.

Aged↗

[Perineal necrotizing cellulitis disclosing rectal adenocarcinoma].

We report one case of rectal cancer disclosed by a perineal cellulitis in a diabetic woman. This infrequent association has a bad prognosis. Diagnosis is mainly clinical. Treatment is urgent with large spectrum antibiotic therapy, surgical debridement, colostomy and hyperbaric oxygen if available. Surgical treatment of the rectal cancer can be done immediately or delayed.

Adenocarcinoma↗

Isolated erythema (cellulitis) of the breast.

This paper reports nine cases of breast cellulitis in women patients (four cases in pregnancy, four postmenopausal cases following hormone replacement therapy and one case of unilateral breast oedema following a mediastinal lymphoma). Biopsies were obtained from the erythematous area in one pregnant patient, one postmenopausal patient and the patient with breast oedema associated with the mediastinal lymphoma. Histology revealed unspecific dermatitis with extensive perivascular lymphoplasmocellular infiltrates. Histopathological examination of biopsies obtained from the underlying mammary tissue along with the corresponding mammographic data gave no evidence of mastitis or mammary carcinoma. The patients complained of sensitivity to touch, a feeling of local tightness or a burning sensation. These findings were reported in both breasts in the pregnant patients, but were unilateral in the others. The submammary fold was unremarkable, that is, no intertrigo was detected. The aetiology of the erthyema is probably associated with swelling of the breast tissue and a causal link with a specific endocrine constellation (pregnancy, postmenopausal HRT) can be postulated. A common factor in all cases presented here is the relatively long period of 4 to 13 weeks before healing of the lesion. Therapeutic intervention with antibiotics or dopamine agonists failed to influence the course. Similarly, steroid cream appeared to be of no value in these cases. Extensive erythema of the breast skin is a benign disease, for which there is still no known effective therapy. The lack of mammographic evidence and, especially, of positive palpatory findings make breast cancer highly improbable as the underlying cause.

Journal Article↗

Malignant melanoma of the choroid presenting as orbital cellulitis: report of two cases with a review of the literature.

Orbital cellulitis can be the initial presentation of malignant melanoma of the choroid when such tumors undergo necrosis or extrascleral extension. We report two unusual cases of malignant melanoma of the choroid presenting with gradual dimness of vision for only two months. Histopathology revealed malignant melanoma of the choroid with extensive necrotic hemorrhages within the tumor. There was extensive infiltration of the sclera with acute inflammatory cells. No evidence of intra- or extrascleral extension by the tumor was seen. Metastatic work-up revealed no evidence of secondary deposits. An unusual presentation of malignant melanoma of the choroid is reported, together with the pathogenic mechanisms and a review of the literature.

Journal Article↗

Nocardia brasiliensis cellulitis in a heart transplant patient.

Three months after undergoing heart transplantation, a 55-year-old man presented with N. brasiliensis cellulitis resulting from a splinter wound acquired during yard work. Surgical débridement was necessary before the infection responded to medical treatment. Although pulmonary nocardiosis is a well-documented complication of immunosuppressive therapy, this is the 1st report of a nocardial infection associated with primary skin involvement in a heart transplant patient.

Journal Article↗

[Efficacy of the combination therapy in early stage of recurrent cholangio celluler carcinoma (CCC)].

We report a case of cholangio celluler carcinoma (CCC) with a good quality of life, in spite of the recurrence of peritoneum and portal hepatic lymph nodes (PHLN), due to the combination therapy that consisted of hepatic arterial infusion, systemic chemotherapy, radiation therapy and an insertion of a metallic stent into the bile duct. The patient was a 61-year-old man. Left hepatectomy was done due to multiple CCC. For the purpose of preventing the recurrence of CCC in residual liver, we performed an arterial infusion therapy. Ten months later, metastases to peritoneum and portal hepatic lymph nodes were found, so the resection of the peritoneum was performed, and cells in ascites were defined to be positive with cytology. After 2 years from the first operation, the size of portal hepatic lymph nodes had grown and both the billilbin and tumor marker levels had increased, so we started systemic chemotherapy, radiation therapy and insertion of a metallic stent into the bile duct. The tumor marker level decreased in a short time. Consequently, we inserted a metallic stent into the bile duct and radiation therapy was performed. Until the patient's death due to peritonitis carcinomatosa, the recurrence in residual liver occurred only once in three years after the first operation, and portal hepatic lymph nodes did not grow for two years after the recurrence.

Bile Duct Neoplasms↗

[Primary necrotizing cellulitis of the scrotum in a diabetic patient].

Necrosing infections of subcutaneous cell tissue are uncommon processes which constitute a diagnostic and therapeutic vital emergency. Generally secondary to anorectal or genitourinary processes, a small percentage of these infections have no apparent cause. This paper presents one case of primary necrosing cellulitis in a diabetic patient. Etiological and diagnostic aspects are discussed, outlining the need of an aggressive surgical attitude as the only valid therapeutic offer.

Aged↗

Cellules grumelées: old terminology revisited. Regarding the cytologic diagnosis of chronic lymphocytic leukemia and well-differentiated lymphocytic lymphoma in pleural effusions.

Distinguishing chronic lymphocytic leukemia (CLL) or well-differentiated lymphocytic lymphoma (WDLL) from a benign chronic inflammatory process involving the serous cavities is often a difficult task for the cytopathologist faced with a lymphocyte-rich effusion fluid. Spriggs and Boddington decribed characteristic heavy chromatin clumping (cellules grumelées) of the lymphocytic nuclei in effusions as diagnostic of chronic lymphocytic leukemia. A study of 23 cases of lymphocyte-rich pleural effusions in our laboratory showed that, while this cytomorphologic feature is a function of cytopreparatory technique and fixation, it was observed only in cases of CLL or WDLL and not in benign inflammatory processes.

Cell Differentiation↗