Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.
Male ; Female ; Child ; Humans ; Abscess/therapy* ; Retrospective Studies ; Sinusitis/therapy* ; Orbital Cellulitis ; Acute Disease ; Exophthalmos ; Orbital Diseases/therapy*

Administration, Oral ; Analysis of Variance ; Anti-Bacterial Agents ; therapeutic use ; Cohort Studies ; Databases, Factual ; Disease Progression ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Follow-Up Studies ; Hospitalization ; statistics & numerical data ; Hospitals, Pediatric ; Humans ; Incidence ; Infusions, Intravenous ; Logistic Models ; Male ; Multivariate Analysis ; Orbital Cellulitis ; diagnosis ; drug therapy ; epidemiology ; microbiology ; Predictive Value of Tests ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Singapore ; Treatment Outcome

BACKGROUND: Implant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure. METHODS: We retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure, and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection. RESULTS: The total infection rate was 4.99% (58 of 1,163 cases) and the total salvage rate was 58.6% (34 of 58). The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus infection was most frequently found, with methicillin resistance in 37.5% of the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction. CONCLUSIONS: Preventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However, when infection is due to methicillin-resistant S. aureus and the patient's clinical symptoms do not improve, surgeons should consider implant removal.
Acellular Dermis ; Body Mass Index ; Breast Implants* ; Breast* ; Cellulitis ; Drug Therapy ; Female ; Hematoma ; Humans ; Hypertension ; Mammaplasty ; Mastectomy ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Necrosis ; Radiation Exposure ; Retrospective Studies ; Risk Factors ; Seroma ; Skin ; Smoke ; Smoking ; Staphylococcus aureus ; Suction ; Surgeons ; Wounds and Injuries

No abstract available.
Humans ; Laser Therapy/methods ; Magnetic Resonance Imaging ; Male ; Orbital Cellulitis/*complications/diagnosis ; Retinal Vein Occlusion/diagnosis/*etiology/surgery ; Tomography, X-Ray Computed ; Young Adult

We are reporting our experience of oral rivaroxaban (Xarelto(R)) treatment for L-asparaginase (L-ASP)-induced deep vein thrombophlebitis in the lower extremity developed during childhood acute lymphoblastic leukemia (ALL) chemotherapy, with a brief review of the literature. A 16-year-old boy was admitted to our institution with right lower leg pain and gait difficulties. He was diagnosed with ALL and started chemotherapy protocol. He had been under a chemotherapy course of delayed intensification (DI)-1. We began antibiotics treatment for possible inflammation including cellulitis of the leg and planned an MRI scan. The MRI scan indicated thrombophlebitis of the right posterior calf deep veins. Subsequent DVT CT and coagulation profiles showed other abnormal findings. Coagulation factor assay were noted with decreased levels of multi factors; Factor II 45%, Factor IX 35.3 %, Factor X 30%, Factor XI 19%, Factor XII 22%, and anti-coagulants levels were decreased also with variant degrees; Protein C Activity 51%, Protein C Ag 54.5%, Protein S Activity 35%, Protein S Antigen, total 27.1%, Protein S Antigen, free 41.7%. Low molecular heparin (LMWH) treatment was initiated and the patient was switched to oral rivaroxaban (Xarelto(R)). After 6 weeks treatment, abnormal coagulation profiles and MRI scan showed improvement. Furthermore, the patient had no other symptoms or recurrence of thrombotic events. There was no significant adverse reaction to rivaroxaban in this patient.
Adolescent ; Anti-Bacterial Agents ; Blood Coagulation Factors ; Cellulitis ; Drug Therapy ; Factor IX ; Factor X ; Factor XI ; Factor XII ; Gait ; Heparin ; Humans ; Inflammation ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Protein C ; Protein S ; Prothrombin ; Recurrence ; Thrombophlebitis ; Veins ; Rivaroxaban

Retinoblastoma is a rare disease, but most common tumor which arises in eye. It can affect one or both eyes, and the main pathophysiology is explained by the "Two-hit theory" - the germline mutation of the RB1 gene. Most common clinical symptoms are leuocoria, strabismus, poor visual tracking, glaucoma, and orbital cellulitis. Diagnosis is made by ophthalmologist through fundoscopic examination; Examination under General Anesthesia (EUA) is recommended until the age 3. Orbital CT and MRI can detect the tumor invasion on optic nerve, central nervous system. CSF studies, examination of bone is helpful if the distant metastasis is suspected. Biopsy is rarely done unless in the case of enucleation. Enucleated eye should be explored for the invasion to the optic nerve, choroid, anterior chamber, iris and pupil. Treatment strategies can be different according to the disease status. If the single eye is involved, the treatment goal will be the removal of tumor and prevention of relapse. Local therapies include cryotherapy, laser photocoagulation, thermotherapy can be the choice, and if the tumor is too large for the local therapy, enucleation should be concerned. Nowadays, chemo-reduction combined with local therapy, intra-arterial and intravitreous chemotherapeutic agent injections are studied to avoid enucleation. In bilateral retinoblastoma, multidisciplinary treatments include chemoreduction, external beam radiotherapy, local therapy and other experimental therapies are needed: like intra-arterial injection, intra-vitreal injection, and high-dose chemotherapy with autologous stem cell transplantation. Early detection of retinoblastoma is important to save the vision and eyeball.
Anesthesia, General ; Anterior Chamber ; Biopsy ; Central Nervous System ; Choroid ; Cryotherapy ; Diagnosis ; Drug Therapy ; Eye Enucleation ; Germ-Line Mutation ; Glaucoma ; Hyperthermia, Induced ; Injections, Intra-Arterial ; Intravitreal Injections ; Iris ; Light Coagulation ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Optic Nerve ; Orbit ; Orbital Cellulitis ; Pupil ; Radiotherapy ; Rare Diseases ; Recurrence ; Retinoblastoma ; Stem Cell Transplantation ; Strabismus ; Therapies, Investigational

Abscess ; microbiology ; therapy ; Cellulitis ; Humans ; Nasal Septum ; microbiology

No abstract available.
Acupuncture Therapy ; Ampicillin/pharmacology/therapeutic use ; Ankle/ultrasonography ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Cellulitis/complications/diagnosis/drug therapy/*microbiology ; Diabetes Mellitus, Type 2/complications ; Gram-Negative Bacterial Infections/complications/diagnosis/drug therapy/*microbiology ; Humans ; Hypertension/complications ; Magnetic Resonance Imaging ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Prevotella nigrescens/drug effects/*genetics/isolation & purification ; RNA, Ribosomal, 16S/*analysis ; Sulbactam/pharmacology/therapeutic use ; Tomography, X-Ray Computed

We report a very rare case of odontogenic orbital cellulitis causing blindness by severe tension orbit. A 41-yr old male patient had visited the hospital due to severe periorbital swelling and nasal stuffiness while he was treated for a periodontal abscess. He was diagnosed with odontogenic sinusitis and orbital cellulitis, and treated with antibiotics. The symptoms were aggravated and emergency sinus drainage was performed. On the next day, a sudden decrease in vision occurred with findings of ischemic optic neuropathy and central retinal artery occlusion. Deformation of the eyeball posterior pole into a cone shape was found from the orbital CT. A high-dose steroid was administered immediately resulting in improvements of periorbital swelling, but the patient's vision had not recovered. Odontogenic orbital cellulitis is relatively rare, but can cause blindness via rapidly progressing tension orbit. Therefore even the simplest of dental problems requires careful attention.
Adult ; Anti-Bacterial Agents/adverse effects/therapeutic use ; Blindness/*diagnosis/etiology ; Drainage ; Fluorescein Angiography ; Humans ; Male ; Optic Neuropathy, Ischemic/complications ; Orbit/*physiopathology ; Orbital Cellulitis/*diagnosis ; Retinal Artery Occlusion/complications ; Sinusitis/diagnosis/drug therapy ; Tomography, X-Ray Computed ; Tooth Root

Ampicillin ; pharmacology ; therapeutic use ; Cellulitis ; drug therapy ; prevention & control ; Comorbidity ; Endocarditis ; drug therapy ; prevention & control ; Female ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Recurrence ; Sepsis ; drug therapy ; prevention & control ; Streptococcal Infections ; drug therapy ; physiopathology ; Streptococcus agalactiae ; pathogenicity