1/10. Cadaveric study of blood supply to the lower intraorbital fat: etiologic relevance to the complication of anaerobic cellulitis in orbital floor fracture.BACKGROUND AND PURPOSE: Although orbital fractures are common, orbital cellulitis rarely develops following orbital fracture. We hypothesized that compromise of the blood supply to the intraorbital fat during orbital floor fracture is responsible for this condition. The purpose of this study was to determine whether or not the lower intraorbital fat is supplied by a branch of the infraorbital artery along the orbital groove or canal on the orbital floor. MATERIALS AND methods: We dissected 14 orbits from seven fixed human cadavers and 12 orbits from six fresh cadaver heads following dye injection into the maxillary artery. The sites of dye-filled vessels branching from the infraorbital artery supplying the lower intraorbital fat were measured and plotted on a two-dimensional orbital floor graph. RESULTS: A main branch of the infraorbital artery rose through the medial orbital floor to supply the lower intraorbital fat in all of the cadaver orbits. The sites of the branching point of the vessel ranged from 0 to 5 mm (mean, 2.2 mm; n = 14) medial to the line connecting the infraorbital foramen and the infraorbital groove. The shortest distance measured from the branching point to the orbital rim ranged from 3 to 20 mm (mean, 14.1 mm; n = 14). This suggests that if orbital fracture were to occur around the infraorbital groove or canal, this vascular pedicle would be in danger of being incarcerated by bone fragments. CONCLUSION: Our cadaveric investigation revealed that the lower intraorbital fat is supplied by a branch of the infraorbital artery along the infraorbital groove or canal on the orbital floor. This finding suggests that compromised blood supply to the intraorbital fat may cause anaerobic cellulitis or enophthalmos.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/10. Eosinophilic cellulitis (Wells' syndrome): ultrastructural study of a case with circulating immune complexes.A 42-year-old woman was observed during 3 bouts of eosinophilic cellulitis over a 6-year-period. skin biopsies were taken at each relapse and processed for histological, immunofluorescent and ultrastructural studies. Histologically the eosinophilic infiltrate extended to the deep dermis and the subcutaneous fat. High levels of circulating immune complexes, and complement and IgG deposits around the vessels were detected for as long as the cutaneous lesions lasted. Under the electron microscope eosinophils were numerous, half of them degranulated and some granules had a double cristal core. No injury to the vessel walls was observed. The 3 recurrences occurred respectively after lincomycin, nesdonal, acetyl salicylic acid and pholcodin ingestion and responded to sulfone and steroid therapy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/10. vibrio cholerae non-01 cellulitis.A 46-year-old man presented with pain and fever and a postphlebitic ulcer on his left leg. The wound was suppurative and open at the margins, but there was little underlying fasciitis and no apparent muscle or blood vessel involvement. Three separate wound cultures were obtained at two-day intervals, and all showed only vibrio cholerae non-01. The patient was successfully treated with cefazolin sodium. This marks the second documented case of V cholerae non-01 type alone as a causative agent of cellulitis, and the first case where no saltwater origin could be demonstrated.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/10. Cutaneous and soft-tissue manifestations of sepsis due to gram-negative enteric bacilli.Four patterns of tissue involvement can be distinguished in sepsis due to gram-negative enteric bacilli. When intense local inflammation predominates, cellulitis or thrombophlebitis results, often with venous or arterial obstruction. bacteria are present in the affected tissues, but not in sufficient numbers to be seen microscopically. When bacterial proliferation is unchecked by an appropriate leukocyte response, ecthyma gangrenosum, erythema multiforme, or diffuse bullous lesions may occur with minimal clinical or histologic signs of inflammation. In symmetric peripheral gangrene associated with disseminated intravascular coagulation, bland fibrinous deposits are seen in small vessels but neither inflammatory cells nor bacteria are present. The fourth kind of lesion is that seen in bacterial endocarditis. In all four patterns a vascular component is prominent clinically and histologically. The pathogenesis of these lesions is multifactorial; in each individual case the interaction between bacterial and host factors probably determines which clinical picture will result. The appearance of symmetric soft tissue lesions of the extremities in the absence of predisposing local conditions suggests the possibility of sepsis due to gram-negative bacilli, especially if other clinical features indicate that sepsis might be present.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/10. Histopathology of marine vibrio wound infections.Although marine vibrio wound infections and septicemia are being reported with increasing frequency, description of the histopathologic changes has been scanty. The histologic alterations in three patients with primary marine vibrio wound infections are presented. The lesions are characterized by intense acute cellulitis of the subcutis with much tissue destruction and extension into the adjacent dermis. The superficial dermis is devitalized and lacks an inflammatory cellular infiltrate. Subepidermal noninflammatory bullae are formed. Many organisms are seen both within the areas of intense acute inflammation and in devitalized areas. Organisms and inflammation are especially oriented around vessels, with associated acute vasculitis. It is concluded that the morphologic picture in marine vibrio wound infections is nonspecific yet characteristic.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/10. Lymphatic vessel-to-isolated-vein anastomosis for secondary lymphedema in a canine model.To design a more rational and effective surgical method of performing lymphatic-venous anastomosis to treat secondary lymphedema of the lower extremities, the following experiments were conducted on three groups of dogs: group A underwent an end-to-side lymphatic node-to-vein anastomosis at the inferior vena cava; group B underwent a "burying" lymphatic vessel-to-vein anastomosis at the femoral vein; and group C underwent a burying lymphatic vessel-to-isolated-vein anastomosis at the femoral vein. In group C, the femoral venous segment was isolated by distal ligation and proximal valvuloplasty and the patency of the anastomosis was investigated by infusing yellow Microfils through the distal lymphatic vessel. The patency of the anastomosis was nil in group A by 10 days after the anastomosis, 40% in group B by 180 days; and 71.4% in group C by 180 days, respectively. Thus, we clinically applied the technique of lymphatic vessel-to-isolated-saphenous-vein anastomosis in a patient with secondary lymphedema of the bilateral lower extremities. A satisfactory reduction in the size of the limbs was achieved and there has been no further recurrence of cellulitis in the 42 months since her surgery. This study shows that lymphatic vessel-to-vein anastomosis is an effective technique for the surgical management of secondary lymphedema, so long as the anastomosis is completely protected from any contact with blood.- - - - - - - - - - ranking = 4.5keywords = vessel (Clic here for more details about this article) |
7/10. Inflammatory breast carcinoma (carcinoma erysipeloides): an easily overlooked diagnosis.A 70-year-old woman developed erythema and induration of the right chest wall, and swelling of her right arm. The provisional diagnosis was deep venous thrombosis and/or cellulitis of the right arm. skin biopsy showed a poorly differentiated adenocarcinoma within lymphatic vessels, and immunohistochemical staining revealed this to be of breast origin. Inflammatory carcinoma or carcinoma erysipeloides represents < 1% of all cases of breast carcinoma. Our case illustrates the importance of considering this entity in the differential diagnosis of unilateral chest wall erythema and induration.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/10. Haemorrhagic cellulitis: a syndrome associated with tumour necrosis factor-alpha.A newly defined clinical syndrome, haemorrhagic cellulitis, is described in 12 patients. The syndrome consists of an acute onset of extremely painful erythema affecting dependent areas, followed by dermal haemorrhage and sloughing of the overlying epidermis, and requiring both antibiotics and systemic corticosteroids for complete resolution. The patients usually have demonstrable Gram-negative or Gram-positive infection, of non-cutaneous origin, and underlying systemic disease. Vacuolopathic necrosis of epidermal keratinocytes, and damaged vascular endothelium of the dermal blood vessels can be demonstrated by light and electron microscopy, as well as by lectin studies. Immunocytochemical studies reveal the presence of activated macrophages and T lymphocytes. We believe the syndrome is due to lipopolysaccharide-induced or bacterial mitogen-induced tumour necrosis factor-alpha (TNF-alpha), secreted by previously primed activated macrophages in a second-set response. TNF-alpha characteristically injures endothelial cells and epidermal keratinocytes. It is thought to induce its cytotoxic effects partly via neutrophil degranulation, and partly via DNAase activation, with resultant dna fragmentation and cell lysis. Corticosteroids have been shown not only to inhibit TNF-alpha secretion by activated macrophages, but also to block its cytotoxicity, thus accounting for the extremely rapid clinical response to this drug in conjunction with adequate and appropriate antibiotic therapy.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/10. Septic thrombosis of orbital vessels due to cutaneous nasal infection.The authors describe two cases of cutaneous nose infection that quickly spread and extended to the orbital venous complex. At first glance, the clinical presentation could be mistaken for a complicated sinusal infection; therefore, the evaluation of the sinuses, by means of physical examination and radiological investigation, was of great concern, showing that there was no important pathology in the sinuses. The CT scan and the color Doppler imaging (orbital ultrasound with Doppler) demonstrated, throughout the development of the disease, that the superior ophthalmic vein was affected in both patients and the cavernous sinus in one of them. On physical examination, chemosis of the conjunctiva, proptosis, and edema of the eyelids were prominent. patients improved only after appropriate intravenous antibiotic therapy against staphylococcus (clindamycin) and corticosteroids, making one conclude that treatment of this disease should be initiated as soon as possible in order to decrease morbidity and mortality.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/10. Periantral soft-tissue infiltration and its relevance to the early detection of invasive fungal sinusitis: CT and MR findings.PURPOSE: Our goal was to illustrate the relevance of periantral soft-tissue infiltration to the early diagnosis of invasive fungal sinusitis and to describe variations in the appearance of normal periantral soft tissues. methods: We reviewed two cases of pathologically proved invasive maxillary fungal sinusitis in which the sole imaging finding suggestive of invasive disease was periantral soft-tissue infiltration. Variations in the CT appearance of normal periantral soft tissues were studied in 112 patients by assessing the appearance of the fat planes along the anterior and posterior bony antral walls and by noting the presence of infraorbital and distal internal maxillary artery branch vessels within the anterior and posterior periantral fat planes, respectively. RESULTS: None of the 112 patients had findings that suggested, or that could mimic, soft-tissue infiltration in the anterior periantral soft tissues. In only one (1%) of the 112 patients was there a loss of visibility of the posterior periantral fat plane that was not clearly attributable to the otherwise normal-appearing posterior periantral soft tissues. CONCLUSION: Infiltration of the periantral fat planes may represent the earliest imaging evidence of invasive fungal disease. When encountered as the sole radiologic finding, periantral soft-tissue infiltration should suggest the possibility of invasive fungal sinusitis in the appropriate clinical setting.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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