Orbital aspergillosis is an uncommon but serious infection that may first present to the ophthalmologist. Usually arising from the paranasal sinuses, it may present in manifold ways within the orbit. Some presentations, such as optic nerve involvement, can respond to systemic corticosteroids, leading to delays in diagnosis and possibly iatrogenic potentiation of the infectious process. In this review, pertinent clinical and radiographic findings are discussed, and the literature is summarized. Classic approaches to therapy include local treatment, debridement, and systemic amphotericin B. We review novel approaches to treating orbital aspergillosis and detail a flow-chart for its management. Four patients from the spectrum of orbital aspergillosis are also described: initially presenting as an infection of an exenteration socket, a complex dacryocystitis, and optic nerve tumor, and post-operative periorbital swelling. Physicians should be familiar with the clinical spectrum of disease and the variable presentation of this infection, as early diagnosis and rapid institution of appropriate therapy are crucial elements in the management of invasive aspergillosis. In the neutropenic or otherwise immunocompromised patient, a high index of suspicion must be maintained as delays in diagnosis of fulminant aspergillosis may lead to overwhelming and rapidly progressive infection. Obtaining adequate diagnostic material for pathological and microbiological examination is critical. Newer methods of therapy, particularly itraconazole and liposomal amphotericin B, may be beneficial in selected patients.

Adult↗

PubMedDate not supplied

Preparation of solutions for atomic absorption analyses of Fe, Mn, Zn, and Cu in plant tissue.

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Copper↗

PubMedDate not supplied

Endophthalmitis following intraocular lens implantation: report of 30 cases and review of the literature.

Bacterial endophthalmitis is a postoperative complication of intraocular lens implantation. A review of 30 cases showed that 77% occurred within seven days of initial cataract surgery and that all cases occurred within 32 days. Common presenting symptoms and signs included pain localized to the involved eye, decreased visual acuity, conjunctival injection, anterior chamber inflammation, hypopyon, and absent or poor red reflex. Diagnosis of an infectious etiology was made by aqueous and vitreous sampling for gram stain and culture. The commonest bacterial agents were coagulase-negative staphylococci and Staphylococcus aureus, but a wide variety of gram-negative and -positive organisms were also isolated. On the basis of this series and review of the literature, optimal treatment includes prompt diagnosis by culture and gram stain of vitreous fluid, frequent application of topical antibiotics, and administration of intraocular antibiotics. Intravenous antibiotics and vitrectomy may improve the visual outcome. Removal of the intraocular lens is unnecessary for bacteriologic cure and is not associated with improved visual outcome.

Aged↗

PubMedDate not supplied

Tuberculosis of the middle ear: review of the literature with an instructive case report.

Tuberculosis of the middle ear is currently a rare disease in developed countries but one that still occurs and typically causes significant morbidity manifested by profound and permanent hearing loss. Diagnosis is difficult since most physicians are unfamiliar with the typical presenting features; in addition, special cultural and pathologic studies are required for diagnosis. A case report and review of the literature are presented to delineate typical clinical, epidemiologic, and laboratory features of tuberculous otitis media and associated tuberculous disease. A diagnostic and therapeutic plan is outlined that would allow early therapy and preservation of hearing.

Adult↗

PubMedDate not supplied

Inflammatory lesions of the neck, including fascial spaces--evaluation by computed tomography and magnetic resonance imaging.

The clinical findings that characterize inflammatory lesions of the neck are briefly presented. The technique of the major imaging methods--computed tomography (CT) and magnetic resonance imaging (MRI)--used for the evaluation of these lesions is described as well as the radiologic appearance of abscesses, enlarged lymph nodes and cellulitis. The only advantage of MRI over CT is its multiplanar capability, sagittal sections being especially useful in the demonstration of the retropharyngeal space.

Bacterial Infections↗

PubMedDate not supplied

Adult supraglottitis. A prospective analysis.

Epiglottitis in pediatric patients is an infection caused by Haemophilus influenzae type b, which can lead rapidly to sepsis and an asphyxial death. In an effort to study the cause and clinical course of adult epiglottitis, eight serially hospitalized adult patients with supraglottitis over a ten-month period were prospectively evaluated, including a daily laryngeal examination. Although multiple anatomic sites in the larynx and oropharynx were inflamed, the epiglottis was often not the most involved area and was actually normal in one patient. Bacterial cultures were harvested from blood, the nasopharynx, the oropharynx, and the vallecula in all patients and the preepiglottic space in two patients. In no case was H influenzae demonstrated. No patient developed respiratory compromise. It was concluded that epiglottitis is an inaccurate description of this disorder and that this non-H influenzae adult variety of supraglottitis seemingly can follow a less pernicious course than the classically described infection.

Adolescent↗

PubMedDate not supplied

An investigation into the aetiology of 'wool slip': alopecia in ewes which are housed and shorn in winter.

Alopecia in housed ewes which are shorn in winter, 'wool slip', was investigated by taking wool and blood samples, skin scrapings and biopsies from affected and unaffected animals. Epidemiological information was also obtained from farm records, and reports from a local weather station. No pathological lesions were seen and no ectoparasites or forage mites were seen in wool samples or skin scrapings. The plasma zinc and copper concentrations of both groups were within the normal range but the copper concentrations were significantly lower in the unaffected animals. There was no difference between the prevalence of the disease in ewes of different breeds or between those producing single or twin lambs. A comparison of the mean temperatures during years of summer and winter shearing suggested that cold stress alone was not involved. Skin biopsies revealed that the wool follicles of affected animals were in an early growth phase (anagen) whereas those of unaffected animals were in the inactive phase (telogen). The clinical and histological signs of the disease were similar to those seen experimentally when corticosteroids are used as chemical depilatory agents. It is suggested that wool slip is due to the high levels of corticosteroids which occur as a result of the combination of housing and shearing and on this basis methods of control are proposed.

Alopecia↗