Acquired nasolacrimal duct obstruction: clinical and histological findings of 275 cases

Background Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct. However, cases exist where the primary nasolacrimal system obstruction is caused by malignancies. Our aim was to investigate lacrimal sac pathologies in patients with acquired nasolacrimal duct obstruction and compare their clinical manifestations. Methods This retrospective clinical study included 275 patients with acquired nasolacrimal duct obstruction who underwent external dacryocystorhinostomy and lacrimal sac biopsy. Cases were classified into tumor or nonspecific pathology groups and subdivided according to the level of inflammation. Histological and clinical data were analyzed. Results Three tumors (1.1%) (an adenoid cystic carcinoma, an eccrine spiradenoma and small B cell lymphoma) were diagnosed. Chronic nongranulomatous inflammation was the most common histological finding, corresponding to 194 cases (70.5%). The other 81 (29.5%) were subacute, acute forms of nongranulomatous inflammation, tumors and fibrosis cases. Epiphora with continuous purulent discharge was the most common clinical sign reported by 144 (52.4%) patients, and two (0.7%) patients had a palpable mass near the medial canthal tendon, which was identified as an eccrine spiradenoma and small B cell lymphoma. There was no significant difference in the clinical symptoms, duration or case history between the nonspecific pathology and tumor groups (p = 0.292). Conclusions Chronic nongranulomatous inflammation of the lacrimal sac was the most common finding among acquired nasolacrimal duct obstruction cases. There were no associations between the histological findings and clinical presentation. The authors recommend a lacrimal sac biopsy only in cases when a tumor is clinically suspected.

Compartment syndrome as a donor-site complication of anterolateral thigh free flap: a case report

Compartment syndrome (CS), a complication at the donor site of anterolateral thigh free flap (ALT-FF), has a low incidence. Our patient was a 26-year-old male, a professional soldier with large thigh muscles. His defect on the right ankle was reconstructed with a 30×10 cm2-sized ALT-FF. By the pinch test, the flap width was designed to be sufficient for primary closure of the donor. However, on the postoperative day 8, severe pain, tense and purulent discharge were found at the donor site. We diagnosed CS clinically, and immediately performed incision and drainage. There are various extrinsic or intrinsic factors that can influence the development of CS. Therefore, in patients with these contributing factors, such as a young man with high muscle mass, a higher level of suspicion for CS is needed. Moreover, it would be safer to design the flap width smaller than the pinch test or to cover the donor site with a skin graft.

Incomplete Removal and Accidental Retention of Temporary Epicardial Pacing Wires in the Chest after Heart Surgery: A Case Report

Temporary pacemaker wires are commonly used for the diagnosis and treatment of arrhythmias in the acute postoperative period. We herein describe a 65-year-old woman with a history of coronary artery bypass graft surgery who was referred to the hospital with a purulent discharge in the lower third of the sternal region while on antibiotics. Two years later, following treatment failure, 2 sternal wires were removed. Several years after the surgery, the patient developed a purulent discharge. On suspicion of rib osteomyelitis, the last left cartilage attached to the sternum was excised and removed together with an infectious tract. During the operation, the right ventricle was torn, and tampons were used to control bleeding. The patient was placed under cardiopulmonary bypass via the cannulation of the left femoral artery and the right femoral vein. The sternum was opened, and the rupture site was repaired. A temporary epicardial pacing wire was found at the site of the right ventricular rupture. Several days later, the patient was taken from the intensive care unit to the operating room due to a pulsatile hematoma in the left groin and a diagnosis of a pseudoaneurysm of the femoral artery. After a week, the purulent discharge at the lower sternum improved, and the patient was discharged. At 1 month’s post-discharge follow-up, the infection was eradicated

Endoscopic findings of dental implant found in the infundibulum showing the mucociliary clearance of the maxillary sinus

Significance statement: A 53-year-old man with left facial pain was referred to our hospital. Nasal endoscopy revealed a purulent discharge at the left middle meatus and bulging of the uncinate process. Computed tomography demonstrated that the dental implant was blocking the left maxillary ostium. Functional endoscopic sinus surgery was performed under general anesthesia. After removal of the uncinate process, a yellowish purulent discharge in the left maxillary sinus discharged from the maxillary sinus. The presence of the dental implant in the infundibulum shows the direction of mucociliary clearance from the nasal sinus. This case indicates how our sinus clears a foreign body, and the direction in which the foreign body is removed.

Evaluating the Effects of Spraying Oxytetracycline on Diabetic Foot Ulcers: A Randomized Clinical Trial

Background: Diabetic foot ulcers (DFUs) can be created due to neuropathy and peripheral vascular disease in the lower limbs. Objectives: This study aimed to evaluate the effects of spraying oxytetracycline on DFU. Methods: This randomized clinical trial was conducted on 60 diabetic patients suffering from DFU. The patients were randomly assigned into two equal groups of intervention and control (n = 30 each). While all subjects received antibiotic therapy, blood sugar control, and, if necessary debridement, the intervention group received oxytetracycline spraying on the DFUs twice a day. After the intervention, the patients were visited every week (for three weeks), photos were taken of the DFUs by special software, and the size of the DFUs was checked. The DFUs were also studied in terms of purulent discharge, the smell, and erythema, and edema around the ulcer. After three weeks, the healing of ulcers were compared in the two groups. Data were gathered and analyzed using the SPSS software version 11.5, descriptive statistical test, chi-square, and t-test. Results: Before the study, the size of the DFUs in the intervention and control groups was 110.87 ± 38.3 and 127.12 ± 40 mm2, respectively. After the treatment, the alterations in the intervention group in the first, second, and third weeks were 14.90 ± 14.41, 26.93 ± 18.86, and 41.25 ± 19.51, respectively. Also, in the control group, the alterations were 19.45 ± 1.35, 23.78 ± 5.31, and 13.29 ± 8.75, respectively. There was a statistically significant difference in the size of DFUs between the two groups (P < 0.05). Conclusions: According to the results, spraying oxytetracycline on DFUs facilitated the process of healing. Thus, it can be used as an affordable, available, and effective method.

Clinical characteristics and outcome of neonates with neonatal mastitis: a hospital based study

Background: Neonatal mastitis is not an uncommon condition, mostly occurs due to Staphylococcus aureus (S. aureus), sometimes leading to breast abscess with detrimental effects.Methods: Our study was retrospective, hospital based observational study carried out at Government Medical College, Baramulla from August 2017 to August 2019, all cases with features of neonatal mastitis were included in the study and also admitted in hospital. Clinical and laboratory data along with demographic data was recorded and analysed.Results: 23 cases were included with age of presentation 8 to 28 days. Babies particularly male babies received breast massage (N=10), besides this pain (15) and redness (N=23) was most common clinical characteristics purulent discharge seen in 2 cases and 7 cases were febrile. Laboratory findings include decreased total leucocyte count (TLC) and positive C-reactive protein (CRP), pus culture from samples revealed S. aureus in 11 cases, coagulase-negative staphylococci (CONS) in 3 cases, E. coli in 2 cases and sterile in 7 cases. Most of cases were sensitive to penicillin (N=14) and in two cases were methicillin resistant S. aureus (MRSA) strains resistant to methicillin. All patients responded well to intravenous (IV) antibiotics while as 8 cases required (I and D), blood cultured showed growth in 19 cases while cerebrospinal fluid (CSF) analysis was sterile in all patients. Above all babies were discharged successfully without any complications.Conclusions: We concluded from our study that neonatal mastitis if treated early has better outcome rather than practicing misbeliefs like breast massage to express so called witch’s milk, in addition we conclude that neonatal mastitis is not an uncommon problem.

Omphalitis with Umbilical Abscess in an Adult with a Urachal Remnant

Omphalitis is an inflammation of the umbilicus and is seldom diagnosed in adults. It is even rarer when it results from an infection of the urachus, an embryological remnant that connects the umbilicus to the dome of the bladder. Patients with omphalitis present with erythema, edema, tenderness, and purulent discharge form the umbilical stump. Workup includes ultrasonography and CT scan of the abdomen and pelvis. Management consists of antibiotics and incision and drainage of the umbilical abscess, followed by surgical resection of the urachal remnant. In this article, we report a case of omphalitis complicated by umbilical abscess in a 20-year-old female with a urachal remnant.

Endodontic Management of a Maxillary Lateral Incisor with Dens Invagination and Periapical Lesion: A Case Report and Mini Review of the Literature

Dens invagination (DI) is a dental anomaly that can cause pulpal and periapical pathoses of the affected tooth. We describe the treatment of a healthy 18-year-old female with a chief complaint of recurrent facial swelling pertaining to a peg-shaped maxillary lateral incisor with DI. Examinations showed necrosis of the involved tooth with symptomatic apical periodontitis. Cone-beam computed tomography corresponded to Oehlers type II DI. Orthograde endodontic treatment was performed. To completely debride the canal and resolve the persistent purulent discharge, various methods and medicaments were used in separate sessions including passive ultrasonic activation of 5.25% sodium hypochlorite solution, calcium hydroxide mixed with 2% chlorhexidine, and double antibiotic paste as intracanal medicament. After resolution of the symptoms, the root canal and the invaginated space were filled by a mineral trioxide aggregate plug and backfilled with thermoplasticized gutta-percha. At the one-year follow-up, complete bone healing was noted in the affected periradicular area.

Study of the correlation between the clinical manifestations of the inflammatory periodontal diseases and the microbiome of periodontal pathogenic microflora in young representatives of a mixed population of the European region

The age of inflammatory periodontal disease (PD) manifestations has tended to decrease over the past decades. The study of the range of periodontal pathogens in young people and their influence on the PD manifestation contributes to the predictor identification for the early prevention of this pathology.The aim was to study the correlation between the range of periodontal pathogens in the dentoalveolar sulcus/periodontal pocket (DS/PC) contents and the clinical PD manifestations in young people.We examined 28 patients (23.1 ± 0.93 years) with dental biofilm-induced gingivitis (BG), 24 patients (30.7 ± 0.6 years) with aggressive periodontitis (AgP), and 87 clinically periodontally healthy patients (21.1 ± 0.49 years) (Control). The hygiene index and the periodontal status were determined in all patients. DNA of five periodontal pathogens was identified by PCR in the DS/PC contents. The statistical analysis was performed in Statistica 13.3. The critical significance level was p ≤ 0.05.DNA was not observed in 60.9 % of the control group samples and 7.1 % of the BG group samples. In other cases, the bacteria were found separately and as part of bacterial complexes. P.g. and T.f. were most often detected in all groups. P.g. (U = 474, р < 0.01) and A.a. (U = 209, р >< 0.05) significantly contributed to the plaque formation in the control group, T.d. – in BG and AgP groups (U = 37.5, р >< 0.05 and U = 34, р >< 0.05, respectively). In the AgP group, purulent discharge was more often recorded if T.d. was detected in the PC contents (χ2 = 5.53, р >< 0.05). T.f. + P.i. and P.g. + T.f. + P.i. complexes were exclusively associated with PD. Complexes of four bacteria were found only in the AgP group. The association of periodontal pathogens and their complexes with different PD forms was revealed.>< 0.01) and A.a. (U = 209, р <0.05) significantly contributed to the plaque formation in the control group, T.d. – in BG and AgP groups (U = 37.5, р <0.05 and U = 34, р <0.05, respectively). In the AgP group, purulent discharge was more often recorded if T.d. was detected in the PC contents (χ2 = 5.53, р <0.05). T.f. + P.i. and P.g. + T.f. + P.i. complexes were exclusively associated with PD. Complexes of four bacteria were found only in the AgP group.The association of periodontal pathogens and their complexes with different PD forms was revealed.

A case report of exophytic nasal papilloma with acute dacryocystitis as the first symptom

Background This study aims to explore a case of exophytic nasal papilloma with acute dacryocystitis as the first symptom. Case presentation A 72-year-old male patient complaining of “a 10-year history of tearing and purulent discharge from the right eye, with subsequent redness and pain in the inner canthus for three days” was initially diagnosed with acute dacryocystitis of the right eye. The patient was treated with anti-inflammatory therapy. However, the redness and swelling of the inner canthus continued to increase. An endoscopic dacryocystorhinostomy of the right eye was performed under general anesthesia. A large amount of purulent secretion was drained during the operation. As a result, the swelling of the inner canthus was significantly reduced. A routine intra-operative biopsy of the wall of the lacrimal sac revealed an exophytic nasal papilloma. A second biopsy, 1 week after the surgery, revealed the same result. The patient was advised to undergo a dacryocystectomy once the swelling had subsided. However, the patient was reluctant to undergo this surgery and remains under clinical observation. Conclusion It is rare for an exophytic nasal papilloma, which is a benign tumor in the lacrimal sac, which has the potential for recurrence and malignant transformation, to manifest with acute dacryocystitis as the first symptom. Therefore, this case report could provide a reference for the future clinical diagnosis of this disease.