Impact of antithrombotic treatment in orbital haematoma.

INTRODUCTION: Orbital haematomas threaten the visual prognosis, but no treatment guidelines have been proposed. Antithrombotics could affect their prognosis and treatment. This study aimed to evaluate the effect of antithrombotics in the management of orbital haematomas and to suggest a standardised protocol. MATERIAL AND METHODS: We conducted a retrospective study by sending a standardised questionnaire to 20 French maxillofacial surgery university departments to collect all the cases of orbital haematoma. RESULTS: Twenty-five cases from 10 centres were collected, including five patients treated with anticoagulant and one patient treated with dual antiplatelet. Antithrombotics increased the risk of amaurosis and ocular disorders significantly. Surgery was performed for 66.7% of patients treated with antithrombotic and for 89.5% of other patients. Surgical delay was longer in patients treated with antithrombotic. Surgical drainage was used in most of the cases, whereas canthotomy with inferior cantholysis was the least-used technique. CONCLUSION: Antithrombotics appear to worsen the functional prognosis of orbital haematomas. A surgical management of orbital haematoma in patients treated with antithrombotics is not contraindicated. Surgical delay must be shortened as much as possible. A lateral canthotomy with inferior cantholysis seems to be an appropriate solution.

Does mandibular third molar have an impact on dental mandibular anterior crowding? A literature review.

Mandibular dental anterior crowding is a common multi-factorial phenomenon. The involvement of the lower third molar remains unclear. These pending questions led us to conduct a literature review to evaluate the impact of the lower third molar on mandibular dental anterior crowding. Twelve articles were selected, published from 1974 to 2014. Four studies were prospective. Sample size ranged from 30 to 9044. The average age was 20.56 years old. Seven studies considered patient with orthodontic treatment. The studies compared two to four groups. Studying tools were radiographs, casts and clinical examinations. Little's irregularity index, TSALD and Ganss ratio were used. In total, 83% of articles (n=10/12) did not find any significant relationship between lower third molar and mandibular dental anterior crowding. However, methods and designs of these studies being questionable, a definite conclusion on the impact of mandibular third molar on mandibular dental anterior crowding cannot be set.

[Update on cutaneous dirofilariasis]. / La dirofilariose cutanée.

Dirofilariasis is a worldwide zoonotic infection that rarely affects humans and is caused by filarial nematodes of the genus Diroflaria transmitted by mosquitoes. Cutaneous dirofilariasis, due to D. repens, presents as inflammatory lesions that develop into subcutaneous nodules. These clinical symptoms may be consistent with Wells' cellulitis. Diagnosis of dirofilariasis involves demonstration of the presence of the nematode during skin biopsy and identification of the worm through macroscopic, histological and PCR analysis. Surgical resection of the nodule remains the gold standard treatment. The number of cases of human cutaneous dirofilariasis has increased in the recent years and the disease must not be misdiagnosed.

Scabietic vasculitis: Report of 2 cases.

BACKGROUND: The infectious causes of cutaneous vasculitis are well known and include streptococcal infections among others. Cases resulting from parasitic infection are less frequent. Scabies, which is currently on the increase, has only been reported in a few isolated cases. Herein, we report two noteworthy cases of profuse scabies complicated by cutaneous vasculitis. PATIENTS AND METHODS: Case 1: a 90-year-old woman, residing in a nursing home, was admitted to our dermatology department complaining of pruritus, present for one month, predominantly on the inside of the thighs and on the buttocks, associated with purpuric lesions on the lower limbs. A skin biopsy revealed leukocytoclastic vasculitis. A diagnosis of scabies was based on severe pruritus and hypereosinophilia and was confirmed by microscopic examination of the parasitology sample and the skin biopsy sample. Despite thorough investigation, no other cause of vasculitis could be found. Complete regression of the skin lesions was achieved with scabies treatment only, without any specific treatment for the vasculitis. Case 2: a 74-year-old man, living in a nursing home, was hospitalized for purpuric papules on the lower limbs, present for one month. Physical examination revealed linear patterns in the interdigital spaces associated with scabies evident on dermoscopic examination. The skin biopsy revealed signs of vasculitis. As in our first case, no aetiology of vasculitis was found and a favorable outcome was achieved by means of scabies treatment alone with no specific treatment for vasculitis. DISCUSSION: Both of our patients presented scabies and vasculitis. In view of the absence of other causes of vasculitis and of the complete regression of lesions due to vasculitis without recurrence achieved with the scabies treatment alone, a diagnosis was made of scabietic vasculitis, probably as a result of cutaneous hypersensitivity reaction to humeral mediators.

[Rituximab-induced acute thrombocytopenia in a patient with chronic lymphocytic leukemia]. / Un cas de thrombopénie aiguë au rituximab dans la leucémie lymphoïde chronique.

INTRODUCTION: Rituximab is a chimeric anti-CD20 monoclonal antibody generally well tolerated. However, a severe but rare rituximab-related immune-toxic syndrome, associating fever, chills and thrombocytopenia can occur shortly after the infusion. CASE REPORT: We report a case of severe acute rituximab-induced thrombocytopenia with favorable outcome in a patient with chronic lymphocytic leukemia and discuss the possible underlying mechanisms. CONCLUSION: Despite the potential initial severity of rituximab-induced thrombocytopenia in CLL, chemotherapy should not be discontinued; tolerance might increase as the hematologic disorder is controlled.

Perspectives from Geriatric In-patients with Heart Failure, and their Caregivers, on Gaps in Care Quality.

BACKGROUND: Evidence indicates that care experiences for complex HF patients could be improved by simple organizational and process changes, rather than complex clinical mechanisms. This survey identifies care gaps and recommends simple changes. METHODS: The study utilized both quantitative and qualitative methods at The Ottawa Hospital, Geriatric Medical Unit during a three-month period. RESULTS: Nineteen patients (average age 85, 12 female) surveyed. Twelve participants lived alone. Fourteen lived in own home. Four patients had formal home-care services. Fifteen relied on family. Gaps were identified in in-patient practice, discharge plan, and discharge summary implementation feedback. Only five participants had seen cardiologist or specialist. Half of patients did not know if they were on a special HF diet. Participants did not recall receiving information on life expectancy but were comfortable discussing EoL care and dying. HF-specific management recommendations were mentioned in only 37% of discharge summaries to PCPs. CONCLUSION: The results provide the starting point for a quality assurance and process re-engineering program in GMU. Organization change is needed to develop and integrate a cardiogeriatric clinical framework to allow the cardiologist, geriatrician, and PCP to actively work as a team with the patient/caregiver to develop the optimal care plan pre- and post-discharge.

Effect of oral mineral and energy supplementation on blood mineral concentrations, energetic and inflammatory profile, and milk yield in dairy cows affected with dystocia.

The objectives of this study were to determine the effect of mineral/energy supplementation of dairy cows with dystocia on blood mineral concentrations, energetic and inflammatory profiles, and milk yield. Multiparous Holstein cows with dystocia were randomly assigned into two groups, (1) treated with a mineral/energy supplement (DME, n= 18) and (2) not treated (DNT, n= 22). A group of cows with normal parturition were randomly selected and were left untreated (NNT, n= 25). Cows in DME received an oral drench of 110 g of calcium and 400 g of propionate as calcium propionate plus 110 g potassium chloride and 150 g of magnesium sulfate administered within 6 h of calving and again 3 days post-partum. Compared to cows with a normal parturition, dystocic cows had decreased plasma calcium concentrations, increased plasma haptoglobin, decreased milk yield at 1 day post-partum, and tended to have increased rectal temperatures from 1 to 12 days post-partum. Compared with cows in DNT, those in DME had decreased plasma calcium concentrations and increased plasma magnesium concentrations 2 and 3 days post-partum, and a tendency for an increase in rectal temperature from 1 to 12 days post-partum. Dystocia is detrimental to calcium homeostasis post-partum, but mineral/energy supplementation as undertaken in this study is not recommended for use in cows with dystocia.

Cutaneous and pulmonary dirofilariasis due to Dirofilaria repens.

Dirofilariasis is a worldwide zoonotic infection that accidentally affects humans. It is caused by filarial nematodes of the genus Dirofilaria, which are transmitted by mosquitoes. Cutaneous dirofilariasis appears as inflammatory lesions that could be consistent with Wells' cellulitis. We present a remarkable case of human infection with Dirofilaria repens, causing both subcutaneous and pulmonary nodules.