RESUMO
Although rare, orbital osteomyelitis secondary to sinusitis can be devastating. Early, aggressive ophthalmologic surgical intervention, as well as otorhinolaryngologic co-management, is necessary to obtain the best outcomes. We present two cases of orbital osteomyelitis. One patient remained infected with Pseudomonas meningitis even after extensive sinus and orbital surgery, rapidly declined, and is now deceased. The other patient, after multiple sinus procedures and a medial orbitotomy, was placed on hyperbaric oxygen and is still undergoing treatment.
Assuntos
Sinusite Maxilar/complicações , Doenças Orbitárias/microbiologia , Osteomielite/microbiologia , Infecções por Pseudomonas/etiologia , Sinusite Esfenoidal/complicações , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Sinusite Maxilar/microbiologia , Pessoa de Meia-Idade , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/terapia , Osteomielite/diagnóstico , Osteomielite/terapia , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/terapia , Sinusite Esfenoidal/microbiologia , Tomografia Computadorizada por Raios XRESUMO
Studies are reported pertaining to platelet-associated IgG (PAIgG) and IgM (PAIgM) in patients with thrombocytopenias considered possibly immune-mediated on clinical grounds. Approximately 14 percent of all patients with these disorders had elevated PAIgM but normal levels of PAIgG. Of patients with classic autoimmune thrombocytopenia (ITP), there was a trend toward more frequently normal levels of PAIgG in chronic ITP compared with patients with acute ITP, but this was not statistically significant. Patients with acute ITP had higher levels of PAIgG and PAIgM in general than those with chronic ITP. Patterns of PAIgG and/or PAIgM elevation were not significantly different when chronic and acute ITP were compared, nor when childhood ITP was compared with adult ITP. Patients with immune thrombocytopenias owing to malignant disorders were likely to have lower levels of PAIgG compared with those with classic ITP. Treated patients with immune thrombocytopenias showed a trend toward earlier response to therapy if they had only elevated PAIgG as opposed to elevated PAIgM alone or elevated PAIgM and PAIgG (p = 0.17). There appear to be great overlaps in the patterns and quantities of PAIgG and PAIgM in patients with immune-mediated thrombocytopenias in widely varied clinical settings. This suggests some underlying common pathophysiologic mechanisms for thrombocytopenia in these clinically diverse disorders. It is believed that the data are most consistent with the hypothesis that thrombocytopenia in patients with elevated PAIgG and/or PAIgM is most probably of immune origin even in such diverse disorders as systemic lupus erythematosus, cirrhosis of the liver, lymphoma, leukemia, cancer, or septic conditions, as well as in ITP.