Daniel Zikk

Cervical necrotizing fasciitis of odontogenic origin

Necrotizing fasciitis is a severe soft tissue infection caused by both aerobic and anaerobic bacteria and is characterized by a rapid extension along fascial planes and by necrosis of soft tissues. The disease rarely occurs in the head and neck. Three cases of necrotizing fasciitis of the neck after a dental infection are presented. The difficulty in diagnosing the early stage of this condition in relation to other soft tissue infections of odontogenic origin in the neck is discussed. The importance of an early diagnosis followed by an appropriate combination of medical, surgical, and dental treatment is emphasized.

Oral Ofloxacin Therapy for Invasive External Otitis

The clinical efficacy and safety of orally administered ofloxacin (400 mg twice daily) were evaluated in 24 adult patients (17 men and 7 women; mean age, 65.8 years) with pseudomonal invasive external otitis (IEO). The patients were divided into two groups: Group A, (n = 9) suffering from a mild form of IEO, and group B (n = 15), suffering from a more severe form of the disease. Diabetes mellitus was the main underlying disease in these patients. Pseudomonas aeruginosa was the only pathogen in 18 infected ears and part of the polymicrobial flora in an additional 6. Cure was observed in 83.3 % of the patients. Two of the cured patients required more than one course of ofloxacin treatment. Development of P aeruginosa resistant to ofloxacin (n = 3) and severe allergic reaction (n = 1) required the discontinuation of ofloxacin therapy. Other side effects such as nausea, arthralgia, and vaginal itching were minimal. Oral administration of ofloxacin seems to be an effective, convenient, relatively safe, and economical therapy of IEO caused by the susceptible organism.

Acute airway obstruction and achalasia of the esophagus

Patients with achalasia tolerate considerable distension of the esophagus. Respiratory symptoms usually are due to regurgitation and pulmonary aspiration of retained food rather than to a space-occupying mechanism. We describe a case of previously undiagnosed achalasia presenting in an elderly woman with symptoms consistent with tracheal obstruction of acute onset.

Sleep apnea following bilateral excision of carotid body tumors.

A patient is described who developed apnea, hypertention, and tachycardia following the excision of bilateral carotid body tumors. Hypertension and tachycardia resulted, most probably, from bilateral ablation of the carotid sinus and/or the nerve of Hering. These phenomena have been described in the literature. The pathogenesis of the apneic attacks may be related to the ablation of the peripheral sensory organs (both carotid bodies), interference with the function of the respiratory automatic control system, and impaired control of ventilation during non‐REM sleep. Temporary unilateral paralysis of the hypoglossal nerve with partial airway obstruction possibly represented a mechanical trigger. The apneic attacks subsided but bouts of hypertention and tachycardia persist.

Measurement of auditory brain stem potentials in Bell's palsy.

Auditory brain stem potentials (ABP) were recorded in 27 patients with Bells palsy during the early phase of the disease and 1‐3 months later. Pathological findings were observed in 6 patients, the dominant features being prolonged brain stem transmission time and diminished amplitude of the second wave. The extension of the pathological process in the so called idiopathic peripheral facial paralysis appears to vary. The observation of brain stem involvement in some patients with Bells palsy may have important clinical implications.

Invasive Multiple Supraglottic Squamous Cell Papillary Carcinoma in an Adult

Invasive papillary squamous cell carcinoma of the supraglottic larynx is described in an adult male. The clinicopathological appearance was that of a multiple growth which displayed various gradients of neoplastic changes: in situ, microinvasion, frank invasion of cartilage and cervical node metastases. No previous history of radiotherapy was elicited. The growth was excised by supraglottic laryngectomy and neck dissection. Typical metastatic papillary formations were observed in lymph nodes.

Sudden Deafness Due to Infection by Mycoplasma Pneumoniae

A case is described of sudden unilateral deafness associated with Mycoplasma pneumoniae. The hearing function of the patient returned to normal on the third day of treatment with tetracycline. M pneumoniae is a common causative agent of protean respiratory disease and the true incidence of hearing loss in these cases may be higher than reflected by the occasional reports. Therefore, appropriate laboratory studies should be included in the evaluation of sensorineural loss associated with diverse infections of the respiratory tract. Prompt diagnosis facilitates the administration of specific treatment. However, the actual contribution of tetracyclines to restoration of hearing cannot be assessed.

Granulation tissue concentrations of ofloxacin after oral administration in invasive external otitis

SummaryFollowing the fourth dose of 400 mg orally administered ofloxacin, simultaneous external ear canal granulation tissue and serum ofloxacin concentrations were estimated in 15 patients with invasive external otitis. The granulation tissue concentration was 2.2 (range 1.17–4.34) times higher than the serum concentration and 3.73 (range 1.95–11.00) times higher than the MIC90 of ofloxacin againstPseudomonas aeruginosa.

Computerized tomography in conditions concomitantly involving the orbits and the paranasal sinuses

Forty-three patients with computerized tomographic (CT) findings demonstrating concomitant orbital and paranasal sinus involvement are presented. Exophthalmos was the most common presenting symptom. Ethmoid and maxillary sinuses were most commonly affected. CT findings were of help in evaluating the extent of the various disease processes and are mandatory for treatment planning. Attention is drawn to the common association of paranasal lesion and ophthalmic manifestations. The combination of clinical presentation and radiological findings might indicate certain etiologies.

Parotid gland hemorrhage as a complication of coumarin compound ingestion

SummaryBleeding in the salivary glands represents a very rare complication of oral anticoagulant therapy. Only one such case has been previously described in the submandibular glands. To the best of our knowledge, we document the first case of hemorrhage in the parotid gland following the ingestion of coumarin compounds.