Use of Posaconazole in the Management of Invasive Orbital Aspergillosis in a Cat

2006 ◽  
Vol 42 (4) ◽  
pp. 302-307 ◽  
Author(s):  
Gillian J. McLellan ◽  
Susette M. Aquino ◽  
David R. Mason ◽  
Joann M. Kinyon ◽  
Ronald K. Myers
Keyword(s):  
Oral Cavity ◽  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Oral Therapy ◽  
Surgical Excision ◽  
Parenteral Therapy ◽  
Orbital Exenteration ◽  
Nasal Sinus ◽  
Complete Surgical Excision ◽  
Disseminated Aspergillosis

Orbital infection with Aspergillus fumigatus was diagnosed in a Persian cat that was presented with chronic third eyelid protrusion and exophthalmos. Evidence of nasal, sinus, or disseminated aspergillosis was not detected in this cat. Complete surgical excision of diseased tissues was not possible during orbital exenteration, and infection subsequently extended into the tissues of the oral cavity. Oral therapy with itraconazole and parenteral therapy with amphotericin B were ineffective in resolving the infection. Oral therapy with a novel triazole, posaconazole, was curative.

scholarly journals Management of Nasal Dermoid Sinus Cyst by Modified Bipedicle Advancement Flap Technique

2015 ◽  
Vol 8 (3) ◽  
pp. 115-120
Author(s):  
Chidananda Ramappa Devasamudra ◽  
Niveditha J Sagar
Keyword(s):  
Computed Tomography ◽  
Recurrent Infection ◽  
Surgical Excision ◽  
Sinus Tract ◽  
Advancement Flap ◽  
Nasal Dorsum ◽  
Nasal Sinus ◽  
Flap Technique ◽  
Complete Surgical Excision ◽  
Dermoid Sinus

ABSTRACT Midline congenital nasal lesions are rarely encountered in adults. Nasal dermoid sinus cysts (NDSC) account for 1 to 3% of dermoid cysts overall and 11 to 12% of head and neck dermoids. Most lesions are diagnosed within the first 3 years of life but in some cases the diagnosis can be delayed. Nasal dermoid sinus cysts are unsightly, prone to infection. Treatment is complete surgical excision. We are presenting a case of 21-year-old man with a NDSC who presented with soft tissue hump over the bony nasal dorsum, recurrent infection and discharge from the two sinus openings over the bony nasal dorsum. We review the embryology of nasal dermoid sinus cysts, discuss their presentation, evaluation and management in adults. Radiological investigations like computed tomography (CT) scan, magnetic resonance imaging (MRI) are essential to know the extension of the sinus tract and CNS involvement. Complete surgical excision and reconstruction of the defect over the bony nasal dorsum by modified bipedicle advancement flap technique will help to give esthetically good looking nose. Abbreviations CNS: Central nervous system, CT: Computed tomography, MRI: Magnetic resonant imaging, NDSC: Nasal dermoid sinus cyst, PNS: Para nasal sinus. How to cite this article Devasamudra CR, Sagar NJ. Management of Nasal Dermoid Sinus Cyst by Modified Bipedicle Advancement Flap Technique. Clin Rhinol An Int J 2015;8(3):115-120.

scholarly journals Midline Nasal Tip Sinus

2021 ◽  
Vol 28 (3) ◽  
pp. 302-305
Author(s):  
Nitin Gupta ◽  
Himani Gupta ◽  
Surinder Kumar Singhal
Keyword(s):  
Surgical Excision ◽  
Sinus Tract ◽  
Intracranial Extension ◽  
Nasal Sinus ◽  
Nasal Tip ◽  
Complete Surgical Excision ◽  
Free Case ◽  
Recurrent Sinus ◽  
External Rhinoplasty ◽  
Rule Out

Introduction Congenital midline sinus over tip of nose is a rare clinical presentation. Accurate diagnosis should be done to rule out intracranial extension and to prevent recurrence. Appropriate surgical approach depends upon location, extent and degree of intracranial extension. Management entails complete surgical excision of sinus tract.  We discuss a rare case, where external rhinoplasty approach was used for excising recurrent sinus and patient was disease free. Case Report A 29 year old male patient with midline nasal tip sinus presented in our institute with history of opening over tip of nose since childhood associated with recurrent episodes of discharge from opening. Our objective is to present clinic-radiological-pathological profile of congenital nasal sinus along with review of literature. Discussion Nasal dermoid is rare embryological anomaly of ectodermal and mesodermal origin. Radiological imaging should be considered to rule out any intracranial extension.  Goal of management is complete surgical excision with meticulous pre-operative and surgical planning to avoid complications and recurrence. External rhinoplasty provides best surgical exposure and allows excision of sinus tract.

scholarly journals Small but Challenging Conjunctival Melanoma: New Insights, Paradigms and Future Perspectives

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5691
Author(s):  
Sacha Nahon-Estève ◽  
Corine Bertolotto ◽  
Alexandra Picard-Gauci ◽  
Lauris Gastaud ◽  
Stéphanie Baillif ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Standard Of Care ◽  
Surgical Excision ◽  
Metastatic Spread ◽  
Orbital Exenteration ◽  
Future Perspectives ◽  
Conjunctival Melanoma ◽  
Complete Surgical Excision ◽  
New Findings ◽  
Multiple Recurrences

Although its incidence has increased over the last decades, conjunctival melanoma (CM) remains a rare but challenging periocular malignancy. While there is currently no recognized standard of care, “no-touch” surgical excision followed by adjuvant treatments is usually recommended. Despite its small size, managing CM is challenging for clinicians. The first challenge is the high risk of tumour local recurrence that occurs in about one third of the patients. The management of locally advanced CM (≥T2) or multiple recurrences may require mutilating surgeries such as orbital exenteration (OE). The second challenge is the metastatic spread of CM that occurs in about one quarter of patients, regardless of whether complete surgical excision is performed or not. This highlights the infiltrative and highly aggressive behaviour of CM. Recently, attention has been directed towards the use of eye-sparing strategies to avoid OE. Initially, wide conservative surgeries followed by customized brachytherapy or radiotherapy have appeared as viable strategies. Nowadays, new biological insights into CM have revealed similarities with cutaneous melanoma. These new findings have allowed clinicians to reconsider the management of locally advanced CM with “medical” eye-sparing treatment as well as the management of metastatic spread. The aim of this review was to summarize the current and future perspectives of treatment for CM based on recent biological findings.

scholarly journals Liposomal Amphotericin B and Echinocandins as Monotherapy or Sequential or Concomitant Therapy in Murine Disseminated and Pulmonary Aspergillus fumigatus Infections

2010 ◽  
Vol 54 (9) ◽  
pp. 3884-3894 ◽  
Author(s):  
Jon A. Olson ◽  
Ancy George ◽  
David Constable ◽  
Peter Smith ◽  
Richard T. Proffitt ◽  
...  
Keyword(s):  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Sequential Therapy ◽  
Liposomal Amphotericin B ◽  
Concomitant Therapy ◽  
Fungal Burden ◽  
Drug Levels ◽  
Drug Concentrations ◽  
Disseminated Aspergillosis

ABSTRACT Monotherapy and combination therapy were compared using optimal doses of liposomal amphotericin B, micafungin, or caspofungin in Aspergillus fumigatus pulmonary and disseminated infections. Mice were challenged intravenously (2.8 × 104 to 5.7 × 104 conidia) or intranasally (5.8 × 107 conidia) with A. fumigatus. Drugs (5, 10, or 15 mg/kg of body weight) were given for 3 or 6 days as single, concomitant, or sequential therapy (i.e., days 1 to 3 and then days 4 to 6). Mice were monitored for survival, and tissues were assayed for fungal burden and drug concentrations. Treatments starting 24 h postchallenge significantly prolonged survival in disseminated aspergillosis (P < 0.002), but only liposomal amphotericin B treatments or treatments beginning with liposomal amphotericin B increased survival to 100% in the pulmonary aspergillosis model. Fungi in kidneys and spleens (disseminated) and lungs (pulmonary) were significantly decreased (P ≤ 0.04) by liposomal amphotericin B, liposomal amphotericin B plus echinocandin, or liposomal amphotericin B prior to echinocandin. In the disseminated infection, liposomal amphotericin B and micafungin (10 or 15 mg/kg) had similar kidney drug levels, while in the spleen, 5 and 15 mg/kg liposomal amphotericin B gave higher drug levels than micafungin (P < 0.02). In the pulmonary infection, drug levels in lungs and spleen with 5-mg/kg dosing were significantly higher with liposomal amphotericin B than with caspofungin (P ≤ 0.002). In summary, treatment of A. fumigatus infections with liposomal amphotericin B plus echinocandin or liposomal amphotericin B prior to echinocandin was as effective as liposomal amphotericin B alone, and a greater decrease in the fungal burden with liposomal amphotericin B supports using liposomal amphotericin B prior to echinocandin.

scholarly journals Influenza-Associated Disseminated Aspergillosis in a 9-Year-Old Girl Requiring ECMO Support

2021 ◽  
Vol 7 (9) ◽  
pp. 726
Author(s):  
Natalia Mendoza-Palomar ◽  
Susana Melendo-Pérez ◽  
Joan Balcells ◽  
Jaume Izquierdo-Blasco ◽  
Maria Teresa Martín-Gómez ◽  
...  
Keyword(s):  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Influenza A ◽  
Ecmo Support ◽  
Fulminant Myocarditis ◽  
Therapeutic Drug ◽  
Immunological Study ◽  
Pulmonary Aspergillosis ◽  
Severe Influenza ◽  
Disseminated Aspergillosis

A previously healthy 9-year-old girl developed fulminant myocarditis due to severe influenza A infection complicated with methicillin-resistant Staphylococcus aureus pneumonia, requiring extracorporeal membrane oxygenation (ECMO) support. Twelve days after admission, Aspergillus fumigatus was isolated in tracheal aspirate, and 12 h later she suddenly developed anisocoria. Computed tomography (CT) of the head showed fungal brain lesions. Urgent decompressive craniectomy with lesion drainage was performed; histopathology found hyphae in surgical samples, culture-positive for Aspergillus fumigatus (susceptible to azoles, echinocandins, and amphotericin B). Extension workup showed disseminated aspergillosis. After multiple surgeries and combined antifungal therapy (isavuconazole plus liposomal amphotericin B), her clinical course was favorable. Isavuconazole therapeutic drug monitoring was performed weekly. Extensive immunological study ruled out primary immunodeficiencies. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) follow-up showed a gradual decrease in fungal lesions. Influenza-associated pulmonary aspergillosis is well-recognized in critically ill adult patients, but pediatric data are scant. Clinical features described in adults concur with those of our case. Isavuconazole, an off-label drug in children, was chosen because our patient had severe renal failure. To conclude, influenza-associated pulmonary aspergillosis is uncommon in children admitted to intensive care for severe influenza, but pediatricians should be highly aware of this condition to enable prompt diagnosis and treatment.

scholarly journals Lipoma of floor of the mouth: A case report

2021 ◽  
Author(s):  
Syeda Hala Raza ◽  
Babar Aman ◽  
Sufyan Ahmed
Keyword(s):  
Case Report ◽  
Oral Cavity ◽  
Male Patient ◽  
Maxillofacial Surgery ◽  
Surgical Excision ◽  
Optimal Treatment ◽  
Mesenchymal Tumor ◽  
Rare Finding ◽  
Floor Of The Mouth ◽  
Complete Surgical Excision

Lipoma a benign mesenchymal tumor is a rare finding in the oral cavity. This paper reports a case of 75 years old male patient with a huge lipoma of the floor of the mouth, along with its manage- ment at the Department of Maxillofacial surgery at Abbasi Shaheed Hospital, Karachi Pakistan. Conclusion: Lipoma of the floor of the mouth is very rare. We endorse complete surgical excision as an optimal treatment of oral lipoma.

scholarly journals Intraosseous Myofibroma of the Mandible in a 7-Year-Old Patient: A Case Report

2021 ◽  
Vol 27 (1) ◽  
pp. 1-7
Author(s):  
Meshala Bala Sundram ◽  
Navasheilla Retna Retnasingam ◽  
Bahruddin Saripudin ◽  
Zuraiza Mohamad Zaini
Keyword(s):  
Differential Diagnosis ◽  
Oral Cavity ◽  
Histopathological Examination ◽  
Smooth Muscle Actin ◽  
Neck Region ◽  
Immunohistochemical Analysis ◽  
Surgical Excision ◽  
Permanent Molar ◽  
Complete Surgical Excision ◽  
Left Posterior

Myofibroma is a benign fibrous tumour that occurs predominantly in the head and neck region followed by the trunk and extremities. However, cases occurring in the oral cavity are rare, presenting with a variable clinical appearances and wide differential diagnosis.  We reported a case of a 7-year-old girl who was referred to the Department of Paediatric Dentistry, Tengku Ampuan Rahimah Hospital with a progressively enlarging painless swelling on the left posterior region of the mandible over the past 3 months.  The swelling was associated with ulceration and displaced lower left first permanent molar.  Radiographic investigations reported well-defined radiolucency at molar area, alveolar expansion and bone resorption of the left posterior alveolar ridge of the mandible. Complete surgical excision of the lesion was performed under general anaesthesia.  Histopathological examination revealed proliferation of spindle shaped cells with biphasic growth pattern. Immunohistochemical staining showed strong positivity with vimentin and smooth muscle actin whilst negative for desmin, S100 and CD34 establishing the diagnosis of myofibroma. Although rare, myofibroma should be considered as a differential diagnosis for solitary firm swelling in the oral cavity. Histopathological examination together with immunohistochemical analysis is essential for an accurate diagnosis.

scholarly journals Neurilemmoma of Retromolar Region in the Oral Cavity

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Ajit Singh Rathore ◽  
Deepti Srivastava ◽  
Nidhi Narwal ◽  
Devi Charan Shetty
Keyword(s):  
Oral Cavity ◽  
Surgical Excision ◽  
Nerve Sheath Tumor ◽  
Common Site ◽  
Immunohistochemistry Analysis ◽  
Nerve Sheath ◽  
Complete Surgical Excision ◽  
Retromolar Region ◽  
Slow Growing ◽  
Tissue Origin

Neurilemmoma also known as schwannoma is benign nerve sheath tumor rarely occurring in the oral cavity. Only 1% of all extracranial schwannomas show that intraoral occurrence with tongue is the commonest site and retromolar region is the least common site. It presents as encapsulated, slow growing, solitary, smooth-surfaced, usually asymptomatic tumor. We report a case of 70-year-old male with well-defined mass on left retromolar region which was painless and slow growing. Diagnosis is made by histological examination and immunohistochemistry analysis to confirm the neural tissue origin of the lesion. The treatment is complete surgical excision of the lesion without recurrence.

scholarly journals Efficacies of Two New Antifungal Agents, the Triazole Ravuconazole and the Echinocandin LY-303366, in an Experimental Model of Invasive Aspergillosis

2000 ◽  
Vol 44 (12) ◽  
pp. 3381-3388 ◽  
Author(s):  
Jenna Roberts ◽  
Kathleen Schock ◽  
Susan Marino ◽  
Vincent T. Andriole
Keyword(s):  
Body Weight ◽  
Invasive Aspergillosis ◽  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Antifungal Agent ◽  
Oral Therapy ◽  
Antifungal Agents ◽  
Rabbit Model ◽  
Active Agent ◽  
Aspergillus Antigen

ABSTRACT The efficacy of ravuconazole, a new triazole antifungal agent, and the echinocandin LY-303366 were evaluated in an immunosuppressed, temporarily leukopenic rabbit model of invasive aspergillosis. Oral therapy with ravuconazole at a dosage of 30 mg/kg of body weight per day or the echinocandin LY-303366, given intravenously in a dosage of 5 or 10 mg/kg, was begun 24 h after a lethal or sublethal challenge, and results were compared with those for amphotericin B therapy and untreated controls. Prophylaxis was also studied with LY-303366 given at a dosage of 5 or 10 mg/kg/day 48 h before lethal or sublethal challenge. Ravuconazole eliminated mortality, cleared aspergillus antigen from the serum, and eliminated Aspergillus fumigatus organisms from tissues of both lethally and sublethally challenged immunosuppressed animals with invasive aspergillosis. Although LY-303366, at both doses, prolonged survival and reduced aspergillus antigenemia, it did not eliminate aspergillus organisms from organ tissues. The half-lives of ravuconazole and LY-303366 in rabbits were 13 and 12.5 h, respectively, and no accumulation of either drug was seen after 6 days of treatment. Although LY-303366 showed activity in this rabbit model of invasive aspergillosis, ravuconazole was the more active agent, comparable to amphotericin B. Additional studies are needed to determine the potential of ravuconazole for use in the treatment of this infection.

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