- Email: [email protected]
Metastatic Fusospirochetal Abscess of the Orbit*
N O T E S , CASES, I N S T R U M E N T S METASTATIC FUSOSPIROCHETAL ABSCESS OF T H E ORBIT* L. L. TITCHE, M.D. Tucson, Arizona
Metastatic abscess of the orbit is not uncommon and orbital abscess caused by Borrelia vincentii and Fusiformis dentium is not rare, but the combination of the two is an unusual occurrence. In most instances the latter condition is the result of the extension to the orbit of an in fection of the maxillary sinus following a dental infection. Dunnington and Khorazo,' in 1936, reported a survey of the literature and found only 13 cases of ocu lar infection due to Borrelia vincentii and Fusiformis dentium. Walker* reported a case of abscess of the orbit and suppura tive panophthalmitis produced by these organisms as the result of an infection of the maxillary sinus following the ex traction of a tooth. Burch" reported a case of metastatic orbital infection from a staphylococcic pulmonary infection. Ber ens^ stated that metastatic abscess of the orbit occasionally arises in infectious dis eases, scarlet fever, chicken pox, and in fluenza, and from surgical operations for infections in other parts of the body, as pelvic cellulitis and uterine disease. Be cause of the rarity of the condition, it is believed that the following case is worth reporting. CASE REPORT
R. M. C , a white man, aged 52 years, was admitted to this hospital on October 10, 1944, for the treatment of bronchi-
ectasis, severe, bilateral. T h e pulmonary condition was too extensive for surgery and his therapy consisted of postural drainage and frequent bronchoscopies with the insufflation of sulfonamides into the bronchial tree. Sputum examination yielded Gram-negative fusiform bacilli and spirilla on smear. O n J a n u a r y 14, 1946, he complained of pain in the right eye. Examination re vealed slight puffiness of the right lower eyelid, but intraocular examination was negative. Heat was applied, and two days later the swelling had increased and it was noted that ocular motion was limited. On J a n u a r y 16, 1946, an abscess on the outer aspect of the left arm was incised. Purulent material was found which had a very acrid odor and was rather viscous and gray in appearance. Smears of this material revealed many spirilla and Gramnegative fusiform bacilli, but there was no growth on culture. By the following day, there was marked swelling of the right lower eyelid and fluctuation could be felt. T h e conjunctiva was markedly injected and the globe was proptosed about 6 mm. and fixed. A 22-gauge needle was intro duced in the area of fluctuation and pus was encountered at a depth of 3 cm. Aspiration yielded 4 cc. of thick, creamy, purulent material with a foul acrid odor. A n incision was made along the needle to the abscess cavity and a drain inserted. Smears of this material were found to contain bipolar staining bacilli, Grampositive cocci in chains, and spirilla. N o growth was obtained on culture. T h e abcess was irrigated frequently with 20,000 units of penicillin in 2 cc. of normal saline and within a week had completely healed. The proptosis subsided rapidly, but some
• From the Veterans Administration Hospital. Published with the permission of tlie chief medical director, Veterans Administration, who assumes no responsibility for the opinions exl)ressed or the conclusions drawn by the author. 1427
K2S
NOTES, CASES, INSTRUMENTS
limitation of motion of the globe persisted for several months. On J a n u a r y 28, 19Ί6, an abscess on the anteromedial aspect of the left thigh was incised with the finding of purulent material similar to that above. During this time a series of daily blood cultures for five days was reported as sterile after two weeks' incubation.
SUMMARY
A case of metastatic abscess of the orbit, accompanied by metastatic abscesses in other parts of the body due to Borrelia vincentii and Fusiformis dentium infec tion of bronchiectasis, has been reported. Veterans
Administration
Hospital.
REFERENCES
' Berens, Conrad. The Eye and Its Diseases. Philadelphia, W. B. Saunders Co., 19.18, p. 325. = Burch, Frank E. Metastatic orbital infection. Amer. Jour. Ophth., 1943, v. 26, March, pp. 253-260, ' Dunnington, J. H., and Khorazo, D,Conjunctivitis due to fusospirochetal infection. Arch, of Ophth., 1936, V. 16, p. 252. ' Walker, G. L. Fusospirochetal infection of the eye and orbit. Amer. Jour. Ophth., 1939, v. 22. June, pp. 622-625. TECHNIQUE OF CATARACT OP ERATION W I T H T H E ORAL.SUCTION C U P P I N G APPARATUS* PEDRO FALCAD, M.D. Ribeiräo Preto, Brazil
Intracapsular extraction of the lens by means of suction in operations for cata ract is an already known and approved method. It is the purpose of this paper to present an improved cupping apparatus and the technique of its use in order to acquaint ophthalmologists with a method of cataract extraction which is at once simple and safe. Although it is not the aim of this paper to discuss the various techniques of cata ract extraction, it would be well to refer to some of the fundamental principles upon which all these techniques are based. Among these a r e ; ( 1 ) Complete anesthesia and akinesia of the eye. ( 2 ) Corneoscleral sutures complete with a conjunctival flap. ( 3 ) Peripheral iridec-
tomy. ( 4 ) Intracapsular extraction of the lens. It is the purpose of this paper to dem onstrate that, no matter what kind of cataract is being operated, the cupping apparatus under discussion is the ideal instrument to use to extract the lens it self. Simple to apply, its handling is easy and delicate. Since there is automatic con trol of vacuum, the surgeon is able to do his task with a feeling of security. A s suring a precise apprehension at a chosen point, it permits an almost nontraumatic rupture of the zonule. T h e nucleus turns within its Ολνη capsule so that its pos terior surface becomes the anterior one when passing through the corneoscleral incision. DESCRIPTION OF APPARATUS
T h e apparatus is made up of four p a r t s : ( 1 ) T h e nozzle (the cupping part, itself) which is made of chrome-plated metal. This concha-shaped nozzle is one of the principal innovations of the instru ment. ( 2 ) A chrome-plated metal tubular body. ( 3 ) A tube made of rubber. ( 4 ) A mouthpiece.
* Report presented to the V. Brazilian Con gress of Ophthalmology, Salvador, Brazil, 1945.
Metastatic abscess of the orbit is not uncommon and orbital abscess caused by Borrelia vincentii and Fusiformis dentium is not rare, but the combination of the two is an unusual occurrence. In most instances the latter condition is the result of the extension to the orbit of an in fection of the maxillary sinus following a dental infection. Dunnington and Khorazo,' in 1936, reported a survey of the literature and found only 13 cases of ocu lar infection due to Borrelia vincentii and Fusiformis dentium. Walker* reported a case of abscess of the orbit and suppura tive panophthalmitis produced by these organisms as the result of an infection of the maxillary sinus following the ex traction of a tooth. Burch" reported a case of metastatic orbital infection from a staphylococcic pulmonary infection. Ber ens^ stated that metastatic abscess of the orbit occasionally arises in infectious dis eases, scarlet fever, chicken pox, and in fluenza, and from surgical operations for infections in other parts of the body, as pelvic cellulitis and uterine disease. Be cause of the rarity of the condition, it is believed that the following case is worth reporting. CASE REPORT
R. M. C , a white man, aged 52 years, was admitted to this hospital on October 10, 1944, for the treatment of bronchi-
ectasis, severe, bilateral. T h e pulmonary condition was too extensive for surgery and his therapy consisted of postural drainage and frequent bronchoscopies with the insufflation of sulfonamides into the bronchial tree. Sputum examination yielded Gram-negative fusiform bacilli and spirilla on smear. O n J a n u a r y 14, 1946, he complained of pain in the right eye. Examination re vealed slight puffiness of the right lower eyelid, but intraocular examination was negative. Heat was applied, and two days later the swelling had increased and it was noted that ocular motion was limited. On J a n u a r y 16, 1946, an abscess on the outer aspect of the left arm was incised. Purulent material was found which had a very acrid odor and was rather viscous and gray in appearance. Smears of this material revealed many spirilla and Gramnegative fusiform bacilli, but there was no growth on culture. By the following day, there was marked swelling of the right lower eyelid and fluctuation could be felt. T h e conjunctiva was markedly injected and the globe was proptosed about 6 mm. and fixed. A 22-gauge needle was intro duced in the area of fluctuation and pus was encountered at a depth of 3 cm. Aspiration yielded 4 cc. of thick, creamy, purulent material with a foul acrid odor. A n incision was made along the needle to the abscess cavity and a drain inserted. Smears of this material were found to contain bipolar staining bacilli, Grampositive cocci in chains, and spirilla. N o growth was obtained on culture. T h e abcess was irrigated frequently with 20,000 units of penicillin in 2 cc. of normal saline and within a week had completely healed. The proptosis subsided rapidly, but some
• From the Veterans Administration Hospital. Published with the permission of tlie chief medical director, Veterans Administration, who assumes no responsibility for the opinions exl)ressed or the conclusions drawn by the author. 1427
K2S
NOTES, CASES, INSTRUMENTS
limitation of motion of the globe persisted for several months. On J a n u a r y 28, 19Ί6, an abscess on the anteromedial aspect of the left thigh was incised with the finding of purulent material similar to that above. During this time a series of daily blood cultures for five days was reported as sterile after two weeks' incubation.
SUMMARY
A case of metastatic abscess of the orbit, accompanied by metastatic abscesses in other parts of the body due to Borrelia vincentii and Fusiformis dentium infec tion of bronchiectasis, has been reported. Veterans
Administration
Hospital.
REFERENCES
' Berens, Conrad. The Eye and Its Diseases. Philadelphia, W. B. Saunders Co., 19.18, p. 325. = Burch, Frank E. Metastatic orbital infection. Amer. Jour. Ophth., 1943, v. 26, March, pp. 253-260, ' Dunnington, J. H., and Khorazo, D,Conjunctivitis due to fusospirochetal infection. Arch, of Ophth., 1936, V. 16, p. 252. ' Walker, G. L. Fusospirochetal infection of the eye and orbit. Amer. Jour. Ophth., 1939, v. 22. June, pp. 622-625. TECHNIQUE OF CATARACT OP ERATION W I T H T H E ORAL.SUCTION C U P P I N G APPARATUS* PEDRO FALCAD, M.D. Ribeiräo Preto, Brazil
Intracapsular extraction of the lens by means of suction in operations for cata ract is an already known and approved method. It is the purpose of this paper to present an improved cupping apparatus and the technique of its use in order to acquaint ophthalmologists with a method of cataract extraction which is at once simple and safe. Although it is not the aim of this paper to discuss the various techniques of cata ract extraction, it would be well to refer to some of the fundamental principles upon which all these techniques are based. Among these a r e ; ( 1 ) Complete anesthesia and akinesia of the eye. ( 2 ) Corneoscleral sutures complete with a conjunctival flap. ( 3 ) Peripheral iridec-
tomy. ( 4 ) Intracapsular extraction of the lens. It is the purpose of this paper to dem onstrate that, no matter what kind of cataract is being operated, the cupping apparatus under discussion is the ideal instrument to use to extract the lens it self. Simple to apply, its handling is easy and delicate. Since there is automatic con trol of vacuum, the surgeon is able to do his task with a feeling of security. A s suring a precise apprehension at a chosen point, it permits an almost nontraumatic rupture of the zonule. T h e nucleus turns within its Ολνη capsule so that its pos terior surface becomes the anterior one when passing through the corneoscleral incision. DESCRIPTION OF APPARATUS
T h e apparatus is made up of four p a r t s : ( 1 ) T h e nozzle (the cupping part, itself) which is made of chrome-plated metal. This concha-shaped nozzle is one of the principal innovations of the instru ment. ( 2 ) A chrome-plated metal tubular body. ( 3 ) A tube made of rubber. ( 4 ) A mouthpiece.
* Report presented to the V. Brazilian Con gress of Ophthalmology, Salvador, Brazil, 1945.