Search

Orbital cellulitis is a rare disease usually caused by sinusitis. Generally, the prognosis of both preseptal cellulitis and orbital cellulitis is favourable. Radiological distinction should be made between an orbital abscess and subperiosteal empyema. Theoretically, empyema is more accessible to antibiotics and, as it arises in a pre-existing anatomical space, it needs less aggressive treatment than an abscess. In contrast, the wall of an abscess created by the bacteria is scarcely permeable to antibiotics. Indications for surgical drainage should be based on clinical findings and not on Chandler's classification. Loss of vision, an unresponsive pupil or a densely packed orbit are indications for immediate surgical drainage. Drainage of an orbital abscess may speed up recovery

Background: Ankylosing spondylitis (AS) is not only characterized by excessive bone formation, but also by excessive bone loss which may lead to low bone mineral density (BMD). So far, little is known about the effect of treatment with bisphosphonates on BMD in patients with AS. Objectives: To evaluate the effect of bisphosphonates in combination with calcium/vitamin D supplements on BMD over 2 years in patients with AS stratified for the use of TNF-α inhibitors. Methods: Patients from the Groningen Leeuwarden AS (GLAS) cohort, fulfilling the modified New York criteria for AS, who were treated with bisphosphonates and had 2-year follow-up BMD measurements available were included. All patients were treated with bisphosphonates in combination with calcium and/or vitamin D supplements. Alendronate (70 mg/week) and risedronate (35 mg/week) were used most frequently. BMD of the lumbar spine (anterior-posterior projection at L1-L4) and hip (total proximal femur) were measured using DXA. Wilcoxon-signed rank test was used to compare BMD scores at first visit and after 2 years. Analyses were stratified for the use of TNF-α inhibitors. Results: In total, 28 patients were included; 68% were male, 82% HLA-B27+, mean age was 53 ± 14 years, median symptom duration 20 years (range 1-60), and mean BASDAI 5.1±2.5. Fifteen patients (54%) started treatment with bisphosphonates before inclusion in the GLAS cohort (median 3.1 years). Most patients (86%) used bisphosphonates during the entire 2-year follow-up within GLAS. Overall, lumbar spine BMD increased significantly from median Z-score of -0.8 at first visit to -0.3 after 2 years of treatment with bisphosphonates within the GLAS cohort. Hip BMD increased significantly from -1.1 at first visit to -0.9 after 2 years. In the 10 patients not using TNF-α inhibitors, only lumbar spine BMD increased significantly after 2 years of treatment. In the 14 patients starting TNF-α inhibitors, lumbar spine and hip BMD increased significantly after 2 years. The remaining 4 patients already used TNF-α inhibitors (Table 1). Comparable results were found for BMD T-scores. Conclusions: In our observational cohort study, lumbar spine BMD improved significantly after 2 years of follow-up in all AS patients treated with bisphosphonates. This improvement was most pronounced in patients starting TNF-α inhibitors. Hip BMD only improved significantly in patients also starting TNF-α inhibitors. (Table Presented).

Objective: Curacao (12 degrees 10N, 69 degrees 0W) is characterized by whole year abundant sunshine (8-10 hours/day). We challenged the automatic assumption that people living in tropical countries do not have a high risk of vitamin D deficiency, and investigated the vitamin D status in a tropical environment. Methods: For this, we selected fifty-two elderly people with little or no exposure to direct sunlight [median 84 (60-96) years; 34 females, 18 males] and who were cared for by community nurses or lived in retirement or nursing homes. Furthermore, six rehabilitating orthopaedic patients [median 72 (38-90) years; one female, five males] were included. Serum 25 (OH)D, calcium, phosphate, parathyroid hormone (PTH) and creatinine were measured. Those exhibiting elevated creatinine, PTH or both had their 1,25-dihydroxyvitamin D [1,25 (OH)(2)D] examined. Results: Serum levels of 25 (OH)D below 25, 50 and 75 nmol/L were detected in, respectively, seven (12%), 22 (38%) and 48 (83%) of the fifty-eight persons. Four persons had combined high creatinine and PTH, and low 1,25 (OH)2D, which was not known by their caregivers. Conclusion: Abundant sunshine outdoors is no guarantee for vitamin D sufficiency More attention is needed for vitamin D deficiency in risk groups living in tropical areas and elderly persons with poor kidney function.