Background The Dundee classification of cellulitis severity, previously shown to predict disease outcomes, provides an opportunity to improve the management of patients with cellulitis. Methods We developed and implemented a pathway to guide the management of adults with cellulitis based on their Dundee severity class, and measured its effect on patient outcomes. We compared the outcomes in patients admitted to Auckland City Hospital (ACH) between July 2014 and July 2015 (the baseline cohort) with those in patients admitted between June 2017 and June 2018 (the intervention cohort). Results The median length of stay was shorter in the intervention cohort (0.7 days, IQR 0.1 to 3.0 days) than in the baseline cohort (1.8 days, IQR 0.1 to 4.4 days; P<0.001). The 30 day mortality rate declined from 1.8% (19/1092) in the baseline cohort to 0.7% (10/1362; P=0.02) in the intervention cohort. The 30 day cellulitis readmission rate increased from 6% in the baseline cohort to 11% (P<0.001) in the intervention cohort. Adherence to the ACH cellulitis antibiotic guideline improved from 38% to 48% (P<0.01) and was independently associated with reduced length of stay. Conclusions The implementation of the Auckland cellulitis pathway, readily generalizable to other settings, improved the outcomes in patients with cellulitis, and resulted in an annual saving of approximately 1,000 bed days.

Tumours of the umbilical cord represent an exceedingly rare group of lesions and include teratoma and vascular lesions. Such vascular lesions have received different labels in the past including haemangioma and angiomyxoma, which are considered by some as variations of the same lesion. Presented here is a case of angiomyxoma of the umbilical cord including clinical and pathological findings, as well as a review of the available literature. This case review involves a 29-year-old, gravida 5 para 3, female who presented with umbilical cord mass detected on ultrasound at 23 weeks gestation. The patient delivered a healthy liveborn infant at 38 weeks by caesarean section. Macroscopic examination of the placenta demonstrated a 68 mm rounded mass towards the placental end of the cord with a glistening cut surface. Microscopic examination revealed an umbilical cord lesion composed of small but variably sized, thin walled vessels with abundant myxoid stroma. The associated endothelial cells were CD31 positive, ERG positive and D2-40 negative without significant atypia or increased mitotic activity. This case has been presented as a demonstration of a rare placental tumour that can be associated with increased foetal morbidity and mortality.

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