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SUMMARY A fulminant case of endophthalmitis due to Clostridium septicum is described. The patient presented with spontaneous gas gangrene panophthalmitis, with early visual loss and an air bubble in the anterior chamber. Death ensued, and necropsy revealed changes consistent with severe arterosclerotic cardiovascular disease, a relationship not uncommon in patients with clostridium sepsis. This association as well as the histopathology of the globe are discussed.Gas gangrene panophthalmitis is a rare condition usually following penetrating injury to the globe. In most of the reported cases the infecting organism has been Clostridiumn perfringens.'Characteristic findings are brawny swelling of the lids, coffee coloured discharge, hypopyon, ring abscess of the cornea, gas bubbles in the anterior chamber, and early loss of vision. Systemic manifestations include fever and leucocytosis, malaise, nausea, and vomiting. Treatment generally consists of evisceration or enucleation of the globe and systemic antibiotics. Extraocular extension of infection is prevented by well timed surgical intervention.To the best of our knowledge, this paper is the first report of gas gangrene panophthalmitis due to Clostridium septiclunm. Case reportA 78-year-old Caucasian woman was admitted to hospital on 15 October 1981 with a 24-hour history of nausea, vomiting, and mild abdominal pain. The diagnosis on admission was dehydration and acute gastroenteritis. There was a history of atherosclerotic heart disease and degenerative arthritis. Vital signs at the time of admission showed a blood pressure of 152/80 mmHg, respiration rate of 20/min, a slight tachycardia, and a temperature of 101°F (38-3°C).Examination revealed a slightly obese Caucasian woman who was vomiting and complaining of abdominal pain. The heart and lung examination was normal. The abdominal examination revealed Corrcspondencc to Michael S Inslcr. MD. 774 tenderness but good bowel sounds. The white cell count was 28 9x 109/1; the haemoglobin was 13 7 g/dl, and the packed cell volume was 40-1%.Later on that evening the patient became confused and hypotensive and had a respiratory arrest. She responded to cardiorespiratory resuscitation and was transferred to the intensive care unit. The differential diagnosis at that time included a myocardial infarction and gastrointestinal haemorrhage. A serous discharge was noted from the right eye, and lid and conjunctival specimens were taken for culture. Erythromycin 500 mg intravenously six hourly was added to the cefamandole begun on admission.Two days after admission while the patient was on a ventilator her temperature spiked to 104-60F (40 3°C) and blood cultures were obtained. A heart and a perfusion lung scan were performed, and both were within normal limits. An ophthalmology consultation was obtained, at which time a gas bubble was noted in the anterior chamber.

Background: The postauricular area is often explored by reconstructive and otologic surgeons. We previously reported on the use of postauricular tissues as a graft for wrapping hydroxyapatite implants in orbital reconstruction. This procedure reduced the incidence of implant exposure, while achieving acceptable cosmetic results. Although much is known about the postauricular area, muscle and fascial relationships and potential variations in anatomy remain ill defined. Objectives: To identify and analyze variations in the patterns of the postauricular muscle complex (PMC) and to study the relationships of the fascial contributions from the components that make up the PMC. Methods: Dissections were performed using 40 fresh specimens. Muscular and fascial components of the PMC were dissected, analyzed, and photographed. Results: The PMC receives contributions from the occipitalis and trapezius muscles, the deep temporal and sternocleidomastoid fasciae, and the superior and posterior auricular and platysma muscles. Major contributors to the PMC were present in every specimen. Minor contributors were more variable in their presence and contributions. The posterior auricular muscle was identified as having several muscle bundles in 1 specimen and absent in 2 specimens (5%). The occipitalis fascia was seen to insert superior to the auricle and to blend with the deep temporal fascia in 3 cases (7%). The platysma muscle contributed to the PMC in 8 cases (20%). Conclusions: This study demonstrated important variations in the presence and contributions of 7 previously known muscular structures and their role in forming the PMC. Seven distinct patterns are identified, and the potential clinical implications of these anatomical variations are illustrated.