Recently, the number of agents to treat ocular allergy has increased dramatically, from three (pheniramine, antazoline, cromolyn) to more than a dozen. A general increase in the incidence of atopy in recent years and the fact that patients are becoming less tolerant of bothersome signs and symptoms have been driving forces in this increase. As visual tasking, such as reading and working on a computer, has become more prevalent, there is an increased awareness of ocular allergy and the impact it has on quality of life and productivity at work and school. With the need for more effective medications, the development of models, such as the conjunctival allergen challenge (CAC), has made the identification of new agents more efficient. In this article, we review the relevant background on the science behind allergen challenges in the eye, how models are designed, and how models are used in the field today.
Four cases of necrotizing soft tissue infections of the upper extremity are presented. Each involved minor wounds to the hand that gradually progressed to fulminant infection. Two of the patients reported a history of alcohol abuse. One patient had psychiatric illness that led to delay in recognizing the infection and seeking intervention. The causative organism in all cases was group A beta hemolytic streptococcus. Fortunately, none of the patients suffered loss of the affected extremity, although long-term function is limited. The necrotizing soft tissue infection encountered in these cases represents a less severe presentation than classic necrotizing fasciitis. Necrotizing soft tissue infections are properly recognized as a spectrum of disease and can, as in these cases, follow a prolonged progression with limited systemic involvement. The current literature regarding diagnosis and treatment of necrotizing soft tissue infections is reviewed.
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