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Juha Kere - One of the best experts on this subject based on the ideXlab platform.
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predictors of recurrent Cellulitis in five years clinical risk factors and the role of ptx3 and crp
Journal of Infection, 2015Co-Authors: Matti Karppelin, Juha Kere, Heini Huhtala, Tuula Siljander, Janne Aittoniemi, Reetta Huttunen, Mikko Hurme, Jaana VuopioAbstract:Summary Objectives To identify risk factors for recurrence of Cellulitis, and to assess the predictive value of pentraxin 3 (PTX3) and C-reactive protein (CRP) measured at baseline. Methods A follow up study of 90 hospitalised patients with acute non-necrotising Cellulitis was conducted. Clinical risk factors were assessed and PTX3 and CRP values were measured at baseline. Patients were contacted by phone at a median of 4.6 years after the baseline episode and the medical records were reviewed. Results Overall, 41% of the patients had a recurrence in the follow up. Of the patients with a history of a previous Cellulitis in the baseline study 57% had a recurrence in five year follow up as compared to 26% of those without previous episodes ( p = 0.003). In multivariate analysis, only the history of previous Cellulitis was identified as an independent predicting factor for recurrence. The levels of pentraxin 3 (PTX3) or C-reactive protein (CRP) in the acute phase did not predict recurrence. Conclusions Risk of recurrence is considerably higher after a recurrent episode than after the first episode. Clinical risk factors predisposing to the first Cellulitis episode plausibly predispose also to recurrences.
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evidence of streptococcal origin of acute non necrotising Cellulitis a serological study
European Journal of Clinical Microbiology & Infectious Diseases, 2015Co-Authors: Matti Karppelin, Juha Kere, Tuula Siljander, Annamaija Haapala, Janne Aittoniemi, Reetta Huttunen, Jaana Vuopio, Jaana SyrjanenAbstract:Bacteriological diagnosis is rarely achieved in acute Cellulitis. Beta-haemolytic streptococci and Staphylococcus aureus are considered the main pathogens. The role of the latter is, however, unclear in cases of non-suppurative Cellulitis. We conducted a serological study to investigate the bacterial aetiology of acute non-necrotising Cellulitis. Anti-streptolysin O (ASO), anti-deoxyribonuclease B (ADN) and anti-staphylolysin (ASTA) titres were measured from acute and convalescent phase sera of 77 patients hospitalised because of acute bacterial non-necrotising Cellulitis and from the serum samples of 89 control subjects matched for age and sex. Antibiotic treatment decisions were also reviewed. Streptococcal serology was positive in 53 (69 %) of the 77 cases. Furthermore, ten cases without serological evidence of streptococcal infection were successfully treated with penicillin. Positive ASO and ADN titres were detected in ten (11 %) and three (3 %) of the 89 controls, respectively, and ASTA was elevated in three patients and 11 controls. Our findings suggest that acute non-necrotising Cellulitis without pus formation is mostly of streptococcal origin and that penicillin can be used as the first-line therapy for most patients.
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factors predisposing to acute and recurrent bacterial non necrotizing Cellulitis in hospitalized patients a prospective case control study
Clinical Microbiology and Infection, 2010Co-Authors: Matti Karppelin, T Siljander, Jaana Vuopiovarkila, Juha Kere, Heini Huhtala, Risto Vuento, T Jussila, Jaana SyrjanenAbstract:Abstract Acute non-necrotizing Cellulitis is a skin infection with a tendency to recur. Both general and local risk factors for erysipelas or Cellulitis have been recognized in previous studies using hospitalized controls. The aim of this study was to identify risk factors for Cellulitis using controls recruited from the general population. We also compared patients with a history of previous Cellulitis with those suffering a single episode, with regard to the risk factors: length of stay in hospital, duration of fever, and inflammatory response as measured by C-reactive protein (CRP) level and leukocyte count. Ninety hospitalized Cellulitis patients and 90 population controls matched for age and sex were interviewed and clinically examined during the period April 2004 to March 2005. In multivariate analysis, chronic oedema of the extremity, disruption of the cutaneous barrier and obesity were independently associated with acute Cellulitis. Forty-four (49%) patients had a -positive history (PH) of at least one Cellulitis episode before entering the study. Obesity and previous ipsilateral surgical procedure were statistically significantly more common in PH patients, whereas a recent (
Daniela Kroshinsky - One of the best experts on this subject based on the ideXlab platform.
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estimating the health care costs associated with recurrent Cellulitis managed in the outpatient setting
Journal of The American Academy of Dermatology, 2018Co-Authors: Jessica St John, Lauren Strazzula, Priyanka Vedak, Daniela KroshinskyAbstract:Background Recurrent Cellulitis is diagnosed in 22% to 49% of all Cellulitis cases, but little is known about the costs associated with these cases. Objective To characterize patients with recurrent Cellulitis in the outpatient setting and estimate the associated costs. Methods A retrospective chart review was conducted for adult patients who presented to the outpatient facilities at our institution from January 1, 2007, to December 31, 2011, with recurrent Cellulitis. Data provided by the Centers for Medicare and Medicaid Services were used. Results A total of 157 patients were identified; 56% were male, with a mean age of 62.7 years. The mean number of episodes of Cellulitis per patient was 3. Antibiotics were prescribed for all patients with a diagnosis of recurrent Cellulitis, with 93% treated with oral antibiotics and 17.6% treated with intravenous antibiotics. A total of 1081 laboratory and 175 radiologic imaging tests were ordered. The minimum average cost per Cellulitis episode was $586.91; the average cost per visit was $292.50. Limitations Retrospective study; use of a single, large academic institution; and utilization of cost estimates that may not adequately reflect the variation of costs across closed-system sites or geographic regions. There was no accounting for the nonfinancial or opportunity costs associated with hospitalization, such as lost days of employment or child care and any long-term morbidities, among others. Conclusions Recurrent Cellulitis in the outpatient setting costs about $586.91 per episode. Although there is no criterion standard for diagnosis or treatment of Cellulitis, our analysis demonstrates the need for more evidence-based management to achieve better outcomes and reduce the significant health care costs.
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skin surface temperatures measured by thermal imaging aid in the diagnosis of Cellulitis
Journal of Investigative Dermatology, 2017Co-Authors: Lauren N Ko, Adam B Raff, Anna Cristina Garzamayers, Allison S Dobry, Antonio Ortegamartinez, Rox R Anderson, Daniela KroshinskyAbstract:Warmth is a characteristic but nondiagnostic feature of Cellulitis. We assessed the diagnostic utility of skin surface temperature in differentiating Cellulitis from pseudoCellulitis. Adult patients presenting to the emergency department of a large urban hospital with presumed Cellulitis were enrolled. Patients were randomized to dermatology consultation (n = 40) versus standard of care (n = 32). Thermal images of affected and unaffected skin were obtained for each patient. Analysis was performed on dermatology consultation patients to establish a predictive model for Cellulitis, which was then validated in the other cohort. Of those evaluated by dermatology consultation, pseudoCellulitis was diagnosed in 28%. Cellulitis patients had an average maximum affected skin temperature of 34.1°C, which was 3.7°C warmer than the corresponding unaffected area (95% confidence interval = 2.7–4.8°C, P P = 0.44). Temperature differences between sites were greater in Cellulitis patients than in pseudoCellulitis patients (3.7 vs. 0.2°C, P = 0.002). A logistic regression model showed that a temperature difference of 0.47°C or greater conferred a 96.6% sensitivity, 45.5% specificity, 82.4% positive predictive value, and 83.3% negative predictive value for Cellulitis diagnosis. When validated in the other cohort, this model gave the correct diagnosis for 100% of patients with Cellulitis and 50% of those with pseudoCellulitis. A difference threshold of 0.47°C or greater between affected and unaffected skin showed an 87.5% accuracy in Cellulitis diagnosis.
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a predictive model for diagnosis of lower extremity Cellulitis a cross sectional study
Journal of The American Academy of Dermatology, 2017Co-Authors: Adam B Raff, Daniela Kroshinsky, Qing Yu Weng, Jeffrey M Cohen, Nicole Gunasekera, Jeanphillip Okhovat, Priyanka Vedak, Cara Joyce, Arash MostaghimiAbstract:Background Cellulitis has many clinical mimickers (pseudoCellulitis), which leads to frequent misdiagnosis. Objective To create a model for predicting the likelihood of lower extremity Cellulitis. Methods A cross-sectional review was performed of all patients admitted with a diagnosis of lower extremity Cellulitis through the emergency department at a large hospital between 2010 and 2012. Patients discharged with diagnosis of Cellulitis were categorized as having Cellulitis, while those given an alternative diagnosis were considered to have pseudoCellulitis. Bivariate associations between predictor variables and final diagnosis were assessed to develop a 4-variable model. Results In total, 79 (30.5%) of 259 patients were misdiagnosed with lower extremity Cellulitis. Of the variables associated with true Cellulitis, the 4 in the final model were asymmetry (unilateral involvement), leukocytosis (white blood cell count ≥10,000/uL), tachycardia (heart rate ≥90 bpm), and age ≥70 years. We converted these variables into a points system to create the ALT-70 Cellulitis score as follows: Asymmetry (3 points), Leukocytosis (1 point), Tachycardia (1 point), and age ≥70 (2 points). With this score, 0-2 points indicate ≥83.3% likelihood of pseudoCellulitis, and ≥5 points indicate ≥82.2% likelihood of true Cellulitis. Limitations Prospective validation of this model is needed before widespread clinical use. Conclusion Asymmetry, leukocytosis, tachycardia, and age ≥70 are predictive of lower extremity Cellulitis. This model might facilitate more accurate diagnosis and improve patient care.
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costs and consequences associated with misdiagnosed lower extremity Cellulitis
JAMA Dermatology, 2017Co-Authors: Qing Yu Weng, Daniela Kroshinsky, Adam B Raff, Jeffrey M Cohen, Nicole Gunasekera, Jeanphillip Okhovat, Priyanka Vedak, Cara Joyce, Arash MostaghimiAbstract:Importance Inflammatory dermatoses of the lower extremity are often misdiagnosed as Cellulitis (aka “pseudoCellulitis”) and treated with antibiotics and/or hospitalization. There is limited data on the cost and complications from misdiagnosed Cellulitis. Objective To characterize the national health care burden of misdiagnosed Cellulitis in patients admitted for treatment of lower extremity Cellulitis. Design, Setting, and Participants Cross-sectional study using patients admitted from the emergency department (ED) of a large urban hospital with a diagnosis of lower extremity Cellulitis between June 2010 and December 2012. Patients who were discharged with a diagnosis of Cellulitis were categorized as having Cellulitis, while those who were given an alternative diagnosis during the hospital course, on discharge, or within 30 days of discharge were considered to have pseudoCellulitis. A literature review was conducted for calculation of large-scale costs and complication rates. We obtained national cost figures from the Medical Expenditure Panel Survey (MEPS), provided by the Agency for Healthcare Research and Quality (AHRQ) for 2010 to calculate the hospitalization costs per year attributed to misdiagnosed lower extremity pseudoCellulitis. Exposures The exposed group was composed of patients who presented to and were admitted from the ED with a diagnosis of lower extremity Cellulitis. Main Outcomes and Measures Patient characteristics, hospital course, and complications during and after hospitalization were reviewed for each patient, and estimates of annual costs of misdiagnosed Cellulitis in the United States. Results Of 259 patients, 79 (30.5%) were misdiagnosed with Cellulitis, and 52 of these misdiagnosed patients were admitted primarily for the treatment of Cellulitis. Forty-four of the 52 (84.6%) did not require hospitalization based on ultimate diagnosis, and 48 (92.3%) received unnecessary antibiotics. We estimate Cellulitis misdiagnosis leads to 50 000 to 130 000 unnecessary hospitalizations and $195 million to $515 million in avoidable health care spending. Unnecessary antibiotics and hospitalization for misdiagnosed Cellulitis are projected to cause more than 9000 nosocomial infections, 1000 to 5000 Clostridium difficile infections, and 2 to 6 cases of anaphylaxis annually. Conclusions and Relevance Misdiagnosis of lower extremity Cellulitis is common and may lead to unnecessary patient morbidity and considerable health care spending.
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Cellulitis a review
JAMA, 2016Co-Authors: Adam B Raff, Daniela KroshinskyAbstract:Importance Cellulitis is an infection of the deep dermis and subcutaneous tissue, presenting with expanding erythema, warmth, tenderness, and swelling. Cellulitis is a common global health burden, with more than 650 000 admissions per year in the United States alone. Observations In the United States, an estimated 14.5 million cases annually of Cellulitis account for $3.7 billion in ambulatory care costs alone. The majority of cases of Cellulitis are nonculturable and therefore the causative bacteria are unknown. In the 15% of Cellulitis cases in which organisms are identified, most are due to β-hemolytic Streptococcus and Staphylococcus aureus . There are no effective diagnostic modalities, and many clinical conditions appear similar. Treatment of primary and recurrent Cellulitis should initially cover Streptococcus and methicillin-sensitive S aureus , with expansion for methicillin-resistant S aureus (MRSA) in cases of Cellulitis associated with specific risk factors, such as athletes, children, men who have sex with men, prisoners, military recruits, residents of long-term care facilities, those with prior MRSA exposure, and intravenous drug users. Five days of treatment is sufficient with extension if symptoms are not improved. Addressing predisposing factors can minimize risk of recurrence. Conclusions and Relevance The diagnosis of Cellulitis is based primarily on history and physical examination. Treatment of uncomplicated Cellulitis should be directed against Streptococcus and methicillin-sensitive S aureus . Failure to improve with appropriate first-line antibiotics should prompt consideration for resistant organisms, secondary conditions that mimic Cellulitis, or underlying complicating conditions such as immunosuppression, chronic liver disease, or chronic kidney disease.
Matti Karppelin - One of the best experts on this subject based on the ideXlab platform.
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predictors of recurrent Cellulitis in five years clinical risk factors and the role of ptx3 and crp
Journal of Infection, 2015Co-Authors: Matti Karppelin, Juha Kere, Heini Huhtala, Tuula Siljander, Janne Aittoniemi, Reetta Huttunen, Mikko Hurme, Jaana VuopioAbstract:Summary Objectives To identify risk factors for recurrence of Cellulitis, and to assess the predictive value of pentraxin 3 (PTX3) and C-reactive protein (CRP) measured at baseline. Methods A follow up study of 90 hospitalised patients with acute non-necrotising Cellulitis was conducted. Clinical risk factors were assessed and PTX3 and CRP values were measured at baseline. Patients were contacted by phone at a median of 4.6 years after the baseline episode and the medical records were reviewed. Results Overall, 41% of the patients had a recurrence in the follow up. Of the patients with a history of a previous Cellulitis in the baseline study 57% had a recurrence in five year follow up as compared to 26% of those without previous episodes ( p = 0.003). In multivariate analysis, only the history of previous Cellulitis was identified as an independent predicting factor for recurrence. The levels of pentraxin 3 (PTX3) or C-reactive protein (CRP) in the acute phase did not predict recurrence. Conclusions Risk of recurrence is considerably higher after a recurrent episode than after the first episode. Clinical risk factors predisposing to the first Cellulitis episode plausibly predispose also to recurrences.
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evidence of streptococcal origin of acute non necrotising Cellulitis a serological study
European Journal of Clinical Microbiology & Infectious Diseases, 2015Co-Authors: Matti Karppelin, Juha Kere, Tuula Siljander, Annamaija Haapala, Janne Aittoniemi, Reetta Huttunen, Jaana Vuopio, Jaana SyrjanenAbstract:Bacteriological diagnosis is rarely achieved in acute Cellulitis. Beta-haemolytic streptococci and Staphylococcus aureus are considered the main pathogens. The role of the latter is, however, unclear in cases of non-suppurative Cellulitis. We conducted a serological study to investigate the bacterial aetiology of acute non-necrotising Cellulitis. Anti-streptolysin O (ASO), anti-deoxyribonuclease B (ADN) and anti-staphylolysin (ASTA) titres were measured from acute and convalescent phase sera of 77 patients hospitalised because of acute bacterial non-necrotising Cellulitis and from the serum samples of 89 control subjects matched for age and sex. Antibiotic treatment decisions were also reviewed. Streptococcal serology was positive in 53 (69 %) of the 77 cases. Furthermore, ten cases without serological evidence of streptococcal infection were successfully treated with penicillin. Positive ASO and ADN titres were detected in ten (11 %) and three (3 %) of the 89 controls, respectively, and ASTA was elevated in three patients and 11 controls. Our findings suggest that acute non-necrotising Cellulitis without pus formation is mostly of streptococcal origin and that penicillin can be used as the first-line therapy for most patients.
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factors predisposing to acute and recurrent bacterial non necrotizing Cellulitis in hospitalized patients a prospective case control study
Clinical Microbiology and Infection, 2010Co-Authors: Matti Karppelin, T Siljander, Jaana Vuopiovarkila, Juha Kere, Heini Huhtala, Risto Vuento, T Jussila, Jaana SyrjanenAbstract:Abstract Acute non-necrotizing Cellulitis is a skin infection with a tendency to recur. Both general and local risk factors for erysipelas or Cellulitis have been recognized in previous studies using hospitalized controls. The aim of this study was to identify risk factors for Cellulitis using controls recruited from the general population. We also compared patients with a history of previous Cellulitis with those suffering a single episode, with regard to the risk factors: length of stay in hospital, duration of fever, and inflammatory response as measured by C-reactive protein (CRP) level and leukocyte count. Ninety hospitalized Cellulitis patients and 90 population controls matched for age and sex were interviewed and clinically examined during the period April 2004 to March 2005. In multivariate analysis, chronic oedema of the extremity, disruption of the cutaneous barrier and obesity were independently associated with acute Cellulitis. Forty-four (49%) patients had a -positive history (PH) of at least one Cellulitis episode before entering the study. Obesity and previous ipsilateral surgical procedure were statistically significantly more common in PH patients, whereas a recent (
Jaana Vuopio - One of the best experts on this subject based on the ideXlab platform.
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predictors of recurrent Cellulitis in five years clinical risk factors and the role of ptx3 and crp
Journal of Infection, 2015Co-Authors: Matti Karppelin, Juha Kere, Heini Huhtala, Tuula Siljander, Janne Aittoniemi, Reetta Huttunen, Mikko Hurme, Jaana VuopioAbstract:Summary Objectives To identify risk factors for recurrence of Cellulitis, and to assess the predictive value of pentraxin 3 (PTX3) and C-reactive protein (CRP) measured at baseline. Methods A follow up study of 90 hospitalised patients with acute non-necrotising Cellulitis was conducted. Clinical risk factors were assessed and PTX3 and CRP values were measured at baseline. Patients were contacted by phone at a median of 4.6 years after the baseline episode and the medical records were reviewed. Results Overall, 41% of the patients had a recurrence in the follow up. Of the patients with a history of a previous Cellulitis in the baseline study 57% had a recurrence in five year follow up as compared to 26% of those without previous episodes ( p = 0.003). In multivariate analysis, only the history of previous Cellulitis was identified as an independent predicting factor for recurrence. The levels of pentraxin 3 (PTX3) or C-reactive protein (CRP) in the acute phase did not predict recurrence. Conclusions Risk of recurrence is considerably higher after a recurrent episode than after the first episode. Clinical risk factors predisposing to the first Cellulitis episode plausibly predispose also to recurrences.
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evidence of streptococcal origin of acute non necrotising Cellulitis a serological study
European Journal of Clinical Microbiology & Infectious Diseases, 2015Co-Authors: Matti Karppelin, Juha Kere, Tuula Siljander, Annamaija Haapala, Janne Aittoniemi, Reetta Huttunen, Jaana Vuopio, Jaana SyrjanenAbstract:Bacteriological diagnosis is rarely achieved in acute Cellulitis. Beta-haemolytic streptococci and Staphylococcus aureus are considered the main pathogens. The role of the latter is, however, unclear in cases of non-suppurative Cellulitis. We conducted a serological study to investigate the bacterial aetiology of acute non-necrotising Cellulitis. Anti-streptolysin O (ASO), anti-deoxyribonuclease B (ADN) and anti-staphylolysin (ASTA) titres were measured from acute and convalescent phase sera of 77 patients hospitalised because of acute bacterial non-necrotising Cellulitis and from the serum samples of 89 control subjects matched for age and sex. Antibiotic treatment decisions were also reviewed. Streptococcal serology was positive in 53 (69 %) of the 77 cases. Furthermore, ten cases without serological evidence of streptococcal infection were successfully treated with penicillin. Positive ASO and ADN titres were detected in ten (11 %) and three (3 %) of the 89 controls, respectively, and ASTA was elevated in three patients and 11 controls. Our findings suggest that acute non-necrotising Cellulitis without pus formation is mostly of streptococcal origin and that penicillin can be used as the first-line therapy for most patients.
Jaana Syrjanen - One of the best experts on this subject based on the ideXlab platform.
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evidence of streptococcal origin of acute non necrotising Cellulitis a serological study
European Journal of Clinical Microbiology & Infectious Diseases, 2015Co-Authors: Matti Karppelin, Juha Kere, Tuula Siljander, Annamaija Haapala, Janne Aittoniemi, Reetta Huttunen, Jaana Vuopio, Jaana SyrjanenAbstract:Bacteriological diagnosis is rarely achieved in acute Cellulitis. Beta-haemolytic streptococci and Staphylococcus aureus are considered the main pathogens. The role of the latter is, however, unclear in cases of non-suppurative Cellulitis. We conducted a serological study to investigate the bacterial aetiology of acute non-necrotising Cellulitis. Anti-streptolysin O (ASO), anti-deoxyribonuclease B (ADN) and anti-staphylolysin (ASTA) titres were measured from acute and convalescent phase sera of 77 patients hospitalised because of acute bacterial non-necrotising Cellulitis and from the serum samples of 89 control subjects matched for age and sex. Antibiotic treatment decisions were also reviewed. Streptococcal serology was positive in 53 (69 %) of the 77 cases. Furthermore, ten cases without serological evidence of streptococcal infection were successfully treated with penicillin. Positive ASO and ADN titres were detected in ten (11 %) and three (3 %) of the 89 controls, respectively, and ASTA was elevated in three patients and 11 controls. Our findings suggest that acute non-necrotising Cellulitis without pus formation is mostly of streptococcal origin and that penicillin can be used as the first-line therapy for most patients.
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factors predisposing to acute and recurrent bacterial non necrotizing Cellulitis in hospitalized patients a prospective case control study
Clinical Microbiology and Infection, 2010Co-Authors: Matti Karppelin, T Siljander, Jaana Vuopiovarkila, Juha Kere, Heini Huhtala, Risto Vuento, T Jussila, Jaana SyrjanenAbstract:Abstract Acute non-necrotizing Cellulitis is a skin infection with a tendency to recur. Both general and local risk factors for erysipelas or Cellulitis have been recognized in previous studies using hospitalized controls. The aim of this study was to identify risk factors for Cellulitis using controls recruited from the general population. We also compared patients with a history of previous Cellulitis with those suffering a single episode, with regard to the risk factors: length of stay in hospital, duration of fever, and inflammatory response as measured by C-reactive protein (CRP) level and leukocyte count. Ninety hospitalized Cellulitis patients and 90 population controls matched for age and sex were interviewed and clinically examined during the period April 2004 to March 2005. In multivariate analysis, chronic oedema of the extremity, disruption of the cutaneous barrier and obesity were independently associated with acute Cellulitis. Forty-four (49%) patients had a -positive history (PH) of at least one Cellulitis episode before entering the study. Obesity and previous ipsilateral surgical procedure were statistically significantly more common in PH patients, whereas a recent (