[Controlled opening of wounds with the apparatus of pin cutaneous fixation as a method of treatment in anaerobic infections of the lower limbs]

A method of postoperative treatment of the anaerobic infection of the lower extremity soft tissues is proposed which consists in the wide opening of the wounds with a simple device. Fixation of the extremity in the device is provided by the intracutaneously conducted and strained extension wires. Due to the effect of decompression of the tissues, gaping wounds and extension of the skin margins, there appear conditions for subsiding the inflammation, effective control, management of the wounds and closing of them by secondary sutures to form a linear cicatrix. The authors succeeded in shortening the time of preparing the wound for closure and obtaining better results.

[Clostridium myonecrosis as a sequelae of intramuscular injections--description of 3 fatal outcomes]

In three fatal cases of clostridial myonecrosis, the following criteria were found: repeated intramuscular injections over several years with anti-inflammatory substances, delay in diagnosis in outpatient care, and following uncontrollable systemic septic complications, despite radical surgical treatment. Only early, aggressive surgical interventions can stop the rapid course of necrotizing soft-tissue infections.

[Group A Streptococcus pyomyositis]

BACKGROUND

Pyomyositis is a group of infectious diseases involving muscle tissue. Staphylococcus aureus is usually the causal agent. Group A Streptococcus infections are uncommonly isolated in pyomyositis. Streptococcal pyomyositis can be distinguished by its severity. Death rate may be as high as 50%.

CASE REPORTS

Diagnosis of cervical pyomyositis was made in 2 patients on the basis of ultrasound and computerized tomography findings. Group A Streptococcus was isolated from local samples. The diagnosis was confirmed at surgery. Host defense mechanisms were not deficient in either patient. Outcome was favorable in both patients after antibiotic therapy.

DISCUSSION

Because of the seventy of group A streptococcal pyomyositis, early diagnosis is essential for prognosis. Ultrasound and computerized tomography are very helpful. Group A streptococcal pyomyositis should be considered as a life-threatening disease.

Peptostreptococcal myonecrosis of extraperitoneal origin--a life-threatening complication of pelvic ring disruption

This report illustrates the clinical and pathological findings of anaerobic streptococcal myonecrosis following extraperitoneal rectal injury in a 28-year-old patient with traumatic pelvic ring disruption. Four days following admission, the patient underwent laparotomy, debridement and drainage of the left-sided abdominal wall and presacral space for gross surgical emphysema and streptococcal anaerobic myonecrosis. The specificity of this infection and its impact on the diagnosis and treatment of the condition are briefly discussed. Accent is given to early recognition, appropriate medical and surgical management, and hyperbaric oxygenation as an additive measure.

Histoplasma capsulatum necrotizing myofascitis of the upper extremity

Necrotizing myofascial fungal infections of the upper extremity is a rare event even in immunocompromised hosts. We report the course of a renal transplant patient who developed extensive necrotizing myofascial infection of an upper extremity secondary to Histoplasma capsulatum. Initial, functional, upper limb salvage was achieved after aggressive surgical debridement and high doses of amphotericin B. The patient ultimately succumbed to systemic fungal sepsis. The etiology and treatment of these infections are discussed.

Iliacus pyomyositis mimicking septic arthritis of the hip joint

The iliacus muscle is closely associated with the psoas muscle, femoral nerve, hip joint, pelvic and intraabdominal structures; thus, its disorders may present as lower abdominal pain, hip pain, or femoral neuropathy. Iliacus pyomyositis, a primary bacterial infection of the skeletal muscle not secondary to a contiguous skin, bone, or soft-tissue infection, presenting as hip pain, femoral neuropathy, and sympathetic effusion of the hip joint in an 8-year-old boy mimicked septic arthritis of the hip joint. Computed tomography was helpful in delineating the accurate location of the lesion. Surgical drainage and appropriate antibiotic therapy led to complete resolution and full functional recovery.

Relapsing focal myositis: a case report

We present a 9 year old boy with a focal myositis presenting as a pseudotumor on the right calf. Other smaller masses were present in the thigh and pretibial area on the same leg. The principal lesion recurred after two surgical excisions. Corticosteroid treatment was unsuccessful. However, methotrexate therapy resulted in a progressive regression of the lesions.

Pyomyositis in an adolescent female athlete

A case of pyomyositis in a healthy 13-year-old female volleyball player is presented and discussed. This case is unusual because, historically, pyomyositis has been more common in males, especially those who participate in strenuous physical activity. However, competitive sports and vigorous exercise programs are becoming more widely available to young females. Therefore, a relative increase in the number of adolescent women with pyomyositis can be expected.

Successful percutaneous drainage of gluteal pyomyositis occurring after intra-arterial chemotherapy and pelvic irradiation

Pyomyositis, an unusual infection of large skeletal muscles, developed in a woman with a history of bulky stage IIIB cervical cancer. Three years prior, the woman had undergone aggressive neoadjuvant intra-arterial chemotherapy followed by pelvic irradiation. The overwhelming majority of pyomyositis cases is caused by Staphylococcus aureus. Group B beta-hemolytic streptococcus, an organism that rarely causes this infection, was isolated in this case. Although surgical drainage is the most common approach, successful percutaneous drainage was accomplished. Pyomyositis has only recently been reported in non-tropical climates. The presentation, diagnosis, risk factors, and management of pyomyositis are discussed.

[Non-tropical pyomyositis]

This is a report on a 51-year-old man with all the symptoms of a non-tropical pyomyositis, namely a prodromal stage with lassitude, associated with a high fever and diffuse joint and muscle pain followed by the gradual development of a full-blown invasive stage. In the suppurative stage, the extensive pus is caused by staphylococcus aureus located in the extensor muscle of the right thigh.

Primary closure following drainage of a rectus sheath muscle abscess

The primary closure of a rectus sheath muscle abscess was performed on an 11-year-old child following evacuation of its contents under antimicrobial cover. Complete healing was achieved in eight days. This method avoids the delays in wound healing and morbidity associated with conventional drainage and shortens convalescence.

Pyomyositis in children

Bacterial infections of muscle, also known as pyomyositis or tropical pyomyositis, occur more commonly in tropical regions. This article reviews five cases of pyomyositis diagnosed in children over a 1-year period. Pyomyositis should be considered in the differential diagnosis of septic-appearing children as well as children complaining of joint pain or muscle aches. The diagnosis can be aided with either a computed tomography (CT) or magnetic resonance imaging (MRI) scan. The MRI is preferable because multiple processes can be evaluated, such as joint effusion suggesting septic arthritis. If the patient does not respond quickly to antibiotics and surgical intervention, either there is a recurrence of the previously debrided abscess, or there is an unrecognized secondary abscess. Multiple abscess sites should be entertained prior to initial debridement.

Focal myositis of the thigh: report of two cases

Focal myositis is a benign inflammatory pseudotumor of skeletal muscle, presenting as a localized painful swelling within the soft tissue of an extremity. Histological examination reveals lymphocytic infiltration, scattered muscle fiber necrosis and regeneration, and interstitial fibrosis. Complete recovery follows surgical removal of the lesion. Two cases are presented of young active males with a localized painful swelling of the thigh. Clinical examination, standard laboratory tests, electromyography (EMG), magnetic resonance imaging (MRI) and surgical biopsies were performed. Surgical biopsies were formalin-fixed, paraffin-embedded and sections were stained with hematoxylin and eosin, van Gieson, modified Gomori trichrome and Mallory's method for iron. Clinical examination in both cases revealed an indolent lump in the quadriceps femoris muscle. Standard laboratory tests and electromyography were normal. MRI prior to surgery visualized the focal nature of the lesions. Histological examination of repeated surgical biopsies showed scattered muscle fiber necrosis, regeneration, and interstitial fibrosis but few lymphocytes. Both patients recovered after surgical removal of the lesion. Two years after surgery there was no recurrence of the lesions and repeated EMGs were normal.

Three cases of staphylococcal pyomyositis in adolescence, including one patient with neurologic compromise

Pyomyositis is rarely reported in the United States and is not easily recognized. In a 4-year period, we treated three adolescents from our vicinity with muscle infection resulting from Staphylococcus aureus. One was an insulin-dependent diabetic patient. Two patients had deep infections about their pelvis, one of which resulted in acute loss of bowel and bladder function. In all three cases, the patient did not recover until the abscess was operatively drained. Diagnosis was delayed because of lack of awareness of the condition, the deep muscles involved, and clinical presentation before formation of a localized abscess. Indium scan may be a very useful initial diagnostic test.

Subcutaneous nodules caused by Pseudomonas aeruginosa: healing without incision and drainage

In a patient with multiple myeloma, numerous indurated, subcutaneous nodules and pyomyositis due to Pseudomonas aeruginosa were noted. These lesions resolved with ciprofloxacin plus ceftazidime therapy without surgical incision and drainage. Despite another course of cancer chemotherapy after total disappearance, there were no recurrences at the end of 3 months. Quinolones initially combined with other antipseudomonal beta-lactam agents may be the drugs of choice in the management of patients with subcutaneous nodules caused by P. aeruginosa.

Spontaneous gas-forming bacterial myonecrosis caused by group B streptococci and peptostreptococci

We present the case of a patient who spontaneously developed a severe gas-forming infection involving the voluntary muscles of both thighs. The organisms responsible were group B beta-haemolytic streptococci together with peptostreptococci. Following surgical and medical treatment, the patient fully recovered. No predisposing factors, in particular no disease causing immunocompromise, could be identified.

Temperate zone pyomyositis

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Management of dysphagia in inclusion body myositis

Inclusion body myositis is an inflammatory myopathy in which dysphagia has been considered a rare finding. However, recent literature finds dysphagia an increasingly common symptom as more cases of inclusion body myositis are identified. Unlike some inflammatory myopathic disorders, inclusion body myositis is resistant to treatment with corticosteroids, and therefore, the otolaryngologist may be consulted regarding surgical options for relief of dysphagia. A patient is described in whom severe progressive dysphagia associated with inclusion body myositis developed. Impaired pharyngeal wall motion and cricopharyngeal achalasia were demonstrated by videofluoroscopic evaluation, and the patient was successfully treated by cricopharyngeal myotomy. The pathophysiologic nature of inclusion body myositis and the mechanisms of cervical dysphagia in the inflammatory myopathies are reviewed.