Pyomyositis in childhood: a case report

Pyomyositis is a primary infection of skeletal muscle. We report the case of a previously healthy six-year-old who suffered from pyomyositis in the right lower back. He presented with lower back pain and low-grade fever for one week. After a series of laboratory and imaging studies, the diagnosis of right multifidus muscle pyomyositis with abscess formation was made. The patient recovered rapidly after incision and drainage therapy, accompanied by antibiotic treatment. Methicillin-resistant Staphylococcus aureus was cultured from the abscess discharge. It was strongly suspected that herbal medicines and common cold medication the patient had been prescribed before admission to our hospital produced a masking effect that delayed the diagnosis.     

Methi-resistant Staphylococcus aureus myositis

INTRODUCTION: Pyomyositis are relatively rare in our countries. CASE REPORT: A 73-year-old-man presented with leg pains and septicemia. Diagnosis of pyomyositis was made and a large incision was performed after which the patient had a progressive improvement. DISCUSSION: Diagnosis of pyomyositis may be difficult in early stages. Diagnosis is greatly facilitated by magnetic resonance imaging. Responsibility of Staphylococcus aureus in cases of pyomyositis due to methi-resistant Staphylococcus aureus may be evocated even if patients was not hospitalized.     

Pyomyositis and staphylococcal scalded skin syndrome

Pyomyositis is a rare musculoskeletal infection in non-tropical countries. We report a child who had pyomyositis complicated by staphylococcal scalded skin syndrome. This complication has not previously been described in patients with pyomyositis. Early diagnosis of pyomyositis was made by ultrasound examination, and percutaneous needle drainage under ultrasound guidance was performed. Pus aspirated and blood cultures grew Staphylococcus aureus. No open surgical drainage was required and resolution of the abscess was documented by serial ultrasound examinations.     

Aplastic anemia in acute viral hepatitis type A. Our experience

Tropical pyomyositis is an infection of large muscle groups that can lead to sepsis and death. The most common etiologic agent is Staphylococcus aureus. It usually occurs in patients living in the tropics but is seen with increasing frequency in temperate climates, particularly in immunosuppressed patients, where it may be misdiagnosed and may cause severe morbidity and mortality. Diagnosis is based on the examination of pus from a muscle aspirate and treatment consists of surgical incision, drainage and appropriate antibiotic therapy. It is stressed to take into account pyomyositis in the differential diagnosis of immunocompromised patients with "cryptic" myalgia.     

Studies on the nature of cytotoxic effects induced by dihydralazine

A case of non-tropical pyomyositis (PM), in a 63-year-old female patient, affecting gluteus and intrapelvic muscles is presented. Delayed diagnosis and treatment led to long-standing morbidity. Magnetic resonance imaging (MRI) of the pelvis provided valuable information on the nature and extent of the disease and helped to plan surgical management. MRI of the pelvis should be undertaken at an early-stage. Prompt examination of material obtained by aspiration or debridement would then permit an accurate diagnosis and appropriate management.     

Increased prevalence of HIV-2 infection in hospitalized patients with severe bacterial diseases in Guinea-Bissau

We studied the association between HIV-2 infection and bacterial pneumonia, sepsis or pyomyositis, as well as the influence of HIV-2 infection on the clinical outcome in patients with these bacterial infections. A total of 201 consecutive hospitalized patients were included at the Simao Mendes National Hospital in Bissau, Guinea-Bissau. Age- and sex-matched controls were selected from an ongoing census in a semi-urban area of Bissau. Among 201 cases with such bacterial infection the prevalence of HIV-1 was 5.4%, HIV-2, 27.9%, and both HIV-1 and HIV-2 reactivity 6.4%. Among controls, the corresponding prevalence rates were significantly lower, 1.5%, 9.0% and 1.0%, respectively. A total of 140, 31 and 30 cases of pneumonia, sepsis and pyomyositis were included, and the differences in prevalence of HIV-2 compared with the controls also remained significant for each diagnosis separately. Lymphocyte subsets were determined in 93 consecutive patients, and the CD4 cell counts and CD4/CD8 lymphocyte ratios were markedly suppressed in the HIV-2-seropositive group. Due to excess mortality in the seropositive groups with sepsis (75.0%) and pyomyositis (25.0%), the mortality during hospitalization was significantly higher among HIV-2 infected compared to HIV-negative patients. Among cases of pneumonia the mortality was low in the HIV-2-seropositive (2.9%) as well as in the HIV-seronegative (3.4%) group.     

Accidental acute fatal sodium nitrite poisoning

OBJECTIVES: To report two patients who developed reactive arthritis in association with Staphylococcus aureus infection. METHODS: A review of the case notes of two patients. RESULTS: Two adult female patients have developed sterile arthritis in association with Staph aureus infection. The first patient has had two episodes of arthritis; the first followed olecranon bursitis, the second followed infection of a central venous catheter used for dialysis. The second patient developed sterile arthritis while being treated for pyomyositis. Both patients had a self limited arthritis and were HLA-B27 negative. CONCLUSION: Reactive arthritis may rarely follow Staph aureus infection. HLA-B27 negativity may be associated with a self limited arthritis in these cases.     

A thrice-told tale of therapy

A case history twice discussed previously in the literature is reexamined. The patient probably suffered a manic-depressive illness, and remission, therefore, is not specifically attributable to psychotherapy. The significance of psychotherapy in the patient's treatment is argued, but for its supportive, not its curative, effects.     

《我们仨》散文艺术表现手法赏析

杨绛散文以真切感人制胜,最新作品《我们仨》尤其如此。1997年、1998年,钱媛钱钟书相继因病去世。四年后,92岁高龄的杨绛饱含深情以及特有的笔调书写《我们仨》,回忆他们坎坷而甜蜜的家庭生活。在失去爱女与伴侣之后,她并未以痛不欲生的姿态回忆,而是用看透红尘大喜大悲之后的宁静娓娓道来过去的故事。细读该作品会发现全文字里行间无不流露着她对于家人的深刻怀念,全书在行文过程中更是哀而不伤。《我们仨》一书中虚实相生、巧设悬念、典型性细节描写、合理背景描写以及写意手法等散文艺术表现手法的运用无处不在,具有其独特的魅力     

Another case of acoustic schwannoma and epidermoid cyst occurring as a single cerebellopontine angle mass: possibly not so rare?

This is the second case of adjacent occurrence of an acoustic schwannoma and epidermoid cyst in the cerebellopontine angle. This case of a 70-year-old woman is presented with a history of her illness, neuroradiologic data, and photographs during the operation. We compare this case with the first of its kind.     

Carcinosarcoma of the gallbladder]

The authors analyse and comment on a case of carcinosarcoma of the gallbladder which they have recently observed. Given the rarity of this form of cancer, it is interesting to note that this case presents some peculiar aspects which have not been recorded in the few cases previously published on the subject. The peculiarities are such that they require a revision of what have until now been considered as intrinsic characteristics in the clinical observation of this kind of cancer. The authors maintain that the peculiarities of this case concern: a) the clinic onset of the illness and the relative aspecific symptomatology: b) that fact that laboratory tests did not signal any biochemical alteration; c) that the instrumental investigation's results pointed toward a non neoplastic pathology; d) that even the intra-operatory examination did not reveal any suspicious element; and last but by no means least the good survival of the patient which is definitely superior to other cases already reported in literature. The neoplasia, which manifested itself through a hemorrhage in the gallbladder, represented in fact the very initial stage of the illness, a condition rarely observed.     

Psychiatric care and health insurance reform

Concerns about cost, access, and quality of health care in the United States have led to a variety of legislative proposals that would reform our health care system and its financing. Health insurance benefits for mental illness, including substance abuse, are treated differently from medical/surgical benefits, with stricter limits on outpatient visits and hospital days. Medicare, Medicaid, and most private health insurance plans contain this historic disparity of coverage for mental illness compared to general medical illness. Psychiatric services are also distinguishable because of the large public sector reimbursement for mental illness treatment and support. Principles for a more equitable design of mental health benefits include a non-discriminatory approach; payment on the basis of service rather than diagnosis; application of cost containment for care of mental illness on the same basis as care of general medical illness; retention of the public sector as a backup system for high-cost, long-term care; encouragement of lower-cost alternatives to the hospital through the development of a continuum of care; and a recognition of the distinction between psychotherapy and medical management. All current approaches to universal health care fall short of these principles. A research agenda is needed now more than ever in order to articulate the case for complete coverage of mental illness and substance abuse.     

Cognitive-behavioral treatment of panic complicated by medical illness.

Notes that cognitive-behavior therapy combined with medication can be an effective treatment combination for individuals suffering from panic attacks. Certain cases may prove difficult however, particularly when an individual is recovering from a serious medical illness in which many of the symptoms of the medical illness overlap with the symptoms of panic. This article reviews some of the complicating factors that may occur with such cases as well as techniques for helping individuals differentiate between symptoms that denote a recurrence of the medical illness and those that involve panic disorder and anxiety. Two case vignettes, one of a 54-yr-old steel worker and one of a 19 yr-old gymnast, are included that portray how cognitive-behavioral techniques can be used to help individuals reduce their anxiety and panic and also effectively differentiate symptoms of a recurring medical illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infectious agents associated with myopathies

Several infectious agents can cause chronic or acute myopathy. Most current investigations into possible infectious causes of the idiopathic inflammatory myopathies have focused on retroviruses, including HIV and human T-cell leukemia-lymphoma virus type I. In both cases, viruses likely do not directly infect muscle fibers but instead induce an immunologically mediated myositis. Other interest has focused on enteroviruses as potential etiologic agents of idiopathic inflammatory myopathy, but their relationship to human myositis is less clear. In addition to chronic muscle disease, several infectious agents can cause acute myositis, including pyomyositis, which is being recognized in temperate climates with increasing frequency, and rhabdomyolysis.     

Quality of life and dementia

OBJECTIVE: To review the relationship between quality of life (QOL) and dementia. Development. QOL is a factor which takes into account all the different aspects of life which make a person feel that life is worth living, such as: 1. Physical health. 2. Functional status. 3. Psychological and cognitive sphere, and 4. Social health. There are two types of instruments for evaluating these aspects: firstly general ones which measure the QOL independently of illness, and secondly those which are specific to the illness concerned. In dementia, QOL covers the same traditional areas: cognitive competence, capacity to carry out everyday activities, social conduct and the balance between positive and negative emotions. However, evaluation of QOL in dementia has its own specific difficulties, since it is often impossible to determine such a fundamental factor as the subjective well-being of the patient, in which case the opinion of the person looking after the patient is essential. According to Lawton's approximation, as well as the subjective aspect of perceived psychic welfare and quality of life, the QOL in dementia is composed of external social and objective dimensions such as behaviorally competence and the quality of the patient's environment. In a review done in 1995 it was found that most of the instruments designed to measure the QOL have not been sufficiently validated for Alzheimer's disease. CONCLUSIONS: QOL in dementia has specific features including external aspects such as the opinion of the carer and the quality of the patient's environment in addition to the subjective aspects. It is necessary to develop and validate specific instruments for QOL in dementia.     

Vaccine-associated polio: a case and its lessons

A case of viral transmission to the father of a newly vaccinated infant shows how the virtual disappearance of a once terrifying illness can obscure its recognition and how perplexing public health issues may arise when an invaluable vaccine is anything less than perfect.     

Cutis marmorata telangiectatica congenita (author's transl)

Authors report a new case of cutis marmorata telangiectatica congenita. This disease has been preferably described by dermatologists and few issues in the pediatrics literature have been published. This is a rare illness recognizable at birth which must be knowed by pediatricians to establish the diagnosis and prognosis in the beginning. A new case with typical features is presented being of localized distribution and having as associated abnormalities. Hemiatrophy, enlarged inferior extremity without Klippel-Trenaunay syndrome and physical growth retardation.     

Mental illness in India and Britain: theory and practice

The paper argues that conceptions of mental illness and its treatment often stem from the normative social and cultural constructions of mental illness. Psychiatrists, psychologists, and other health professionals do not work in a social vacuum; they work within the accepted traditions and values prevalent in their culture. To understand mental illness it is therefore necessary to examine the salient normative beliefs, attitudes, and values of a given culture. The paper proposes a cross-cultural theoretical and empirical model which permits a close examination and comparison of mental illness in two cultures: India and Britain. The proposed model from which several testable hypotheses have been deduced, rests on the following four factors; [Table See Text]. The nature and the importance of the factors in explaining mental illness and the culture-specific treatment strategies which follow in the two cultures are critically discussed in the paper.