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At least 991 records · Page 55Linked to original sources

Cutaneous vasculitis as a presenting feature of multiple myeloma: a report of 2 cases.

We report two male patients who presented with symmetrical, painful purpura that evolved into bullae and necrotic ulcers, predominantly on the extremities, over two months in spite of conventional therapy including oral steroids. Examination showed livedoid and purpuric patches with necrotic centers in starburst pattern over the extremities and buttocks. The first case also had similar lesions over the ears. The clinical presentation and the histopathological examination suggested a diagnosis of necrotizing leukocytoclastic vasculitis (LCV). Blood testing ruled out connective tissue disease, hepatitis B or C infection or streptococcal infection as underlying cause of vasculitis. Serum antinuclear factor, antineutrophilic cytoplasmic antibody and anticardiolipin anticoagulant were negative in both cases. Cryoglobulins were positive in case 2. An incidental finding was raised serum proteins and globulins in case 2. Further investigations revealed M band on electrophoresis and features of multiple myeloma on bone marrow biopsy in both cases. These cases emphasize the importance of simple investigations like serum proteins in the evaluation of LCV.

Adult↗

Severe staphylococcal pneumonia complicating pyomyositis.

Severe staphylococcal pneumonia developed secondary to pyomyositis of the buttock in an adult male Melanesian in East New Britain, Papua New Guinea. Penicillin-resistant Staphylococcus aureus was cultured from the abscess, and S. aureus, together with Gram-negative organisms, were cultured from sputum. Despite treatment with high dose cloxacillin together with supportive chemotherapy, progressive deterioration of lung function occurred and acute respiratory failure developed. As suitable ventilators were unavailable, tracheal intubation was performed, and manual assisted ventilation was carried out for 4 days. Progressive improvement in ventilation and general status resulted, and the patient recovered without sequelae.

Adult↗

[Musculoskeletal hydatidosis: an unusual location].

Hydatidosis is a zoonosis with a continuing high prevalence in our environment. The most commonly affected organs are the lungs and the liver, with the musculoskeletal location being considered an unusual one. We comment the case of a patient who presented a series of lesions in his left iliac crest and middle left buttock with spontaneous fistulization to the skin surface. In this case a combined treatment was given; prior to the surgical operation we administered a cycle of albendazol. Following removal of the lesion, the patient was given two further cycles of albendazol in order to minimize the risk of a recurrence of the illness. This patient is currently free of any symptoms relating to this illness.

Buttocks↗

Remission of lymphoma after drug withdrawal in rheumatoid arthritis.

A 63-year-old man with rheumatoid arthritis presented with pain and swelling of his right buttock. Imaging and tissue biopsy revealed a diffuse large B-cell, non-Hodgkin's lymphoma. The disease-modifying drugs he was taking, cyclosporin and methotrexate, were stopped, and the lymphoma resolved spontaneously without the use of chemotherapy.

Arthritis, Rheumatoid↗

Piriformis syndrome.

The author presents a case of a female runner with left buttock pain aggravated by exercise. She underwent extensive testing by other physicians and received cortisone injections on two occasions. The patient was referred to the podiatry department because of continued discomfort and the inability to run. Examination revealed pain on hip flexion and abduction against resistance. Because of the possibility of piriformis syndrome, she started stretching exercises, reduced her activity, and the pain disappeared. The diagnosis of piriformis syndrome was confirmed by a general surgeon.

Adult↗

Generalized morphea with blisters. A case report.

A patient suffering from generalized morphea developed blisters in the morpheic plaques on her buttocks. The plaques had an increased concentration of serum aminoterminal propertice of type III procollagen, an echo response and thickened skin on ultrasound scanning, and compact bundles of collagen fibrils with bimodal distribution of the diameters. The blisters appeared as an echo-free band in the subepidermal zone by ultrasound scanning. Electron microscopy revealed blisters in the upper papillary dermis, surrounded by degraded collagen fibrils.

Aged↗

[A posterior horn syndrome presumably due to direct trauma to the sacral cord: a rare complication of epidural anesthesia].

I report here a case of a posterior horn syndrome presumably due to sacral cord injury during the procedure of epidural anesthesia. A 43-year-old female underwent hysterectomy for myoma uteri. The operation was initially planned to be performed under epidural anesthesia. When a needle was inserted at the level of Th 12/L 1, she felt severe pain in the medial aspect of the left thigh. After the operation under general anesthesia, intolerable pain continued in the buttocks, the medial aspect of the left thigh, and the posterolateral aspect of the left lower leg. Lumbar MR images demonstrated slight disc hernia but no intra- and extramedullary hematomas. Seven weeks after the operation, she was referred to my clinic for neurologic evaluation. Motor functions were intact. Knee jerks on both sides were hyperactive; other tendon reflexes were normal. Plantar reflexes were indifferent. Thermal and pin-prick sensations were lost in the left S1 dermatome, and moderately impaired in the left S2 dermatome. Light touch and vibration sense showed no remarkable changes. Her sensory disturbance could have been caused by a lesion involving the left posterior horn and lateral spinothalamic tract within the S1 segment of the spinal cord.

Adult↗

Lipoblastoma and lipoblastomatosis in children.

Lipoblastoma and lipoblastomatosis are rare mesenchymal benign tumors of embryonal white fat. They are found primarily in children less than 5 years of age. This tumor presents in two forms: a localized well-circumscribed lesion (lipoblastoma), or a multicentric type (lipoblastomatosis). The authors presents three cases, two of them with a buttock lesion, the last with a paravertebral one. It is recommended a complete but conservative excision of the tumor because there is a natural tendency to involution, although in the first year of life a local reexcision for recurrence is sometimes described.

Abdominal Neoplasms↗

Cellulite treatment: a myth or reality: a prospective randomized, controlled trial of two therapies, endermologie and aminophylline cream.

Cellulite is a common phenomenon that particularly affects the thighs and buttocks of women. Little scientific evidence exists to support any of the many advertised treatments for it. A total of 52 of 69 women, who were divided into three groups, completed a 12-week, randomized, controlled trial in which the effectiveness of two different treatments for cellulite was assessed. The patients acted as their own controls. The treatments investigated were twice-daily application of aminophylline cream and twice-weekly treatment with Endermologie ES1. Group 1 (double blind) received aminophylline to one thigh/buttock and a placebo cream to the other. Group 2 (singly blind) received Endermologie to one thigh/buttock. Group 3 received Endermologie to both sides and used the same cream regimen as group 1. Results were assessed subjectively by the patient and by clinical examination and photographic assessment by the surgeon (before and after the trial). Morphologic assessment included body mass index, thigh girth at two points, and thigh fat depth measurement by ultrasound. No statistical difference existed in measurements between legs for any of the treatment groups (paired t test, p > 0.4). The best subjective assessment, by the patients themselves, revealed that only 3 of 35 aminophylline-treated legs and 10 of 35 Endermologie-treated legs had their cellulite appearance improved. The authors do not believe that either of these two treatments is effective in improving the appearance of cellulite.

Adipose Tissue↗

Koebner phenomenon on skin graft donor site in cutaneous angiosarcoma.

An 81-year-old woman developed a necrotic plaque and a surrounding purple-red, irregularly shaped macule on her scalp. The diagnosis of angiosarcoma was confirmed histologically. A wide surgical excision was made followed by a split-thickness skin graft from her right buttock. Nine months later, she noticed a dark purple-red lesion on the donor site which grew rapidly into a large mass. Histological examination revealed irregular clefts and vascular channels lined by atypical endothelial cells. Lung metastasis and pneumothorax were also noted. The secondary tumor appeared to represent Koebner phenomenon in a patient with angiosarcoma of the scalp.

Aged↗

[Disseminated granuloma annulare].

A case of generalized granuloma annulare in a 55 year old man is reported. The disease appeared five years before the first admission to the hospital. A large number of bluish-red or skin-colour papules were scattered mainly around the earlobes, buttocks and on the extremities. Some of the lesions were lined up in rings or plaques. Small depigmented and brownish scars were present. Two biopsies revealed characteristic foci of complete collagen degeneration accompanied by a palisading infiltrate in the upper dermis. Treatment with tuberculostatics and antimalarics was without improvement. The lesions cleared after a course of prednison, but reappeared when the drug was discontinued.

Arm↗

[Obesity, diabetes mellitus, and gas gangrene: a major therapeutic challenge].

Soft tissue infections are uncommon but prognosis is severe (20 to 50%). Management consists in surgical debridement, antibiotic therapy against anaerobic and aerobic bacteria, and appropriate intensive care. When available, hyperbaric oxygen therapy is an integral part of the treatment. We report the case of 56-year-old female patient with diabetes (150 kg) was hospitalized in our unit a few days after surgical treatment of a buttocks abscess for clinical signs of peripheral gas gangrene. Surgical exploration showed necrotizing soft tissue infection with fasciitis. Adequate therapy using antibiotics, surgery daily and hyperbaric oxygen was given. Therapy had to be adapted to the patient's obesity. Outcome was good with recovery and few sequelae, allowing transfer to a medical ward.

Abscess↗

Perianal abscess caused by Propionibacterium avidum in a cirrhotic patient.

We describe the first case of community-acquired Propionibacterium avidum subcutaneous tissue infection in a cirrhotic patient. A 70-year-old Chinese male with a 2-year history of hepatitis B virus-induced chronic liver failure and hemorrhoidectomy 17 months previously presented with a painful left buttock abscess, which was culture positive for P. avidum. Being a normal flora of skin with low pathogenicity, there have been only 3 case reports on P. avidum infection, all associated with surgical intervention within 2 to 6 weeks before the onset of P. avidum infection. We hereby review the literature on P. avidum summarizing

Abscess↗

Hip surgery skin cellulitis.

Of 583 erysipelas/cellulitis seen in our Department between 1981 and 1991, six (1.04%) were localized to the buttock and hip. Five patients had had a dynamic hip screw implanted for coxarthritis on the side where the skin infection developed. This does not appear to be secondary to superinfection of the surgical wound as the erysipelas/cellulitis occurred weeks (7 to 520) after surgery. The possible surgical compromise of the venous/lymphatic circulation appears to be the causative factor. In all patients, the course was satisfactory upon systemic antibiotic therapy and no recurrence was seen after a mean follow up of 28 months.

Adult↗

Upper gastrointestinal bleeding from Merkel cell carcinoma.

Merkel cell carcinoma is a rare small cell carcinoma of the dermis with aggressive clinical features and frequent local recurrence. Intra-abdominal spread of the cancer has previously been noted primarily in the liver and retroperitoneal nodes. We report a patient with previously diagnosed Merkel cell carcinoma of the right buttock with metastases to the stomach and duodenum presenting with acute upper gastrointestinal bleeding.

Aged↗

Rationale for treatment of hip abductor pain syndrome.

Patients with lower back or buttock pain that radiates into the posterior or lateral leg are often referred to physical therapy with a diagnosis of sciatica. Often the physical exam does not reveal neurologic findings indicative of radiculopathy. Instead, there is hip abductor muscle pain and weakness. This syndrome involves muscle imbalances that result in overuse strain of the gluteus medius and gluteus minimus muscles, myofascial trigger points, and trochanteric bursitis. This paper describes hip abductor pain syndrome and provides a rationale for the diagnosis and treatment.

Algorithms↗

Onchocerciasis (river blindness).

A 37-year-old African man presented for excision of a dermal nodule after a diagnosis of ocular onchocerciasis (river blindness). A nodule from the patient's left buttock contained several adult filarial worms, and results from adjacent skin biopsy specimens revealed numerous dermal microfilariae. The patient was admitted to the hospital and treated with one dose of ivermectin. Recommendations were made for ivermectin treatments every 6 months for up to 10 years. The history, clinical presentation, diagnosis, and treatment of onchocerciasis are discussed.

Adult↗

Bite mark or bottle top?

An alleged assault was reported by a 42-year-old female, with initial medical examination revealing an apparent bite mark on the right buttock. Odontological examination, including visual assessment, full history and photographs showed that the injury did not meet the class characteristics of a human bite. Subsequent digital overlay production showed that the injury pattern was consistent with a corrugated bottle top. This case highlights the need for careful assessment of injuries alleged to be caused by human teeth.

Adult↗