Extensive clostridial myonecrosis after gluteal intramuscular injection in immunocompromised patient treated with surgical debridement and negative-pressure wound therapy

Gas gangrene is infectious disease caused by Clostridium perfringens infection.

We are presenting extremely rare case of gluteal clostridial myonecrosis after intramuscular injection of diclofenac in immunocompromised young patient on a long-standing corticosteroid therapy presented with sepsis and initially absent clinical signs of severe anaerobic infection. After delayed diagnosis, she was treated with aggressive surgical removal of necrosed tissue and targeted antibiotic therapy which led to a rapid improvement allowing application of a negative-pressure wound therapy device with favorable outcome.

This report shows the importance of timely diagnosis with pitfalls of imaging. It confirms that surgical debridement along with specific antibiotic therapy is the mainstay of treatment, but also promotes negative-pressure wound therapy which has proved convenient for accelerated closure of large incisions with tissue loss without any adverse effects or the need for complex reconstructive procedures.

Recurrent pleural effusion and pain in the shoulder in women of reproductive age could have a gynecological cause: case series

Background

Endometriosis is a benign disorder defined as the presence of endometrial glands and stroma outside of the uterine cavity. It has been estimated that approximately 10% of the women of reproductive age and 30–50% of the women with infertility are affected.

Case presentation

We report two nulliparous patients with recurrent pleural effusion and pain in the right shoulder highly suspicious for thoracic endometriosis syndrome (TES).

Conclusion

The objective of this study was to present patients with unusual symptoms related to gynecological disease. The second aim was to show our single institution experience as a second level hospital in terms of treatment and diagnosis of TES and diaphragmatic endometriosis.

Tumor angiogenesis as an important prognostic factor in advanced non-small cell lung cancer (Stage IIIA)

The aim of the present study was to evaluate angiogenesis by determining the micro vascular density (MVD) and the expression of vascular endothelial growth factor (VEGF-A) in advanced non-small cell lung cancer (NSCLC) tumor samples, and to analyze their associations with clinical parameters and survival. Tumor tissue specimens of fifty patients (41 males and 9 females), who underwent radical surgical treatment for NSCLC in stage IIIA (T1-3N2) were collected for immunohistochemical analysis. MVD evaluation was performed using an anti-CD31 monoclonal antibody and VEGF-A expression using a polyclonal anti-VEGF-A antibody. The results were associated with two-year survival. Statistical analysis revealed significant associations in the level of angiogenesis (high MVD) and shorter survival of patients with NSCLC (P=0.0007). VEGF-A expression showed no association with micro vascular density (P=0.51) or survival (P=0.68). There was no significant association between MVD and VEGF-A. The measurable, clinical MVD parameters could be used as a reliable prognostic factor for the survival of patients with advanced NSCLC.