Acute Osteomyelitis of the Humerus mimicking Malignancy: Streptococcus pneumoniae as Exceptional Pathogen in an Immunocompetent Adult

Background Chronic osteomyelitis due to direct bone trauma or vascular insufficiency is a frequent problem in orthopaedic surgery. In contrast, acute haematogenous osteomyelitis represents a rare entity that almost exclusively affects prepubescent children or immunodeficient adults. Case Presentation In this article, we report the case of acute pneumococcal osteomyelitis of the humerus in an immunocompetent and otherwise healthy 44-year-old male patient presenting with minor inflammation signs and misleading clinical features. Conclusions The diagnosis had to be confirmed by open biopsy which allowed the initiation of a targeted therapy. A case of pneumococcal osteomyelitis of a long bone, lacking predisposing factors or trauma, is unique in adults and has not been reported previously

Ward reduction of gastroschisis: risk stratification helps optimise the outcome

Purpose: Categorization of gastroschisis into low risk (simple) and high risk (complex) has been reported as an important determinant of outcome. The role of risk categorization in choosing the optimal surgical approach is unreported. This study aims to investigate the role of risk categorization in decision making for ward reduction of gastroschisis. Methods: Data on a cohort of 52 consecutive neonates with gastroschisis between 2000 and 2009 were reviewed. A clinical pathway based on risk categorization was implemented in 2004, and children with simple gastroschisis underwent ward reduction and those with complex gastroschisis underwent surgical closure. Thirty-three neonates since 2004 were analysed and compared to the 19 born prior to 2004. Results: Of the 33 children with gastroschisis in the study group, 23 were assessed as simple and underwent ward reduction with 96% survival. Ten had complex gastroschisis and underwent varying surgical procedures. Only six out of ten children (60%) with complex gastroschisis survived in spite of multiple surgical attempts. Conclusions: Risk stratification of gastroschisis at birth helps in choosing optimal surgical management. Ward reduction can be successfully and safely performed in all children with simple gastroschisis. Those with complex gastroschisis require conventional surgical treatment