Successfully treated osteomyelitis involving the entire ischium in a patient with lower-limb paraplegia (a case report)

Introduction: Pelvic bones, probably due to their anatomical features (deep location, good blood supply and other unknown reasons), are rarely affected by exogenous or hematogenous infections. Usually, the flora isolated from the infected pelvic bone is polymicrobial, with the most common microorganisms causing this type of infection being Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa. The ischial bone (os ischii) is the pelvic bone most often affected by infections, adjacent to deep IV degree decubitus wounds. These wounds are typical for patients with severe neurological symptoms—paraplegics or quadriplegics, as well as those with cerebral disorders, and the process may remain undiagnosed for a long time.Aim: The aim of this article is to focus on the difficulties associated with the early diagnosis of an infection affecting the entire ischial bone and the soft tissues of the adjacent pelvis, as well as the high risk to the patient if adequate treatment is not carried out.Patient and Methods: One patient, a 60-year-old man, with lower-limb paraplegia, after a spinal cord trauma dating back to 10 years ago, is presented.Results: After the applied treatment—resection, removal of the entire ischial bone, and soft tissue debridement, the surgical wound healed primarily, the bone and soft tissue infection of the pelvis was successfully managed. General intoxication of the body was prevented.Conclusion: Accurate and timely debridement, including the risky total excision of the os ischii, as well as the infected adjacent soft tissues in the pelvis, combined with appropriate drainage, may prove to be the only effective and life-saving procedure for the patient

Testicular mixed germ-cell tumor - seminoma, embryonal carcinoma and yolk sac tumor

Introduction: Germ-cell tumors are a heterogeneous group of neoplasms which are classified differ­ently according to different literature. Mixed germ-cell tumors are a combination of two or more his­tological types and can include a seminomatous and non-seminomatous component. The following case presents a rare mixed germ-cell tumor with the characteristics of embryonal carcinoma, semi­noma and yolk sac tumor.Methods and Materials: A 27-year-old male presented with a history of left sided scrotal pain and swelling. By self-examination the patient discovered a rounded formation in the left testicle. After a consult with an urologist the patient was referred for surgery and a high funiculo-orchiectomy was performed, due to psychologically traumatic experience an insertion of prosthesis was suggested.Results: Ultrasonography showed a capsulated hypoechoic tumor formation. Computed tomography (CT) of the chest, abdomen and pelvis revealed no evidence of lymphadenopathy and metastases. During blood tests increased levels of alpha-fetoprotein were established. Macroscopically the forma­tion was oval-shaped and solid, on the cut surface hemorrhages and necroses were observed. The bi­opsy materials showed a picture of heterogeneous three-component malignant tumor. The mass was partially consisted of atypical cells with optically empty cytoplasm forming tubular structures which demonstrated the seminomous part. The presence of Schiller-Duval bodies signified yolk sac malig­nancy. The embryonic component was represented by microcystic structures comprised of cells with hyperchromic nuclei.Conclusion: Mixed germ cell tumors sometimes contain an unusual mixture of histologic types that are important to be correctly identified in reference to the selection of an appropriate treatment and therefore getting the best results for the patient