combination of the 2. The mean period of antibiotic use was 11.4 weeks. One patient with melioidosis involving the T9 to T11 vertebrae caused by P pseudomallei died of empyema and septicaemia 22 months after presentation. Conclusion. Pyogenic vertebral osteomyelitis is not uncommon in the elderly, especially those with predisposing conditions such as diabetes mellitus. Computed tomography-guided needle biopsy is recommended to investigate causative microorganisms. Aggressive surgical debridement and prolonged antibiotic therapy were necessary in patients with methicillin-resistant S aureus, P pseudomallei, and S agalactiae.
he early detection of compartment syndrome is essential in order to reduce disability and the consequences of ensuing ischemia. We report a case of posttraumatic bilateral gluteal compartment syndrome that initially was thought to be a simple buttock contusion. Gluteal compartment syndrome has been associated with sciatic nerve palsy, massive rhabdomyolysis, renal failure, multiple-organ failure, and death 1-3 . It is essential for the trauma surgeon to understand the anatomy of the nondistensible osseofascial compartments of the gluteal region and to be aware of the techniques of compartment pressure measurement at this uncommon site so that adequate decompression can be carried out early, before irreversible tissue damage occurs. Our patient had an adverse outcome resulting from the failure to recognize and diagnose the condition in time. The patient was informed that the data concerning the case would be submitted for publication.
Case Reportthirty-six-year-old man who worked as a technician presented to the emergency room with a history of a fall that had occurred two hours previously. The patient had fallen from a height of 10 m and had landed on the buttocks. The patient was able to get up and walk after the fall, but he had severe pain in the buttock area. Initial physical examination demonstrated that the patient was stable and well. He had some swelling over the buttocks but no bruising. Hip movements were full bilaterally, although they were painful at the extremes of flexion. Roentgenograms of the pelvis and hips revealed normal findings. The patient was diagnosed with a buttock contusion and was discharged with a prescription for analgesics. Two days later, the patient presented again with severe unrelenting pain in the buttocks that was not relieved by the prescribed analgesics. He was still able to walk. General examination, including an evaluation of vital signs, revealed normal findings. Examination of the gluteal region revealed a tender and tense swelling of both the buttocks and the proximal parts of the thighs. Movement of either hip in any plane of motion was restricted secondary to pain. The distal pulses and the neurological status of the lower limbs were normal. On further inquiry, the patient revealed that T A Fig. 1 T1-weighted magnetic resonance image showing extensive edema and swelling in the subcutaneous plane, the superficial and deep fascia, and the gluteus medius and minimus muscles (A) bilaterally. Less extensive changes are seen in the gluteus maximus muscles (B).
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