We describe two cases of Clostridium glycolicum wound infections in immunocompetent adults. The bacterium was identified by 16S rRNA gene sequencing. This is the third published report of the recovery of this organism from human clinical material and highlights the importance of the organism as a potential human pathogen. Our report extends the spectrum of the diseases caused by C. glycolicum. CASE REPORTSCase 1. The patient was a 24-year-old man who presented to the clinic with a painful wound in his scalp. He stated that he was pushed into some shrubs and, as a result, sustained a deep laceration. The patient initially did well, but after about 2 weeks, he noted significant drainage from the wound as well as increasing pain, which prompted him to present to the clinic.On examination, the patient appeared alert and oriented. Vital signs were normal, and the patient was afebrile. The physical examination was normal except for the scalp. On the left temporal scalp, there was a 1.5-cm laceration draining purulent material. A piece of foreign material (which appeared to be a piece of wood) was impacted in the wound, and it penetrated through the skin, soft tissue, and fascia, deep into the belly of the temporalis muscle. The patient underwent surgery, during which he had debridement of the skin, subcutaneous tissue, muscle, and a portion of the fascia. The piece of wood was removed.Swabs from the wound tissue were transported to the microbiology laboratory in anaerobe transport medium for bacterial culture. The aerobic culture was positive after 1 day for Bacillus laterosporus and a second Bacillus species. The anaerobic cultures were positive after 6 days for Clostridium glycolicum and a second Clostridium species. The patient was treated with 875 mg amoxicillin-clavulanic acid orally twice daily for 14 days. He responded well to debridement and had good wound healing on follow-up visits.Case 2. The patient was a 20-year-old woman who reportedly sustained multiple injuries, including an open left radius and ulnar shaft compound fracture, following a motor vehicle accident. She was treated with open reduction and internal fixation of her left forearm at an outside hospital. She had delayed the union of both of the left forearm fractures. She was scheduled for a bone graft 2 months later; however, during the appointment, they noted on the plain radiograph that the hardware was loose, which delayed the procedure.She presented to the emergency department of the Johns Hopkins Hospital (JHH) on 19 January 2008 with worsening pain in her forearm and pus draining through a wound at the surgical site for a week. She was started on cephalexin and was admitted to JHH for nonunion of the left radius and ulnar fractures and possible osteomyelitis. Other than the forearm, there were no significant findings in a systemic review. She underwent irrigation and debridement, hardware removal, antibiotic spacer placement, and provisional fixation on 22 January 2008. Intraoperative findings included nonunion of the left radius and ulna...

SUMMARYA 20-year-old woman with a functioning ventriculoperitoneal (VP) shunt consistently reported unbearable vertex headaches and nausea during the last hour of her haemodialysis (HD) sessions. After one particularly severe episode, which was associated with vomiting, restlessness and blurred vision, her team suspected that she was developing dialysis disequilibrium syndrome. She improved fully on cessation of HD, requiring simple analgaesia only, and continued dialysis three times per week. Several more distressing episodes of nausea and headaches compelled us to give intravenous mannitol during HD, resulting in temporary improvement. Subsequently, shorter and more frequent dialysis sessions along with intravenous mannitol resulted in satisfactory clinical response. BACKGROUND

Background: A postoperative discal/annular cyst following lumbar discectomy may reproduce the symptoms/signs of a recurrent lumbar disc herniation (i.e., back pain and radiculopathy). Case Description: A 21-year-old rugby player developed leg pain after an uncomplicated lumbar microdiscectomy. The repeat lumbar magnetic resonance imaging confirmed a postoperative lumbar annular/ discal cyst, for which he underwent repeat surgery. The diagnosis was further confirmed histopathologically at surgery. Conclusion: Although rare, postoperative discal/annular cysts may be potential causes of recurrent postoperative pain and lumbar radiculopathy mimicking recurrent disc herniations.