[Acute injection-induced injuries in drug addicts. A review of 146 consecutive admissions]. / Akutte injektionsskader hos narkomaner. En gennemgang af 146 konsekutive indloeggelser.

Admissions of drug abusers with acute soft tissue lesions at the injection site increased in number over the period 1985-1989. There were 146 admissions in 90 patients. The diagnoses were: 58 superficial abscesses, 27 deep abscesses, 57 cellulitis, one tenosynovitis, one purulent arthritis, one not further categorised abscess and one case of arterial spasm. The commonest location was the groin (25%). Serious complications occurred in 17 cases, including four femoral amputations due to arterial lesions. Ultrasonic examination is recommended before surgery if central vessels can be involved, especially in the groin. Sufficient microbiological examination was performed in 78 cases. There was a predominance of polybacterial infections (53% polybacterial, 38% monobacterial, 9% sterile). The most common bacteria were Streptococcus spp. with a preponderance of oropharyngeal bacteria, Staphylococcus aureus, and anaerobes, especially Bacteroides spp. Typical intestinal bacteria were rare. We recommend that aerobic and anaerobic culturing with susceptibility testing always be carried out, that primary antibacterial therapy should be with an antistaphylococcal agent like dicloxacillin plus metronidazole and that free injection paraphernalia with disinfection swabs should be made easily available.

Soft tissue infections from drug abuse. A clinical and microbiological review of 145 cases.

We evaluated clinical and microbiological aspects in 145 hospitalizations of 89 intravenous drug abusers with acute soft tissue infections at the injection site. There were 58 superficial abscesses, 27 deep abscesses, 57 cellulitis with or without concomitant ulcer, 1 purulent arthritis, 1 tenosynovitis and 1 incompletely categorized abscess. The commonest location was the groin. Serious complications occurred in 17 cases, including 4 lower-extremity amputations due to arterial lesions. There was a predominance of polybacterial infections (53 percent polybacterial, 38 percent monobacterial, 9 percent sterile). The commonest bacteria isolates were Streptococcus species with a preponderance of oropharyngeal bacteria, Staphylococcus aureus, and anaerobes, especially Bacteroides species. Typical intestinal bacteria were rare. In addition to surgical treatment we recommend that aerobic and anaerobic culturing with susceptibility tests always are carried out, that primary antibacterial therapy should consist of an antistaphylococcal agent, such as dicloxacillin plus metronidazole, and that free injection paraphernalia with disinfection swabs are easily available.

Below knee amputation in war surgery: a review of 111 amputations with delayed primary closure.

The results of 111 acute below-knee amputations in war wounded were reviewed. The majority of the patients were wounded by exploding mines. The amputation stumps were not closed primarily but secondarily after an average of 6.4 days. Reamputation above the knee was necessary in only one case of wound sepsis. After delayed primary closure 84% of the stumps healed without problems. The best results were obtained when the stump closure was performed within 1 week after the amputation. No cases of gas gangrene or tetanus were encountered.

Mediastinal tumours. A report of 129 cases.

Primary mediastinal tumour or cyst was surgically treated in 129 patients (including 19 younger than 12 years) during a 16-year period. All histologic specimens and smears from fine-needle aspiration biopsy were reviewed. Intrathoracic goitre, neurogenic lesions and thymomas comprised 62% of all the tumours. Fifty lesions (39%) were found at routine radiographic examination and were asymptomatic. Eight of these 50 lesions were malignant. Chest pain, fatigue, weight loss and fever were significantly more common in malignant than in benign disease. Despite extensive investigations, the diagnosis was not established preoperatively in 32% of the cases. Chest radiography, CT-scanning and fine-needle aspiration biopsy usually provide satisfactory diagnostic information, thereby substantially reducing the need for other preoperative procedures. Early operative intervention is mandatory in these cases.

[Intervertebral disk prolapse as an unusual cause of Horner's syndrome]. / Torakal discusprolaps en sjaelden årsag til Horner's syndrom.

A case of protrusion of the first thoracic intervertebral disc is presented. The patient suffered from severe acute pain in the chest and left arm. Horner's syndrome was present, probably due to compression of the preganglionic sympathetic fibres as they leave the spinal cord through the anterior root. The diagnosis was confirmed by myelography and CT scanning. The prolapsed disc was removed by laminectomy and the symptoms resolved.

Spondylolysis in Eskimo skeletons.

Spondylolysis was found in 25 of 46 spines of Eskimos from Greenland, at L1 in one case, at L3 in five cases and at L4 and L5 in 14 cases each. Two spondylolytic vertebrae were seen in the same spine in nine cases. Among young individuals, spondylolysis was found in 2 out of 15 spines and in older in 23 out of 31. The prevalence of spondylolysis was higher, the fourth vertebra was more commonly affected, and spondylolysis occurred at an older age in Eskimos than in other ethnic groups.