Peracute streptococcal pyomyositis: report of two cases and review of the literature

Pyomyositis occurs infrequently in temperate climates. The fulminating peracute form caused by group A Streptococcus is exceedingly rare. We present two children with streptococcal pyomyositis. One child was admitted in septic shock and required intensive supportive care during the acute stage of his illness. Persistent swelling and tenderness of his left thigh presented a diagnostic problem, which was eventually resolved with the aid of computerized tomography. Despite appropriate antibiotic therapy from the onset of illness, surgical debridement of the affected muscle was necessary. The second child presented with pyomyositis of the left paravertebral muscles and signs of incipient shock but did well on antibiotic therapy alone.     

Concomitant and discriminatory validity of the Adolescents' Fear of Dental Treatment Cognitive Inventory

The revised edition of the Inventaire cognitif de la peur des traitements dentaire pour adolescent(e)s [Adolescents' Fear of Dental Treatment Cognitive Inventory] (ICPTD-A) was administered to 38 subjects chosen at random and to nine subjects chosen with an obvious dental phobia problem. Its concomitant validity was established by relating the ICPTD-A scores to those of a behavioral test. The Pearson correlation coefficients that were thus obtained were -0.66 for the general population and -0.87 for the population suffering from dental phobia. The discriminatory validity was then established with a repeated measurement variance analysis based on the scores of the dental phobics after the administration of a recognized psychological treatment program intended to reduce their phobia. The results have shown a statistically significant difference between the experimental and control groups as well as a significant difference between pre- and posttreatments. The authors have therefore concluded that the ICPTD-A is a valid tool for the assessment of dental phobia in 12-15-year-old adolescents.     

Blastomycosis in solid organ transplant recipients

BACKGROUND: Blastomyces dermatitidis, the etiologic agent of blastomycosis, causes severe disease and substantial mortality in those immunocompromised by acquired immunodeficiency syndrome or malignancy. In solid organ transplant recipients, the epidemiology, clinical features, and outcomes have not been fully described. METHODS: We conducted a retrospective case-series at the University of Wisconsin Hospital and Clinics. Case patients were solid organ transplant recipients with blastomycosis. RESULTS: From 1986 to 2004, we identified 11 cases of post-transplant blastomycosis with 64% occurring between 2000 and 2004. Onset of infection occurred a median of 26 months post transplantation with near equal distribution before and after the first year of transplantation. Rejection did not precede any case of post-transplant blastomycosis. Opportunistic co-infections were common, occurring in 36% of patients. Pneumonia was the most common clinical presentation and was frequently complicated by acute respiratory distress syndrome (ARDS). Extrapulmonary disease predominantly involved the skin and spared the central nervous system. The overall mortality rate was 36%; however, this increased to 67% in those with ARDS. None of the surviving patients relapsed or received routine secondary antifungal prophylaxis. CONCLUSION: Blastomycosis is an uncommon infection following solid organ transplantation that is frequently complicated by ARDS, dissemination, and opportunistic co-infection. After cure, post-transplant blastomycosis may not require lifelong antifungal suppression.     

Neuromuscular junctions in adult and developing fast and slow muscles

Functional changes that occur just before hatching in future fast muscles of the chicken are thought to be influenced by the pattern of innervation. We have compared the neuromuscular junctions of two fast muscles, the posterior latissimus dorsi (PLD) and the pectoralis, which differ in their myosin composition at 18 days in ovo. We have also presented new information on the neuromuscular junctions of the adult fast muscles and an adult slow muscle, the anterior latissimus dorsi (ALD). Both categories of adult muscles were heterogeneous, and there was little difference between endplates of the two fast muscles or between the fast and slow muscles. In contrast, there were significant structural differences between the two fast muscles during embryonic development. In early embryonic muscle fibers, which synthesize embryonic forms of myosin, individual motor endplates were contacted by multiple axon terminals. At 18 days in ovo, the majority of the neuromuscular junctions in the pectoralis continued to be multiterminal, whereas all but one of the terminals had been withdrawn from each endplate in the PLD. This single terminal had a unique form that distinguished it from the embryonic pectoralis and also from the two adult muscles. By 7 days after hatching, the neuromuscular junctions of both muscles had single terminals. They were different from the embryonic terminals, though not necessarily equivalent to adult terminals. The results show that multiple terminals persist at 18 days in ovo in the muscle that continues to express an embryonic myosin, but they have been withdrawn from the muscle that has lost this myosin. It is concluded, from combined data on the two muscles, that maturation of the neuromuscular junction during embryonic and late posthatch development is correlated with transitions in the myosin pattern and in contractile properties.