Total hip prosthesis complication, periprosthetic infection with external fistulizing due to Enterobacter cloacae complex multiple drugs resistance: A clinical case report.

INTRODUCTION: The Enterobacter cloacae is a microorganism found in the intestinal flora of the majority of animals, including humans. Primary infections caused by E. cloacae are rare in immunocompetent patients, but are very common in hospital settings in newborns and immunocompromised patients, and can be aggravated by the insurgence of antibiotic resistance. The incidence of periprosthetic hip infections is just below 2%. CASE PRESENTATION: A 76year old woman with multiple comorbidities underwent surgical implantation of intermediary total hip prosthesis of the left hip, in a different health facility, in February 2014, after the basicervical fracture of the upper femur extremity due to trauma. After an episode of dislocation of the prosthetic implant, in September 2014, she underwent a surgical operation to implant the acetabular component. A month later not in our facility, following a re-hospitalization for the dislocation of the arthroprosthesis, an infection from E. cloacae complex was discovered. After 2 years of chronic infection she came to our attention; the clinical picture featured coxalgia and secreting fistula in the surgical wound. Following a specific antibiotic therapy, carried out intravenously over the course of a month, we decided to intervene removing the left hip arthroprosthesis and placing an antibiotic spacer following the direction deduced from the antibiogram study of August 2016. CONCLUSION: The patient was hospitalized in our facility and 2 months later she underwent another operation to remove the antibiotic spacer and to place a new total hip arthroprosthesis. Multiple swabs showed the complete healing from the infection, which was confirmed a couple of months later.

["New" virus and "old" risks. Reflections on H1N1 pandemic in the newspapers in Italy, France and UK]. / "Nuovi" virus e "vecchi" rischi. Riflessioni sul caso del virus H1N1 nelle principali testate giornalistiche di Italia, Francia ed Inghilterra.

AIMS: Social scientist Ulrick Beck links the idea of "risk society" with images of chronic uncertainties. The aim of this paper is to study how health risks are communicated in this social context. MATERIALS AND METHODS: In order to do that we explored a selection of articles published by two of the most popular newspapers in Italy, Corriere della Sera e La Repubblica, the UK, The Times e The Guardian, and France, Le Monde e Le Figaro, during 2009. RESULTS. This study allowed us to identify a transnational interest towards H1N1 pandemic that is characterized by picks of attention followed by periods of general indifference, and an alarmist frame. In alternative to this cross-country representation of H1N1 pandemic, however, we also identified three specific frames, one per each country. According to our analysis these frames can only be understood in close relation to citizens' trust towards the policy of science and the institutions, as well as the local and cultural traditions of science communication. CONCLUSIONS: Having said that, we are convinced that there is no perfect receipt that transcends the local context can be implemented to communicate health risks such as the ones associated H1N1. Nevertheless, our data indicate that there are good examples of health risks communication actually happening in Europe balancing between the risks of generating alarmism and denying the uncertainties of science become that are by now more and more evident.

Patellofemoral dysplasia in infantile cerebral palsy.

The authors have studied the biomechanical basis of functional alterations in the extensor apparatus of the knee in cases of infantile cerebral palsy. Several interesting aspects of the problem, some of which are controversial, have emerged from this study and from a review of patients with flexion contracture of the knee treated surgically: 1. The neurological pathology of the motor system leads to problems of posture and dysplastic conditions of the hip (coxa valgus, etc.) which favour the development of patellofemoral pathology. 2. By contrast, the early clinical manifestations of this pathology are relatively insignificant and completely overshadowed by the major problems of adaptation and compensation imposed by the more serious overall disabilities which face the patient in order to stand and walk. The knee plays a prevalently static role at this stage and is not particularly stressed during joint movement. 3. The clinical manifestations of patellofemoral pathology are thus paradoxically brought into focus by surgery on the flexor apparatus to deal with contracture. Although on the one hand this improves function, on the other it brings to light the more complex functional mechanisms of the knee, thus emphasizing any deficit in the extensor apparatus.

Grice's operation for spastic flat foot.

The authors report 24 cases of severe spastic pes valgus in children affected by cerebral palsy, treated surgically by a technique derived from that of Grice - taking the transplant from the calcaneus itself instead of from the usual sites. They discuss the parameters usually considered in assessing the results and describe their own method of interpreting the measurements derived from the angles usually employed in the evaluation of pes valgus.

Vertebral compression syndrome in multiple exostoses (case report).

The authors present a case, the second in the world literature, of Spinal Compression Syndrome in Multiple Exostoses. The diagnosis, not revealed on standard radiographs of the vertebral column, was suspected on radiculography and confirmed only by oblique stratigraphic projection. These demonstrated bone formation on the right vertebral lamina of L4 encroaching considerably on the spinal canal. Surgical laminectomy was followed by complete remission of neurological symptoms.