Partial hardware removal in guided growth surgery: A convenient strategy? / Retiro parcial del implante en cirugía de crecimiento guiado: ¿Una estrategia conveniente?

BACKGROUND: Tension band plates (TPBs) are frequently used in guided growth (CG) surgeries. Recently, the concept of removing the metaphyseal screw only to stop the growth modulating effect rather than completely removing the implant, has gained popularity. Although this strategy would have certain potential advantages, the associated risks are unknown. The aim of this study is to report the experience of three institutions with this strategy. METHODS: A database was compiled with the demographic information of patients treated by guided growth using TBPs between January 2014 and January 2019 at three institutions. The cases where only the metaphyseal screw was removed were identified. The records were reviewed to analyze the indications, demographic data, characteristics of the procedure, complications and need for additional procedures. RESULTS: We reviewed 28 partial hardware removals, performed in 10 patients (all male). Initial surgery was indicated for angular deformity (N = 6), and leg-length discrepancy (N = 4). The average age at the time of surgery was 9.5 ± 2.9 years (range 4 to 13 years). Three procedures were performed on the distal femur, 3 on the proximal tibia, 2 on the distal tibia, and 20 combined. The average follow-up was 23.3 ± 11 months (range 12 to 52 months). We observed recurrence of deformities in 7 of 28 (22%) limbs that required re-insertion of the metaphyseal screw. Two patients presented complications from the procedure: soft tissue irritation (N = 1) and angular deformity (N = 1). Both patients required unplanned surgery. DISCUSSION: Partial hardware removal in guided growth surgery could favor the presentation of complications. The benefits of this strategy must be considered against the possible undesired effects generated by its application. STUDY DESIGN: Therapeutic study (Level IV).

The isoflavone daidzein directly affects porcine ovarian cell functions and modifies the effect of follicle-stimulating hormone.

The key biological active molecule of soya is the isoflavone daidzein, which possesses phytoestrogenic activity. The direct effect of soya and daidzein on ovarian cell functions is not known. This study examined the effect of daidzein on basic porcine ovarian granulosa cell functions and the response to follicle-stimulating hormone (FSH). We studied the effects of daidzein (0, 1, 10 and 100 µm), FSH (0, 0.01, 0.1, 1 IU/ml) and combinations of FSH (0, 0.01, 0.1, 1 IU/ml) + daidzein (50 µm) on proliferation, apoptosis and hormone release from cultured porcine ovarian granulosa cells and ovarian follicles. The expression of a proliferation-related peptide (PCNA) and an apoptosis-related peptide (Bax) was analysed using immunocytochemistry. The release of progesterone (P4) and testosterone (T) was detected using EIA. Leptin output was analysed using RIA. Daidzein administration increased granulosa cell proliferation, apoptosis and T and leptin release but inhibited P4 output. Daidzein also increased T release and decreased P4 release from cultured ovarian follicles. Follicle-stimulating hormone stimulated granulosa cell proliferation, apoptosis and P4, T and leptin release. The addition of daidzein promoted FSH-stimulated apoptosis (but not proliferation) but suppressed FSH-stimulated P4, T and leptin release. Our observations of FSH action confirm previous data on the stimulatory effect of FSH on ovarian cell proliferation, apoptosis and steroidogenesis and demonstrate for the first time the involvement of FSH in the upregulation of ovarian leptin release. Our observations of daidzein effects demonstrated for the first time that this soya isoflavone affected basic ovarian cell functions (proliferation, apoptosis and hormones release) and modified the effects of FSH. Daidzein promoted FSH action on ovarian cell proliferation and apoptosis and suppressed, and even inverted, FSH action on hormone release. The direct action of daidzein on basic ovarian cell functions and the ability of these cells to respond to FSH indicate the potential influence of soya-containing diets on female reproductive processes via direct action on the ovary.

[Tuberculous orchiepididymitis and CNS complication]. / Die tuberkulöse Epididymoorchitis und die Zentralnervensystemkomplikation.

INTRODUCTION: Hydrocephalus as a complication of tuberculous orchiepididymitis is extremely rare. In this reported case, hydrocephalus was the consequence of a disseminated tuberculous process. CASE REPORT: A 28-year-old man was treated for a left-sided orchiepididymitis. He developed the signs of increased intracranial pressure. Computer tomography (CT) of the brain showed a hydrocephalus. The diagnostics that followed confirmed disseminated tuberculosis (Tbc). CONCLUSIONS: Urogenital system is at the present rarely affected by Tbc. Especially rare is disseminated Tbc, which affects at the same time three different organ systems. Disseminated Tbc presented with many different but non-specific clinical symptoms, sometimes mimicking neoplasm. This makes diagnosis and therapy more difficult. We point out that in any case of orchiepididymitis not responding to standard antimicrobial therapy Tbc must be taken into consideration as the one of the differential diagnostic possibilities.

Cervical necrotizing fasciitis: sources and outcomes.

BACKGROUND: Abscesses of the peritonsillar region are among the most common deep abscesses of the head and neck. However, cervical necrotizing fasciitis (CNF) associated with a peritonsillar abscess is an extremely rare condition, with only 12 well-documented cases described. PATIENTS: We reviewed and compared all 12 cases of CNF arising from peritonsillar abscesses, including our own case. CNF that developed after peritonsillar abscesses was also compared with that developing predominantly after odontogenic infection. RESULTS: The overall mortality was higher in the group with peritonsillar abscesses (33% vs 25%). CONCLUSION: It is probable that of all cases of CNF, that arising from peritonsillar abscess has the worst prognosis.

Clinical, epidemiological and epizootic features of Q fever in the northern coastal part of Croatia from 1989 to 1998.

Although Q fever is endemic in the northern coastal part of Croatia, it usually occurs sporadically. Analysis of 58 patients hospitalized for Q fever during the last 10-year period (1989-1998) revealed some differences in the clinical manifestation compared to a previous study (1954-1977). Most cases of Q fever (N = 55; 91%), presented with pneumonia, but no rash was noticed, compared to 46% of patients with Q fever developing exanthema in the previous study. The previously observed high seropositivity to Coxiella burnetii among domestic animals was confirmed in this study. A two-peak seasonal distribution of Q fever observed in 1991 was connected with the imported Russian sort of sheep with special biology of delivery. The clinical outcome was favorable for all patients, since no complications or chronic forms of the disease were recorded. Disproportion between the number of registered and hospitalized patients, including a number of asymptomatic and several undiagnosed or misdiagnosed infections, leads to a conclusion that the real number of persons infected with Coxiella burnetii in the area is several times higher.

Antimicrobial utilization and bacterial resistance at three different hospitals.

It has been generally recognized that the prevalence of bacterial resistance among bacteria is an unavoidable consequence of antibiotic use and is positively linked to the overall use of antibacterial drugs. The purpose of this study was to investigate the extent of antimicrobial usage and to evaluate the antimicrobial resistance at three different hospital settings in Croatia: a clinical hospital, a general hospital and a specialized clinic for infectious diseases. In this survey the antimicrobial drug consumption and antimicrobial susceptibility test results were analyzed for the first 6 months of 1997 in three different hospitals in Croatia: the University Hospital Center (UHC), Rijeka, the Clinic for Infectious Diseases 'Dr Fran Mihaljevic', Zagreb and the Dubrovnik General Hospital. The data were collected from corresponding hospital pharmacy records and microbiology laboratories. Antimicrobial drug utilization was expressed in number of defined daily doses (DDDs) per 100 bed days. High antimicrobial utilization and high resistance rates were found in all three hospitals. At the Clinic for Infectious Diseases, the most frequently used antimicrobials where those of narrow spectrum while at the UHC Rijeka and the Dubrovnik General Hospital the broad spectrum antimicrobials were mostly used. The highest antimicrobial consumption was noted at the Susak locality of the UHC, Rijeka, where the highest resistance rates of bacteria to antimicrobials were also found. Results of this observational study indicate that attempts should be made to reduce the influence of factors that may lead to emergent resistance. The most effective approach to the prevention of transmission of multidrug-resistant pathogens is preventing the initial emergence of resistance. A rational and strict antibiotic policy is thus of great importance for the optimal use of these agents.

Low sero-prevalence of Lyme borreliosis in the forested mountainous area of Gorski Kotar, Croatia.

AIM: Clinical forms of Lyme disease in Gorski Kotar have occurred only sporadically, in contrast to the northwestern Croatia and the neighboring areas of Slovenia, which are well-known Lyme borreliosis endemic regions. Our aim was to assess the level of sero-prevalence of Borrelia burgdorferi sensu lato in a high-risk population of forestry workers in the mountainous region of Gorski Kotar, Croatia, and compare it with the sero-prevalence in the residents of that area and the neighboring littoral region. METHODS: A sero-epidemiological study was conducted on 520 healthy subjects, divided in 3 groups: the first group included 234 forestry workers, residents of Gorski Kotar, the second 100 residents of various professions in the same region, and the third 186 subjects of various professions from the neighboring littoral region. The sera were collected during the winters of two successive years, 1997 and 1998. Lyme borreliosis serology was performed by indirect immunofluorescence assay. Sera from 10 hunting dogs from Gorski Kotar were also analyzed. RESULTS: The IgG antibodies to B. burgdorferi sensu lato were found in 11 examinees (4.7%) from the group of forestry workers, in 3 (3%) from the second group, and in 5 (2.7%) from the third group. Four out of 10 dogs (40%) had IgG antibodies against B. burgdorferi. CONCLUSION: Our results show that the forest and mountainous area of Gorski Kotar, Croatia, has the characteristics of a low sero-prevalence area, in contrast to the endemic neighboring areas.

Antibiotic utilization at the university hospital after introducing an antibiotic policy.

OBJECTIVE: Antibiotic formulary restrictions are among the most popular methods to control antibiotic utilization in hospitals. The aim of the present survey was to investigate the influence of "reserve antibiotic" on antimicrobial utilization at the University Hospital Center (UHC) Rijeka. METHODS: At the UHC Rijeka, reserve antibiotic was implemented in July 1997. The antimicrobial drug consumption was monitored 6 months prior to and 6 months after the introduction of the method. Antimicrobial consumption was measured in defined daily doses (DDDs) among the major clinics. RESULTS: Reserve antibiotic has led to a decrease in total antibiotic consumption at the UHC Rijeka (45.9 DDDs/100 bed days vs 32.9 DDDs/100 bed days). Antibiotic utilization decreased in the second semester at most clinics: at the Clinic for Infectious Diseases 41%, at the Anesthesiology and Intensive Care Unit 30%, at the Clinic for Internal Medicine 18% and at the Surgical Clinic 12%. At the Clinic for Gynecology and Obstetrics, the antibiotic utilization remained the same, while at the Pediatric Clinic an increase of 28% in antibiotic utilization was noted. CONCLUSION: Our study indicates that restriction of usage of some antibacterial agents is a successful method to decrease antibiotic consumption and a way to bring cost savings and helps prevent emergence of resistant microorganisms in hospitals. To improve antimicrobial prescribing, additional methods such as education are required.

Opsoclonus-myoclonus syndrome in a child with neuroborreliosis.

Opsoclonus-myoclonus is a rare neurological syndrome affecting children and adults. In children it occurs as a parainfectious process or a paraneoplastic syndrome in association with neuroblastoma. Here we report it presenting as an unusual neurological manifestation of Lyme borreliosis. To our knowledge, this is the first report which describes recovery from this syndrome in a child.

Human hydatidosis in Dalmatia, Croatia.

Human echinococcosis remains a very serious public health problem worldwide, although a decline in incidence has been observed in some endemic areas during the last decades. However, in some non-endemic areas an increase in new cases and new foci of animal echinococcosis were registered during the same time. In Dalmatia, a well known endemic area of hydatidosis in the most Mediterranean part of Croatia, from the mid-1950s until present a decrease of incidence of over 70% has been registered. Age, sex and occupational category specific incidence as well as lethality rate have remained the same as before. Migrations from rural to urban regions seem to be the most important parameter in the changing epidemiology of human hydatidosis in Dalmatia.

[Azithromycin in the prevention of Mediterranean spotted fever]. / Azitromicin u profilaksi mediteranske pjegave groznice.

Antibodies to Rickettsia conorii were detected by the indirect immunofluorescence (IFA) assay in 64 (51.6%) out of 124 examinees living in North Dalmatia (Croatia) who had a history of recent tick bites during 1994 and 1995. Positive titers of IFA antibodies to R. conorii were detected in 12 (31.5%) out of 38 examinees with carried out prophylaxis by azithromycin. The usual clinical signs of Mediterranean spotted fever were registered in 22 (25.6%) and asymptomatic infection in 30 (34.8%) out of 86 examinees without prophylaxis. Clinical signs of the disease were not registered in examinees with prophylaxis.

[Post-streptococcal reactive arthritis: diagnostic problems]. / Poststreptokokni reaktivni artritis: dijagnosticke teskoce.

The authors present clinical, microbiological and scintigraphic findings in eight children with poststreptococcal reactive arthritis, hospitalized in the Zadar General Hospital from 1990 to 1992. In all patients an antecedent throat infection was noticed, 7-10 days before the first symptoms and signs of arthritis developed. Antistreptolysin O microtitration and/or throat culture revealed streptococcal infection in all patients. Scintigraphic examination with Te-99m yielded four positive (50%) results. In the follow-up one of the positive scans was later suggestive of tumorous process. The authors conclude that accurate diagnosis of poststreptococcal reactive arthritis depends on microbiological identification of streptococcal infection and longitudinal clinical follow-up in which scintigraphy may be of differential diagnostic benefit.

Isolation of Rickettsia akari from a patient in a region where Mediterranean spotted fever is endemic.

Rickettsia akari was isolated from blood collected from a patient in Croatia in 1991. We believe this is the first human isolate of R. akari to be reported in more than 40 years and the first ever from southern Europe. The Croatian isolate was antigenically and genetically indistinguishable from the prototype American strain and a Ukrainian strain. In all probability, rickettsialpox would be diagnosed more frequently and over a wider geographic area if physicians gave greater consideration to the diagnosis and if laboratory diagnostic methods were better able to distinguish among spotted fever group rickettsioses.

Antigen-capture enzyme immunoassay: a comparison with other methods for the detection of spotted fever group rickettsiae in ticks.

To evaluate the prevalence of spotted fever group rickettsiae along the Adriatic Coast of Croatia, 832 ticks were examined by hemolymph test, direct immunofluorescence, antigen-capture enzyme immunoassay, and polymerase chain reaction. Very good agreement was observed among direct immunofluorescence, polymerase chain reaction, and antigen-capture enzyme immunoassay. Twelve ticks that were positive by hemolymph test and negative by both direct immunofluorescence and polymerase chain reaction presumably do not represent spotted fever group rickettsiae. By direct immunofluorescence, spotted fever group rickettsiae were present in 12% of Rhipicephalus bursa, 10.6% of Rh. sanguineus, and 7.8% of Dermacentor marginatus. From the 98 ticks containing rickettsia-like organisms by hemolymph test, seven spotted fever group rickettsial isolates were established in cell culture. Four isolates were identified as Rickettsia conorii. The antigen-capture enzyme immunoassay, which utilizes a monoclonal antibody to antigens of the 135-kD surface protein shared among many members of the spotted fever group, is recommended for primary screening of tick samples because it is reliable and yet less labor-intensive than the hemolymph and direct immunofluorescence tests. Although the polymerase chain reaction is too expensive for use as a screening method, it is recommended for confirmation of positive screening results. In addition to the technologic advance of the antigen-capture enzyme immunoassay, this study documented by contemporary methods that R. conorii is present along the eastern Adriatic Coast not only in the classic vector, Rh. sanguineus, but also in Rh. bursa and D. marginatus.

Prevalence of antibodies to spotted fever group rickettsiae along the eastern coast of the Adriatic sea.

A seroepidemiological survey in coastal Croatia detected antibodies reactive with Rickettsia conorii in 4.2% of sera by immunofluorescence assay and in 5.0% of sera by enzyme immunoassay. Western immunoblotting demonstrated antibodies to the 120-kDa surface protein in all 20 positive serum samples examined and to rickettsial lipopolysaccharide in 3 of these serum samples. Humans in this area are clearly being exposed to spotted fever rickettsiae.

Histopathology and immunopathology of skin biopsy specimens in Mediterranean spotted fever.

Histology of skin lesions and demonstration in them of Rickettsia conorii by direct immunofluorescence test (DIF) are presented in 13 patients with Mediterranean spotted fever (MSF). The lymphohistiocytic vasculitis which dominated the picture is not specific, however, it could be suggestive for the diagnosis of rickettsiosis. By DIF we demonstrated rickettsial coccobacillary forms in all the patients: in 12 macular lesions and in one "tache noire". The diagnosis was also confirmed by indirect immunofluorescence test in each case. DIF test was shown to be sensitive, specific and reliable in early diagnosis of MSF.

Comparison of serologic methods for the diagnosis of Mediterranean spotted fever.

During summer Mediterranean spotted fever (MSF) is prevalent in the subcostal part of Croatia (North Dalmatia) as well as in other areas of the Mediterranean coast. We compared the specificity and sensitivity of complement fixation (CF), latex agglutination (Latex-R. conorii), microimmunofluorescence (micro-IF) and enzyme-linked immuno assay (ELISA) for detection and measuring antibodies against Rickettsia conorii in 78 sera from 46 patients with/or suspected Mediterranean spotted fever. The seroreactivity with SFG antigens containing the Rickettsia conorii-antigen(s) as a common determinant, was positive in all four serological tests suggesting that Rickettsia conorii was the probable causative agent of infection in our patients.

[The clinical spectrum of rickettsiosis in the area of Zadar]. / Klinicki spektar rikecioze na zadarskom podrucju.

The clinical spectrum of rickettsioses in patients admitted to our hospital (Department of Infectious Diseases, General Hospital of Zadar) from 1983 to 1988 has been analysed. This spectrum consisted of the following diseases: murine typhus, Q-fever, boutonneuse fever and Brill-Zinsser disease. The low number of hospitalized patients with rickettsioses was in disproportion with the prevalence of antibodies to these rickettsiae in general population of the Zadar area. Our results indicate that the main reason for this disproportion are misdiagnosed and undiagnosed diseases.