The first case of septic arthritis of the knee caused by Eggerthia catenaformis.

Eggerthia catenaformis has been reported as a human pathogen. We present the first case of the primary knee infection caused by Eggerthia catenaformis in a 23-year-old male patient with a knee infection, after primary anterior cruciate ligament reconstruction. Eggerthia catenaformis was confirmed by MALDI-TOF mass spectrometry from synovial fluid. The dental focus was excluded. The isolated bacterial strain showed sensitivity to all of the tested antimicrobials. However, for successful management of knee infection, besides culture-directed antibiotics therapy, arthroscopic debridement and lavage were necessary.

Glucocorticoid levels after exposure to predator odor and chronic psychosocial stress with dexamethasone application in rats.

This study was conducted to explore the effects of specific psychosocial paradigm on predator animal posttraumatic stress model and to test the hypothesis that psychosocially stressed rats would exibit abnormal levels of cortisol and a larger suppression of cortisol levels after the application of dexamethasone. Animals were divided in two groups: experimental and control groups. The experimental group was exposed to two types of stressors: acute immobilization stress, and combined predator stress and daily social stress with application of dexamethasone. Blood sampling was performed at three different times. We found statistically significant results after analyzing the differences between cortisol levels in different times of blood sampling in the group of animals exposed to stress with dexamethasone application. Statistical significance was found when we compared the experimental group with the control group in terms of elevated cortisol levels during blood sampling after stress paradigm exposition. Many significant disruptions in the functioning of the hypothalamic-pituitary-adrenal axis were observed, such as decrease in basal cortisol levels and enhanced dexamethasone-induced inhibition of cortisol levels. These findings are important because their impact can translate to human individuals with posttraumatic stress disorder, which is the most important role of every animal model in research.

Volumetric analysis of amygdala, hippocampus, and prefrontal cortex in therapy-naive PTSD participants.

OBJECTIVE: In our study we have hypothesized that volume changes of amygdala, hippocampus, and prefrontal cortex are more pronounced in male posttraumatic stress disorder participants. MATERIAL AND METHODS: We have conducted a study of 79 male participants who underwent MRI brain scanning. PTSD diagnosis was confirmed in 49 participants. After MRI was taken all scans were software based volume computed and statistically processed. RESULTS: We found that left amygdala is the most significant parameter for distinction between PTSD participants and participants without PTSD. There were no significant differences in volumes of hippocampi and prefrontal cortices. Roc curve method outlined left amygdala AUC = 0.898 (95% CI = 0.830-0.967) and right amygdala AUC = 0.882 (95% CI = 0.810-0.954) in the group of PTSD participants which makes both variables highly statistically significant. CONCLUSION: The present investigation revealed significant volume decrease of left amygdala in PTSD patients. Concerning important functions of the amygdala and her neuroanatomical connections with other brain structures, we need to increase number of participants to clarify the correlation between impared amygdala and possible other different brain structures in participants with PTSD.

Chiari pelvic osteotomy in the treatment of adolescent hip disorders: possibilities, limitations and complications.

Ninety-nine hips treated by the Chiari pelvic osteotomy were included in this study designed as a retrospective review. The group consisted of 36 male and 50 female patients, with mean age of 15.6 years. Each was diagnosed with developmental dysplasia of the hip (DDH) or avascular necrosis of the femoral head--Legg-Calve-Perthes disease (LCP)--and postreduction avascular necrosis (PAN). Five hip parameters (the acetabular angle of Sharp, the center-edge (CE) angle of Wiberg, the percentage of femoral head uncoverage, the acetabular depth ratio, and the Shenton-Menard arch continuity) were evaluated. Functional outcome was assessed according to Harris hip score (HHS) and McKay criteria for clinical evaluation. The postoperative results showed improvement in all the radiographic parameters. The angle of Sharp showed a decrease of 8.62º (p < 0.01). The CE angle of Wiberg showed an increase of 28.76º (p < 0.01), and the uncoverage of the femoral head showed a decrease of 51.51% (p < 0.01). The improvement of HHS was 11.93 (p < 0.05). The patients' satisfaction was indicated by grade 4.1 ± 0.94 and the doctor's satisfaction by grade 3.7 ± 1.16. The Chiari pelvic osteotomy, in spite of the development of biologically better procedures, has retained its position in the treatment of adolescent hip disorders.

[Medial subtalar dislocation--case report].

INTRODUCTION: Subtalar dislocation (SI) is a term that refers to an injury in which there is dislocation of the talonavicular and talocalcanear joint, although the tibiotalar joint is intact. CASE OUTLINE: A case of medial subtalar dislocation as a result of basketball injury, so-called "basketball foot", is presented. Closed reposition in i.v. anaesthesia was performed with the patient in supine position and a knee flexed at 90 degrees. Longitudinal manual traction in line of deformity was carried out in plantar flexion. The reposition continued with abduction and eversion simultaneously increasing dorsiflexion. It was made in the first attempt and completed instantly. Rehabilitation was initiated after 5 weeks of immobilization. One year after the injury, the functional outcome was excellent with full range of motion and the patient was symptom-free. For better interpretation of roentgenogram, bone model of subtalar dislocation was made using the cadaver bone. CONCLUSION: Although the treatment of such injury is usually successful, diagnosis can be difficult because it is a rare injury, and moreover, X-ray of the injury can be confusing due to superposition of bones. Radiograms revealed superposition of the calcaneus, tarsal and metatarsal bones which was radiographically visualized in the anterior-posterior projection as one osseous block inward from the talus, and on the lateral view as in an osteal block below the tibial bone. Prompt recognition of these injuries followed by proper, delicately closed reduction under anaesthesia is crucial for achieving a good functional result in case of medial subtalar dislocation.

[The results of surgical and nonsurgical treatment of mallet finger].

INTRODUCTION: The injury of the hand tendon classified as mallet finger presents the loss of continuity of the united lateral band of the extensor apparatus above distal interphalangeal joint, which consequently leads to specific deformity of distal interphalangeal joint which is called mallet (hammer) finger. OBJECTIVE: Our paper had several research objectives: presentation of the existing results of surgical and nonsurgical treatment of mallet finger deformities and comparison of our findings and other authors' results. METHOD: The study was retro-prospective, and analyzed 62 patients treated in the Clinical Center of Serbia in Belgrade (at the Institute of Orthopedic Surgery and Traumatology, and the Emergency Center) in the period 1998 to 2003. The follow up of these patients lasted at least 8 months (from 8.3 months to 71.7 months). An average follow up was 28.7 months. The objective parameters used in the study were as follows: sex, age, dominating hand, hand injury, finger injury, mode of treatment, complications, distal interphalangeal joint flexion and total movement of the distal interphalangeal joint. Collected data were analyzed by chi2-test and Student's t-test. The confidence interval was p = 0.05. RESULTS: A total range of motion was 51.9 +/- 6.6 for nonsurgically treated patients, and 48.2 +/- 4.2 degrees for operated patients. Mean extension deficit of the distal interphalangeal joint was 6.5 +/- 3.3 for nonsurgical and 10.0 +/- 3.2 for operated patients. CONCLUSION: The results confirmed that nonsurgical mode of treatment of mallet finger deformity was much more successful than surgical method of treating the same deformity.

[External fixation war injuries of the proximal humerus]. / Spoljna fiksacija ratnih povreda proksimalnog okrajka humerusa.

Nine patients with open fractures of the proximal humerus were treated using an external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Radial nerve injury was present in five and two multiply injured patients with thoracic wall and abdominal viscera were present. There were no major arterial injuries. Chronic osteitis with fistula and sequestra developed in one. There were no nonunions and no refractures. Minor painless limitation of shoulder and elbow motion presented in all patient. Upper-third humeral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted therefore, stable fixation is difficult or impossible to achieve. On the other hand, the risk of infection is high following plate fixation. External fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early mobilization of the shoulder and elbow.