Systemic and deep-seated infections caused by Arcanobacterium haemolyticum.

Arcanobacterium haemolyticum has been implicated mainly in non-streptococcal pharyngitis and wound infections. Rarely, it has been reported to cause systemic infection, often in combination with other pathogens. Two cases of systemic and deep-seated infections caused by Arcanobacterium haemolyticum are reported, and the literature is reviewed. Sixteen cases of bacteremia and seven cases of non-bacteremic deep-seated have been published previously. Eight of the bacteremic and two of the non-bacteremic cases occurred in younger, apparently healthy immunocompetent patients. Six patients had infections of the central nervous system. The optimal treatment of infections caused by Arcanobacterium haemolyticum is not known. Although in vitro susceptibility tests have demonstrated tolerance of Arcanobacterium haemolyticum to penicillin, penicillins with or without aminoglycosides have been the most widely used antibiotics, in most cases with success.

Improved method for examination of microvascular structures in bone tissue.

Scanning electron microscopy of methylmethacrylate vascular corrosion casts was used for the morphologic examination of the microvascular system in bone. The methylmethacrylate used for vascular casting was prepared by prepolymerization with ultraviolet light. To approximate the viscosity of blood in the microcirculation, where the hematocrit of blood is lower than in the rest of the circulation, a viscosity between that of plasma and full blood was chosen for the casting material. Neither the ultraviolet prepolymerization of methylmethacrylate nor the choice of a viscosity this low has been used in microcorrosion casting in bone before. Further preparation of the tissue followed 2 directions: (1) complete maceration and decalcification of the specimens, thereby exposing all the vascular structures for detailed examination. By this procedure, it was possible to show detailed and sharp impressions of the vascular bed, and to show, for the first time, the vascular loop from a cutting cone; and (2) maceration without decalcification of the specimens, which is suitable for examination of relations between the microvascular system and the bone tissue. This technique enables studies of the role of the vascular system in bone remodeling and of the involvement of vascular structures in bone disorders. This improved technique for examination of microvascular structures in bone enables detailed studies of the vascular system and its relation to active remodeling sites in bone.

Results of the total bi-metric cementless hip arthroplasty.

A 2.9-year follow up of 50 primary Bi-Metric System cementless, porous-coated hip arthroplasties (Biomet) is presented. Four patients were operated bilaterally. In two patients, revision arthroplasty was carried out, in one because of infection, in the other because of loosening of the stem. The average Harris hip score was 96 points. The pain level according to d'Aubigné was 5.87. All patients belonged to Jensen's social function group 1. According to Engh's x-ray score, the femoral component achieved an average total of 19 points. Twenty-three patients with heterotopic ossification were graded according to Brooker et al; 18 patients belonged to group I-II, and 5 patients to group III. Discrepancy of leg length was measured in 20 patients, and averaged 0.52 cm (range: 0 cm to 2.5 cm). Four patients complained of thigh pain, but they had no radiographic evidence of loosening of components. The mean age was 63.4 years for women and 58.1 for men. Acceptably high Harris Hip Scores were obtained for the Bi-Metric hip prosthesis at 2-year follow up.

Manubrium sterni stress fracture: an unusual complication of non-contact sport.

Tremendous force is usually required to cause sternal fractures. Normally this is caused either by a direct blow to the chest or by an indirect injury from hyperflexion of the torso. A case is presented of a fracture of the manubrium sterni in a young man as a complication of body building exercises-a non-contact sport. It appears that this has not been reported before.

Pseudoarthrosis between a patellar tendon ossicle and the tibial tuberosity in Osgood-Schlatter's disease.

We report a case of pseudoarthrosis between a patellar tendon ossicle and the tibial tuberosity. A man, 18 years of age, had persistent symptoms of Osgood-Schlatter's disease from the left knee for 3 years. Conservative treatment was without effect. Excision of the ossicle resulted in complete relief of symptoms. Histologic examination showed a pseudoarthrosis covered with cartilage and no sign of inflammation. Persistent symptoms of Osgood-Schlatter's disease for more than 2 years indicate exploration.

Arthroscopic repair of the ruptured meniscus: one to 6.3 years follow up.

Forty-nine patients underwent arthroscopic meniscal repair. Twenty-three had an isolated tear of the medial meniscus, four an isolated tear of the lateral meniscus, two a tear of the medial meniscus combined with a rupture of the medial collateral ligament, and 20 a tear of the anterior cruciate ligament (ACL) and a tear of one or both menisci. At the time of repair of the menisci, seven had undergone reconstruction of their ACL, whereas 13 had been treated conservatively for their ACL rupture. Seven of 10 retears were in patients with a conservatively treated ACL tear, and three were in patients with an isolated tear of a meniscus. Thirty-five patients without retears were reexamined after 5.5 years (1-6.3 years). The average Lysholm knee score before the trauma was 98 (range 75-100), and at follow-up it was 87 (range 29-100). The average Tegner's activity score before the trauma was 6 (range 3-9), and at follow-up it was 5 (range 0-9). When there is no retear, the clinical results of arthroscopic repair of the menisci are excellent. In those patients who had isolated lesions of the menisci, there were very few retears, 11% in this study. ACL deficiency of the knee greatly increases the risk of retear. In this study 46% of patients with persistent instability after an untreated ACL rupture incurred retears. There were no retears in the patients who underwent ACL reconstruction concomitant with the meniscal repair.