Surgical removal of metallic foreign body (shrapnel) from the lumbosacral spine and the treatment of chronic osteomyelitis: a case report.

We report a case of a retired soldier who was severely injured by an explosion in 1993 during the war in Bosnia and Herzegovina. Among other wounds, he suffered an explosive wound in the lumbosacral spine with steel foreign body (shrapnel). A year after primary wound treatment, a purulent fistula appeared which was treated and stopped with antimicrobial therapy. Subsequently, fistula which was activated several times after the antibiotic therapy was discontinued, but in the last eight years, the fistula has been continuously present so the patient decided on surgery. During surgery, the shrapnel was removed from the lumbosacral spine and there was debridement of necrotic bone. During two weeks of peri-operative and postoperative period, chronic osteomyelitis was treated by intravenous ciprofloxacin and gentamycin, and after that by a combination of rifampicin and trimethoprim-sulfamethoxazole orally, for six months. The patient did not show any signs of infection after two years of follow-up.

Envenomation by the horned viper (Vipera ammodytes L.).

Snake venom poisoning is a medical emergency that requires urgent therapeutic procedures. The treatment of venomous snakebites is still controversial because of unclear therapeutic modalities. Choice of treatment is dictated in part by regional characteristics with regard to patient population and types of venomous snakes. The purpose of the study presented here was to report regional experience with venomous snakebites and to describe first-aid, pre-hospital, and hospital therapeutic procedures for horned viper bite. During a 16-year period, from 1980 to 1996, at the Clinical Hospital Split (Croatia) we collected data on 389 victims of horned viper bite. Incidence of the local and general complications is presented. We also reviewed therapeutic modalities and outcome with special attention to compartment syndromes and the indications for fasciotomy.

Early intracranial infections after brain missile injuries--the role of computer tomography in diagnosis and treatment.

During the war in Croatia, from August 1991 until December 1994, 138 soldiers were treated at the Split University Hospital for different brain injuries inflicted by missiles. Nine of these 138 patients developed intracranial infection. This retrospective study reports on the outcome of these 9 intracranial infections caused by penetrating missile head injuries. In case of clinically suspected infection, computerized tomography scan was obtained at two time points during the course of infection in the same patient. Scans were obtained with and without contrast media, 7 to 14 days after the injury and the 4 weeks later. The role of computerized tomography in the detection and follow-up of various intracranial infections and long-term consequences were evaluated.

[Epidemiologic and clinical characteristics of anthrax in patients at the University Hospital in Split 1956-1987]. / Epidemioloska i klinicka obiljezja antraksa u bolesnika KBC Split u razdoblju od 1956. do 1987. godine.

This paper discusses the epidemiological and some clinical characteristics of 61 patients who were diagnosed as having anthrax at the Department of Infectious Diseases, University Hospital Split in the period from January 1, 1956, to December 31, 1987. The pathogenesis of the disease is also reviewed. Clinical diagnosis was confirmed in 36 (59.02%) patients, 32 (52.46%) were diagnosed by microscopic examination of Gram's stained smears and 4 (6.56%) patients by cutaneous lesion fluid culture. In 54 (88.52%) patients the disease presented as a malignant pustule and in 7 (11.48%) as a malignant edema. Only 3 patients had clinical signs of septicemia, but the diagnosis was not confirmed by positive blood cultures in none of these patients. The subjects contracted the infection either by a direct contact with a diseased animal or indirectly by contaminated products of animal origin or by hematophagic insects in approximate ratio 8:2:1. No mode of infection was identified in 27 (44.26%) patients. The male/female and professional/nonprofessional anthrax ratio was 1:1. The majority of children were in the 0-9-year and 30-39-year age groups. Most of the patients were treated with penicillin, and the others with tetracyclines or a combination of antibiotics. Serum was applied in 29 (47.54%) patients. Only one patient died (1.64%). Three different modes of infection are described in the last four treated patients.

[Determination of antibody kinetics in Mediterranean spotted fever using the Weil-Felix agglutination test, complement fixation and indirect immunofluorescence]. / Kretanje protutijela u osoba s mediteranskom pjegavom groznicom odredivano Weil-Felixovom aglutinacijom, reakcijom vezanja komplementa i neizravnom imunofluorescencijom.

The kinetics of antibodies in human cases of Mediterranean spotted fever was studied by applying Weil-Felix (WF) agglutination with Proteus OX antigens, complement fixation (CF) and indirect immunofluorescence (IF) tests with Rickettsia conorri antigen to 46 sera from 21 patients. The kinetics of specific (CF and IF) and nonspecific (WF) antibodies was similar. The percentage of the positive sera and geometric mean titers of antibodies reached the maximum after 14 days from the onset of illness.

Hepatitis B virus infection among pregnant women in Split region.

A seroepidemiologic survey of pregnant women in Split region was performed in order to determine a strategy for prenatal screening for HBsAg. Thirty (7.5%) of 400 women had the markers of past or current HBV infection, while 3/400 (0.75%) were carriers. According to demographic data and risk factors they represent low risk population. General prenatal screening for HBsAg is advisable.

Antibodies to spotted fever group rickettsiae and Coxiella burnetii among domestic animals in southern Croatia.

The sera of dogs, goats, sheep and cattle (total 153) from the Kastelas' bay area (middle part of the eastern coast of the Adriatic Sea) were tested for antibodies against Rickettsia conorii and Coxiella burnetii by a complement fixation test. The overall percentages of positive sera among the tested animals were 23.9% for R. conorii and 16.4% for C. burnetii. The results show that animals in this area are clearly being exposed to spotted fever group rickettsiae as well as to C. burnetii. For comparison, six sheep sera from the flock, living in known Q fever focus in hinterland area and linked with outbreak of Q fever among owners were tested. Antibodies to C. burnetii but not for R. conorii were present in all six sera.

Antibodies to spotted fever group rickettsiae in dogs in Croatia.

The prevalence of IgG antibodies to spotted fever group rickettsiae was studied by the indirect immunofluorescent antibody assay in a sample of 194 canine sera from different parts of Croatia. Dogs (n = 141) from urban and suburban-semirural environs from the middle part of the eastern coast of Adriatic sea, and dogs (n = 53) from Zagreb, the capital of Croatia located in the northern continental part of Croatia, were tested. The total of 88 (62.4%) dogs from southern coastal Croatia had antibodies to Rickettsia conorii, with a significantly higher prevalence (69.9%) in suburban-semirural areas. The prevalence rate of antibodies to Rickettsia conorii in canine sera from urban environment in the north of Croatia was 20.7%. The results show that the members of spotted fever group rickettsiae are present in both coastal and continental Croatia.

Erysipelas-like cellulitis with Pasteurella multocida bacteremia after a cat bite.

A 73-year-old female patient presented with Pasteurella multocida erysipelas-like cellulitis, bacteremia, and shock. The onset of the disease occurred 24 h after a cat bit her to the right lower leg. Initially, the picture of bacteremia and shock developed, with minimal local cellulitis. Pasteurella multocida grew in blood culture. A combination of amoxicillin and clavulanic acid was therapeutically successful in respect that the signs of bacteremia and shock disappeared. However, extensive erysipelas-like cellulitis developed on the bitten leg within the next 2 days. The disease was efficiently treated with penicillin G combined with netilmicin and administered for 10 days. This report documents the first case of Pasteurella multocida erysipelas-like cellulitis with bacteremia and shock.

Primary echinococcosis of the sternocleidomastoid muscle.

Muscular echinococcosis accounts for 0.5% to 5.4% of all hydatid disease cases, with very little data on the incidence of muscular echinococcosis of the head and neck. We report a unique case of primary echinococcosis of the right sternocleidomastoid muscle in a 56-year-old man. Preoperative assessment by ultrasound and fine needle aspiration did not point to echinococcosis. We suspected the right diagnosis intraoperatively and confirmed it postoperatively by pathohistology and serologic tests. Echinococcosis of the liver and the lungs was also excluded postoperatively. Combination of operative treatment and postoperative albendazole herapy in two 28-day cycles one month apart resulted in complete regression of the disease. Echinococcosis should be considered as differential diagnosis of a multicystic mass in neck, particularly if it is of longstanding duration. Serologic tests for echinococcosis should be included in differential diagnostic procedures for each multicystic formation on the neck, especially in endemic areas.

Two outbreaks of typhoid fever related to the war in Bosnia and Herzegovina.

Two outbreaks of typhoid fever caused by Salmonella typhi of the same phagotype (A, biotype II), and antibiotic susceptibility are reported. Both occurred during the war in Bosnia and Herzegovina. The first outbreak appeared among the refugees from the town of Jajce. The second outbreak appeared among the inhabitants in the village of Vidosi near Livno. This report describes main clinical, epidemiological and laboratory findings for 22 patients treated in Split University Hospital, Croatia, in the period November 1992-January 1993. Possible epidemiological connections between those two outbreaks are discussed.