Rothia mucilaginosa, rarely isolated pathogen as an etiological factor of infection of soft tissues in young, healthy woman.

This paper presents a rare case of facial soft tissue infection caused by the bacterial strain of Rothia mucilaginosa. Odontogenic background of infection and initial clinical presentation suggested the presence of typical bacterial flora and uncomplicated course of treatment. However, despite surgical intervention and broad-spectrum antibiotic therapy, the expected improvement of a clinical status was not achieved. Only detailed bacteriological examination allowed to establish a bacterial pathogen and start a targeted antibiotic therapy. The unusual clinical course was monitored by imaging CT examination and further surgical interventions. A significant improvement was obtained in the third week of hospitalization and further antibiotic therapy was continued by means of outpatient treatment. Rothia mucilaginosa infection together with dental intervention is a rare case, since most of the reports in the literature concern the patients with decreased immunity. In such patients, the most common areas of infection were: the peritoneum, lung tissue and meningeal spaces of the brain and the presence of a foreign body. 

Nurses' Readiness to Undertake Controlled Negative Pressure Therapy in the Treatment of Chronic Wounds-Research Report.

Local wound treatment with negative pressure wound therapy (NPWT) shortens the healing process but requires the supervision of trained medical personnel for administering the therapeutic procedures. Professional supervision and control of the effectiveness of NPWT, as well as education conducted by nurses, are of particular importance for therapeutic and caring processes, both in hospital and at home. The aim of the study was the assessment of the perception of NPWT by certified nurses in the topical treatment of chronic wounds. The study was conducted using the method of estimation and a diagnostic survey with the proprietary NPWT perception questionnaire: 495 subjects were enrolled in the study and 401 respondents aged 25-67 years qualified for statistical analysis. Despite their experience and competence, the respondents critically assessed their knowledge, pointing to an average subjective level of knowledge related to wound treatment and a low level of knowledge related to NPWT. Most of the respondents had no experience of independent treatment using this method. The data obtained from the questionnaire clearly indicate theoretical preparation and high motivation to undertake activities related to the implementation of NPWT in their own practice. Low readiness values suggested that the subjects did not have the resources or the ability to implement the method. The perception of NPWT in the surveyed group of nurses was determined by numerous factors, including self-assessment of their own knowledge, motivation and readiness to use NPWT. A high level of NPWT perception was noted, despite low motivation related to the availability and knowledge of the method. Theoretical knowledge is insufficient to implement innovative methods in local wound treatment. Practical skills and motivation are indispensable elements that should be met during the training and education of nurses in the field of wound care.

Complications of dislocated calcaneal fractures.

BACKGROUND: Calcaneal fractures are the most common of all tarsal fractures, with the majority being the result of high energy injuries causing comminution of bone and lesions of the posterior articular surface. If the bone fragments are left dislocated or non-operative reduction is attempted, the outcome is poor, often with chronic disability. On the other hand, operative treatment does not always lead to a good result and there is an inherent risk of devastating complications. MATERIAL AND METHODS: During a 3-year period (2002-2005) the authors treated operatively (by open reduction and internal fixation) 23 dislocated calcaneal fractures involving the posterior calcaneotalar joint. A control group of 12 patients was treated non-operatively or using minimally invasive techniques. Medium-term results were compared by evaluating the Bohler and Gissane angles and the shape of the posterior calcaneal articular surface on radiographs (lateral and Broden views), while functional outcomes were rated according to the Creighton-Nebraska scale. Complications not included into this scheme were noted. RESULTS: Both anatomic and functional results were markedly better in the group treated with open reduction and internal fixation. In this group, there were three cases of infectious complications that were attributed to the surgical procedure, while in the other group, two such cases were associated with open fractures. Both groups developed clawing of the toes. The quality of reduction was always unsatisfactory in the non-operative group. CONCLUSIONS: 1. Complications of calcaneal fractures significantly worsen the therapeutic outcome. 2. Proper care based on meticulous evaluation of the foot in the early period is crucial for reducing the incidence of complications.

Intraspinal migration of a Kirschner wire as a late complication of acromioclavicular joint repair: a case report.

BACKGROUND: Penetrating neck trauma involving foreign bodies is a rare event in European countries. Due to its relatively high mortality rate, the correct management strategy must be initiated from the beginning to prevent fatal complications. In the medical literature, there are only a few cases describing foreign bodies penetrating the cervical spine. Because of its rareness, many trauma centers lack the proper routine to adequately manage such injuries. CASE PRESENTATION: This case report describes a 34-year-old white man of Central European descent with Kirschner wire migration and perforation of his vertebral foramen. He underwent acromioclavicular joint repair surgery 7 years ago, presented with a painful sensation around the area of his left clavicle and left side of his neck after a motorcycle accident. No neurological deficit was detected. CONCLUSIONS: In such cases, a thorough radiological evaluation of the spinal cord and the surrounding vasculature is mandatory for a complete understanding of the extent of the injury and determining the proper surgical management. In cases of vertebral artery trauma both an endovascular and an open approach can be contemplated.

Fracture, osteosynthesis, union of fractured bones - historical reflections.

This article presents the review of the achievement and progress in fracture treatment from ancient ages till XXth century. There was shown the development of the conservative treatment - creating the suitable immobilizing splints, casts and the first surgical procedures, equipment, plates, screws, nails for the osteosynthesis. Besides there were presented the first observations and remarks of former researcher on biology of the fracture healing process.

Why do fractures of long bones heal faster in patients with coexisting brain injury?

Healing of fractured long bones is faster in patients with coexisting brain injury. This phenomenon has been observed for many years but it is not clearly explained. So far it has not been settled if the problem has its origin in Central Nervous System or represents systemic response on a severe trauma. The following article presents the literature review concerning this issue.

The sun--our friend or foe?

INTRODUCTION AND OBJECTIVE: Sunlight is the major source of the energy on Earth. Visible light, ultraviolet and infrared radiation are necessary to sustain life on our planet. However, besides the range of positive effects, such as photosynthesis in plants, warmth, vision, and synthesis of vitamin D, sunlight may also be responsible for negative biologic effects - sunburn, induction of photodermatoses or carcinogenesis. Ultraviolet is regarded as the major environmental, physical hazard to the human skin. ABBREVIATED DESCRIPTION OF THE STATE OF KNOWLEDGE: The acute clinical effect of ultraviolet involves melanogenesis, i.e. tanning, which protects from sunburn if exposure is overdosed. A single exposure, as well as acute suberythemal irradiation, suppresses sensitization of the contact hypersensitivity. The chronic biological effects are photoageing and skin cancer, especially squamous cell carcinoma (SCC). Vitamin D synthesis is regarded as a benefit of natural acute and chronic exposure to ultraviolet. Ultraviolet also plays an important role in aetiology of the group of disorders characterized by photosensitivity. On the other hand ultraviolet is a known inducer of immunosuppression in the skin; therefore, phototherapy is a therapeutic option for patients with activation of dermal immunity. SUMMARY: Without sunlight, the existence of life on Earth is not possible. On the other hand, UVR radiation is regarded as representing one of the most important environmental hazards for human skin. For a better understanding of the mechanisms related to the influence of UVR on human skin, and the most dangerous chronic effects of carcinogenesis, it is necessary to undertake some protective activities. Moreover, UVR may become our ally in the treatment of selected skin disorders.

Femoral neck fracture following intramedullary nailing with misplacement of an end cup: report of two cases.

Femoral neck fracture is an unusual complication of intramedullary fixation of a broken femur. We report on two cases of femoral neck fractures attributed to misplacement of an end cup and subsequent invasive maneuvers in an effort to remove it. Iatrogenic fractures of the femoral neck during or after intramedullary nailing are reported in the medical literature. Authors associate it with many possible technical mistakes performed during the procedure, yet no complications after missed end cup placement were noted. We suggest that the fractures described below were a consequence of injury to the vascular supply and bone stock of the initially intact femoral neck.