[Osteomyelitis due to Escherichia coli complicating a closed humeral fracture]. / Osteomielitis por Escherichia coli sobre fractura cerrada de húmero.

Patients with indwelling urethral catheters have an important risk of developing Escherichia coli bacteremia. Several cases of hematogenous vertebral osteomyelitis due to E. coli after diagnostic or therapeutic urinary tract procedures have been reported. An 88-years-old male patient with indwelling urethral catheter was admitted because of a closed subcapital humeral fracture and macroscopic hematuria due to bladder carcinoma. During his hospital admission he was treated with bladder irrigations with glycine solution. Also a cystoscopy was done. On 8th day after admission the size of his left shoulder increased. Free air in the proximity of the humeral fracture was observed at X-ray radiography and at CT scan. The patient was operated and an abscess close to the fracture with malodorous pus was drained. A culture of pus yielded E. coli. In order to prevent infections similar cases, use of indwelling urethral catheters should be strictly limited to patients that do not have any other option.

Chronic recurrent multifocal osteomyelitis: report of a case with epiphyseal and metaphyseal involvement.

Chronic recurrent osteomyelitis is a recognized clinicopathological entity with typical radiographic findings in the metaphyses of the long bones. Epiphyseal lesions usually are small and may easily be overlooked. Bone scintigraphy is helpful in identifying multiple lesions whether symptomatic or not. The diagnosis is one of exclusion without pathognomonic findings. Recognition of the condition is important to avoid treatment with antibiotics and repeated operations.

[Detection campaign for hemoglobinopathies and thalassemias among school children in northern Extremadura]. / Campaña de detección de hemoglobinopatías y talasemias en la población escolar del norte de Extremadura.

PURPOSE: To detect carriers of thalassaemia and haemoglobin variants among the northern Extremadura school population. MATERIAL AND METHODS: The study was carried out in the Plasencia health service area, comprising about 120,000 people. All children between 4 and 15 years of age were offered to take part in the programme. The first-stage screen was mean corpuscular volule (MCV) measured in a Coulter STKS automatic counter. When low VCM was detected, ferritin estimation was carried out; if ferritin was normal, hemoglobin A2 was quantified. Haemoglobin electrophoresis at pH 8.4 was performed in all samples whatever the MCV, and patients were classified into the following groups: iron deficiency, beta-thalassaemia, Hb Lepore, structural haemoglobin variant, or atypical microcytosis. RESULTS: Out of 22 schools from 20 towns, 2,818 children were studied, the participation reaching 75.48%. Lower than normal MCV was found in 162 children (5.74%), who were grouped as follows: thalassaemia, 15 cases (0.53%), Hb Lepore, 8 cases (0.28%), iron deficiency, 77 cases (2.73%), atypical microcytosis, 55 cases (1.95%), and structural variants 7 cases (0.24%). These variants were further identified as HbS (3), Hb Hofu (1), in natives, and HbC (3) in children from Morocco. Higher prevalence of anomalies was seen in some places: Riolobos, 1.5%, Galisteo, 2.5%, Jaraiz de la Vera, 3.02%; a significant group of Hb Lepore carriers was detected in this last town. CONCLUSIONS: The prevalence of abnormalities seen in some small towns or villages grants this type of programmes as such places, which could be considered as isolated communities, might provide a number of high-risk couples.