Isolated quadrilateral plate fracture with central hip dislocation after epileptic seizure in a postpartum patient: A case report.

Isolated quadrilateral plate fractures are extremely rare and their treatment is complex. The postpartum period and recent caesarean section additionally increase already significant risks of surgical treatment. Modified Stoppa approach and the use of infrapectineal plate represent the optimal surgical treatment method. One case of central hip dislocation and isolated quadrilateral plate fracture was reported during an epileptic seizure 1 day postpartum, which was treated with open reduction and internal fixation. A 25-year-old female patient had given birth via cesarean section. One day postpartum, she had multiple generalized tonic clonic seizures. Arteriovenous malformation was identified as the cause of seizures by MRI. The patient complained of left hip pain and inability to move the left leg which prompted clinical and radiological examination. A pelvic CT scan verified multifragmentary fracture of the quadrilateral plate without fracture of the acetabular columns. The central hip dislocation was verified. Due to the rarity of the fracture, the clinical decision-making process was difficult. The patient, being in the postpartum period, was also at a greater risk of infection. The patient was treated surgically, and osteosynthesis was performed with an infrapectineal plate for the acetabulum using the modified Stoppa approach. The initial incision was done through the same Pfannenstiel incision from caesarean section. The patient's postoperative recovery was good at 1 year follow-up.

Impact of the earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia.

PURPOSE: To determine the impact of an earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia. METHODS: A case-control study was performed at the tertiary trauma centre registry. Two different periods were studied. The case group included a period during COVID-19 lockdown right after the earthquakes until the end of the confinement period in Croatia. And the control group corresponded to the equivalent period in 2019. We identified all consecutive patients who were admitted due to urgent care requirements for the musculoskeletal trauma. Patient's demographic data and admitting diagnoses were assessed. Data were analyzed by statistical procedures using the program MedCalc statistical software version 16.4.3. RESULTS: We identified 178 emergency admissions due to musculoskeletal trauma. During the COVID-19 lockdown and post-earthquake period, there was a drastic reduction in total admissions (359 vs. 662; p < 0.0001) with an increased proportion of trauma admissions within the emergency admissions (34.9% vs. 26.5%; p = 0.02926, Z = -2.1825). Furthermore, in the case group there was a significant increase in hospital admissions due to ankle/foot trauma (11 vs. 2, p = 0.0126) and a trend towards a decrease in the admissions due to tibia fractures (5 vs. 12, p = 0.0896), however without statistical significance. Also, an increased proportion of women within the group of femoral fractures in both case group (81.6% vs. 52.6%, p = 0.00194, Z = 3.1033) and the control group (82.3% vs. 60.5%, p = 0.0232, Z = 2.2742) was observed. In both analyzed periods, the osteoporotic hip fracture was the most common independent admitting diagnosis. CONCLUSION: It is crucial to understand how natural disasters like earthquakes influence the pattern of trauma admissions during a coexisting pandemic. Accordingly, healthcare systems have to be prepared for an increased influx of certain pathology, like foot and ankle trauma.

Pilot study: Internally cooled orthopedic drills - standard sterilization is not enough?

Bone drilling causes focal temperature rise due to metal-to-bone contact, which may result in thermal osteonecrosis. Newly constructed internally cooled medical drill of an open type decreases temperature rise at a point of metal-to-bone contact although standard sterilization of such a drill could be inadequate due to bacteria retention within the drill lumen. The aim of this pilot study was to examine the effectiveness of sterilization and to propose sterilization recommendations for internally cooled open type bone drills. Unused internally cooled medical steel bone drills were tested. Drills were contaminated with Pseudomonas aeruginosa, Bacillus sp., beta-hemolytic Streptococcus sp., Enterobacter sp. and methicillin-resistant Staphylococcus pseudintermedius and then incubated for 24 hours at 37 °C. Afterwards, drills were autoclaved for 15, 20 and 30 minutes at 132 °C and 2.6 bar. When 15-minute sterilization was used, one out of 16 drills was contaminated with Pseudomonas aeruginosa, while the other 15 drills were sterile. Extended cycle sterilization in autoclave lasting for 20 and 30 minutes resulted in 100% sterility of all drills tested. In conclusion, lumened drills should be exposed to extended sterilization times in autoclave. Minimal recommended time for sterilization of lumened drills is 20 minutes.

Awareness, attitudes, and perceptions of Croatian-based orthopedic and trauma surgeons toward scientific manuscripts, publishing internationally and medical writing. Results of an online questionnaire.

The objective of this survey was to identify the importance placed by Croatian-based surgeons on writing scientific manuscripts and publishing them internationally, as well as their awareness of and attitudes toward medical writing. A link to an online survey was sent to 327 Croatian-based orthopedic and trauma surgeons. The electronic questionnaire consisted of rating scales, multiple choice questions and free text reply boxes. A total of 61 surgeons based in Croatia replied to the survey, yielding a response rate of 19% (61/327). The survey results indicate that surgeons in Croatia are active in both research and the writing of manuscripts. There is also a high level of interest among them to publish internationally in English to further their careers. While 68% (38/56) of respondents initially claimed to know about medical writing, further questioning on the subject revealed a reduced level of familiarity with the concept. Only 19% (11/58) of respondents had ever engaged the services of a medical writer and they were generally satisfied with the work done across the three areas of language, editing and scientific knowledge. Medical writers are advised to increase awareness of their services among Croatian-based orthopedic and trauma surgeons who may well have a need for their expertise.

Stable Gastric Pentadecapeptide BPC 157 May Recover Brain-Gut Axis and Gut-Brain Axis Function.

Conceptually, a wide beneficial effect, both peripherally and centrally, might have been essential for the harmony of brain-gut and gut-brain axes' function. Seen from the original viewpoint of the gut peptides' significance and brain relation, the favorable stable gastric pentadecapeptide BPC 157 evidence in the brain-gut and gut-brain axes' function might have been presented as a particular interconnected network. These were the behavioral findings (interaction with main systems, anxiolytic, anticonvulsive, antidepressant effect, counteracted catalepsy, and positive and negative schizophrenia symptoms models). Muscle healing and function recovery appeared as the therapeutic effects of BPC 157 on the various muscle disabilities of a multitude of causes, both peripheral and central. Heart failure was counteracted (including arrhythmias and thrombosis), and smooth muscle function recovered. These existed as a multimodal muscle axis impact on muscle function and healing as a function of the brain-gut axis and gut-brain axis as whole. Finally, encephalopathies, acting simultaneously in both the periphery and central nervous system, BPC 157 counteracted stomach and liver lesions and various encephalopathies in NSAIDs and insulin rats. BPC 157 therapy by rapidly activated collateral pathways counteracted the vascular and multiorgan failure concomitant to major vessel occlusion and, similar to noxious procedures, reversed initiated multicausal noxious circuit of the occlusion/occlusion-like syndrome. Severe intracranial (superior sagittal sinus) hypertension, portal and caval hypertensions, and aortal hypotension were attenuated/eliminated. Counteracted were the severe lesions in the brain, lungs, liver, kidney, and gastrointestinal tract. In particular, progressing thrombosis, both peripherally and centrally, and heart arrhythmias and infarction that would consistently occur were fully counteracted and/or almost annihilated. To conclude, we suggest further BPC 157 therapy applications.

Stable Gastric Pentadecapeptide BPC 157 Therapy: Effect on Reperfusion Following Maintained Intra-Abdominal Hypertension (Grade III and IV) in Rats.

Given in reperfusion, the use of stable gastric pentadecapeptide BPC 157 is an effective therapy in rats. It strongly counteracted, as a whole, decompression/reperfusion-induced occlusion/occlusion-like syndrome following the worst circumstances of acute abdominal compartment and intra-abdominal hypertension, grade III and grade IV, as well as compression/ischemia-occlusion/occlusion-like syndrome. Before decompression (calvariectomy, laparotomy), rats had long-lasting severe intra-abdominal hypertension, grade III (25 mmHg/60 min) (i) and grade IV (30 mmHg/30 min; 40 mmHg/30 min) (ii/iii), and severe occlusion/occlusion-like syndrome. Further worsening was caused by reperfusion for 60 min (i) or 30 min (ii/iii). Severe vascular and multiorgan failure (brain, heart, liver, kidney, and gastrointestinal lesions), widespread thrombosis (peripherally and centrally) severe arrhythmias, intracranial (superior sagittal sinus) hypertension, portal and caval hypertension, and aortal hypotension were aggravated. Contrarily, BPC 157 therapy (10 µg/kg, 10 ng/kg sc) given at 3 min reperfusion times eliminated/attenuated venous hypertension (intracranial (superior sagittal sinus), portal, and caval) and aortal hypotension and counteracted the increases in organ lesions and malondialdehyde values (blood ˃ heart, lungs, liver, kidney ˃ brain, gastrointestinal tract). Vascular recovery promptly occurred (i.e., congested inferior caval and superior mesenteric veins reversed to the normal vessel presentation, the collapsed azygos vein reversed to a fully functioning state, the inferior caval vein-superior caval vein shunt was recovered, and direct blood delivery returned). BPC 157 therapy almost annihilated thrombosis and hemorrhage (i.e., intracerebral hemorrhage) as proof of the counteracted general stasis and Virchow triad circumstances and reorganized blood flow. In conclusion, decompression/reperfusion-induced occlusion/occlusion-like syndrome counteracted by BPC 157 therapy in rats is likely for translation in patients. It is noteworthy that by rapidly counteracting the reperfusion course, it also reverses previous ischemia-course lesions, thus inducing complete recovery.

Pentadecapeptide BPC 157 as Therapy for Inferior Caval Vein Embolization: Recovery of Sodium Laurate-Post-Embolization Syndrome in Rats.

After inferior caval vein embolization therapy, post-embolization syndrome (sodium laurate 10 mg/kg, 0.1 mL into rat inferior caval vein, assessment at 15, 30, 60 min, prime lung lesions, thromboemboli occluding lung vessels), as a severe occlusion/occlusion-like syndrome, might be resolved as a whole by stable gastric pentadecapeptide BPC 157 therapy. At 5 min after laurate injection, stable gastric pentadecapeptide BPC 157 was implemented as therapy (10 µg/kg, 10 ng/kg intraperitoneally or intragastrically). As before, confronted with the occlusion of major vessel(s) or similar noxious procedures, such as rapidly acting Virchow triad circumstances, the particular effect of the therapy (i.e., collateral pathways activation, "bypassing vascular key", i.e., direct blood flow delivery via activation of azygos vein) assisted in the recovery of the vessel/s and counteracted multiorgan failure due to occlusion/occlusion-like syndrome as a whole in the laurate-injected rats. Along with prime lung lesions and thromboemboli occluding lung vessels, post-embolization syndrome rapidly occurred peripherally and centrally as a shared multiorgan and vessel failure, brain, heart, lung, liver, kidney, and gastrointestinal tract lesions, venous hypertension (intracranial (superior sagittal sinus), portal, and caval), aortal hypotension, progressing thrombosis in veins and arteries and stasis, congested and/or failed major veins, and severe ECG disturbances. Whatever the cause, these were all counteracted, eliminated, or attenuated by the application of BPC 157 therapy. As recovery with BPC 157 therapy commonly and rapidly occurred, reversing the collapsed azygos vein to the rescuing collateral pathway might initiate rapid direct blood delivery and start blood flow reorganization. In conclusion, we suggest BPC 157 therapy to resolve further vascular and embolization injuries.

From Selye's and Szabo's Cysteamine-Duodenal Ulcer in Rats to Dopamine in the Stomach: Therapy Significance and Possibilities.

We reviewed gastric ulcer healing by dopamine considering several distinctive duodenal key points. Selye and Szabo describe the cysteamine-induced duodenal ulcer in rats as a duodenal stress ulcer in patients. Szabo's cysteamine duodenal ulcer as the dopamine duodenal healing and cysteamine as a dopamine antagonist signifies the dopamine agonists anti-ulcer effect and dopamine antagonists ulcerogenic effect. From these viewpoints, we focused on dopamine and gastric ulcer healing. We mentioned antecedent studies on the dopamine presence in the stomach and gastric juice. Then we reviewed, in the timeline, therapy significance arising from the anti-ulcer potency of the various dopamine agonists, which is highly prevailing over the quite persistent beneficial evidence arising from the various dopamine antagonists. Meanwhile, the beneficial effects of several peptides (i.e., amylin, cholecystokinin, leptin, and stable gastric pentadecapeptide BPC 157, suggested as an acting mediator of the dopamine brain-gut axis) were included in the dopamine gastric ulcer story. We attempt to resolve dopamine agonists/antagonists issue with the dopamine significance in the stress (cysteamine as a prototype of the duodenal stress ulcer), and cytoprotection (cysteamine in small dose as a prototype of the cytoprotective agents; cysteamine duodenal ulcer in gastrectomized rats). Thereby, along with dopamine agonists' beneficial effects, in special circumstances, dopamine antagonists having their own ulcerogenic effect may act as "mild stress (or)" or "small irritant" counteracting subsequent strong alcohol or stress procedure-induced severe lesions in this particular tissue. Finally, in the conclusion, as a new improvement in further therapy, we emphasized the advantages of the dopamine agents' application in lower gastrointestinal tract therapy.

Mangled extremity--case report, literature review and borderline cases guidelines proposal.

Treatment of a mangled lower extremity represents a major challenge. The decision whether to amputate or attempt reconstruction is currently based upon surgical evaluation. The aim of this paper is to propose a new approach to surgical evaluation based on scoring systems, local clinical status of the patient as well as comorbidities, mechanism of trauma and hospital resources. Available literature regarding this topic was evaluated and a case of patient with mangled extremity is presented. Based on current literature guidelines and evidence-based medicine, management for borderline cases is proposed to aid clinical decision making in these situations. We describe a 44-year old male patient who presented with mangled lower left leg. Despite a borderline Mangled Extremity Severity Score (MESS), due to the overall health status of the patient and local clinical status with preserved plantar sensitivity and satisfactory capillary perfusion, reconstruction was attempted. After 6 months of treatment, all wounds healed completely with no pain, and satisfactory motor and sensory function was achieved. In conclusion, the treatment of mangled extremity treatment should be based on evidence based literature along with a clinical evaluation of every individual patient. Scores are helpful, but should not be taken as the sole indication for amputation.

Good functional recovery after bilateral elbow dislocation associated with bilateral distal radius and ulna fractures.

Bilateral elbow dislocation associated with bilateral distal forearm fractures is extremely rare, therefore its optimal treatment, complications, and outcomes remain unclear. We present an illustrative case with a 2-year follow up of a patient who sustained a complex injury of the upper extremity and underwent combined surgical and conservative treatment.

Stable Gastric Pentadecapeptide BPC 157 and Striated, Smooth, and Heart Muscle.

First, we review the definitively severed myotendinous junction and recovery by the cytoprotective stable gastric pentadecapeptide BPC 157 therapy, its healing that might combine both transected and detached tendon and transected muscle, ligament and bone injuries, applied alone, as native peptide therapy, effective in rat injury, given intraperitoneally or in drinking water or topically, at the site of injury. As a follow up, we reviewed that with the BPC 157 therapy, its cytoprotective ability to organize simultaneous healing of different tissues of and full recovery of the myotendinous junction might represent the particular muscle therapy against distinctive etiopathology muscle disabilities and weakness. In this, BPC 157 therapy might recover many of muscle disabilities (i.e., succinylcholine, vascular occlusion, spinal cord compression, stroke, traumatic brain injury, severe electrolyte disturbances, neurotoxins, neuroleptics, alcohol, serotonin syndrome and NO-system blockade and tumor-cachexia). These might provide practical realization of the multimodal muscle-axis impact able to react depending on the condition and the given agent(s) and the symptoms distinctively related to the prime injurious cause symptoms in the wide healing concept, the concept of cytoprotection, in particular. Further, the BPC 157 therapy might be the recovery for the disabled heart functioning, and disabled smooth muscle functioning (various sphincters function recovery). Finally, BPC 157, native and stable in human gastric juice, might be a prototype of anti-ulcer cytoprotective peptide for the muscle therapy with high curing potential (very safe profile (lethal dose not achieved), with suited wide effective range (µg-ng regimens) and ways of application).

Distribution of coolant during drilling with open type internally cooled medical steel drill.

INTRODUCTION: Internally cooled bone drills with an open system, conduct coolant directly to the point of contact of cutting surface of the drill and the bone and lower the temperature at the drilling site. During bone drilling with internally cooled drills of open type, there is a possibility that coolant enters the intramedullary canal and has an adverse effect on intramedullary pressure. In this research, the intramedullary distribution of the coolant during and after drilling was analyzed. MATERIALS AND METHODS: Specially constructed open type internally cooled medical steel drills were used. Experimental studies were conducted on the porcine femoral bone diaphysis. Coolant (saline) was mixed with water-soluble contrast agent and x-ray images of the distribution of coolant during and after drilling were taken with different regimes of drilling (drill rotational speed from 1300 rpm to 5000 rpm, and coolant flow rate from 0,6 l/min to 1,35 l/min). RESULTS: An x-ray images showed that coolant did not spread from the borehole and has not spread intramedullary with any combination of coolant flow and drill rotation regimes. CONCLUSION: Coolant does not disperse into the intramedullary canal outside of the borehole in given flow ranges (0,6-1,35 l/min) and drill rotational speed regimes (1300-5000 rpm). Open type internally cooled can safely be used for bone drilling.

Intramedullary nailing of adult forearm fractures: Results and complications.

INTRODUCTION: The aim of this study was to evaluate the clinical and radiological results of adult forearm fractures treated with interlocking intramedullary nailing. METHODS: This retrospective study included 21 patients who were treated with intramedullary interlocking nailing for forearm fractures between January 2010 and September 2017. All patients were treated with intramedullary forearm nails designed to allow interfragmentary compression. The medical records and radiographs of all patients were evaluated. Fractures were classified according to the AO/OTA classification system by analyzing the radiographs. Union time, union rate, clinical outcome, and complications were evaluated. RESULTS: Primary intramedullary osteosynthesis was performed in 17 patients with forearm shaft fractures. The average union time was 10 weeks (range, 8-16 weeks) in the primary osteosynthesis cohort. Secondary intramedullary osteosynthesis was performed in four patients following the removal of plates and screws due to nonunions. For this group of patients, bone union took an average of 17 weeks (range 8-24 weeks). The overall union rate was 95.24% in the 21 forearm fractures which were treated with an intramedullary interlocking nail with a compression screw that allows interfragmentary compression to be obtained. Overall complications included one nonunion, one postoperative rupture of the extensor pollicis longus tendon, and 1 postoperative transitory radial nerve palsy. CONCLUSIONS: Intramedullary interlocking nailing with a compression screw is an alternative method of fixation for treating adult forearm fractures and provides good clinical outcomes with reliable union rates.

Surgical treatment of scapular fractures: Results and complications.

INTRODUCTION: The aim of this study was to describe a surgical technique and report on patient-based functional outcomes and complications following open reduction and internal fixation in patients with scapular fractures. METHODS: The study comprised 14 patients who were treated with open reduction and internal fixation (ORIF) of a scapular fractures between September 2010 and July 2018. Surgical indications were as follows: medial/lateral displacement greater than 20 mm; shortening greater than 25 mm; angular deformity greater than 40°; intra-articular step-off greater than 4 mm; and double shoulder suspensory injuries (including fracture of the clavicle, coracoid or acromion with displacement greater than 10 mm). All patients underwent X-ray examination (true AP, Y scapular view) and computed tomography (CT) scans. Fractures were classified according to the revised (AO/OTA) classification system. Functional outcomes were measured using Constant-Murley scores. RESULTS: Seven patients had glenoid fossa fractures, six patients had scapular body fractures and one patient had an acromion process fracture. All glenoid fossa and scapular body fractures were exposed via the Judet approach. Eleven of 14 patients were given Constant-Murley scores at the final follow-up examination; three patients were lost to follow-up. The mean follow-up after injury was 44 months (range, 6-92 months). We found infraspinatus muscle hypotrophy in four patients. The mean Constant-Murley score was 93.45 (±8.93) for the injured arm and 98.36 (±2.91) for the uninjured arm. The mean score between the injured and uninjured arm was 4.91(±6.49), which is an excellent functional outcome according to the Constant-Murley score. CONCLUSIONS: Open reduction and internal fixation of displaced scapular fractures is a safe and effective treatment option that results in a reliable union rate and good-to-excellent functional outcome.

Stable Gastric Pentadecapeptide BPC 157 as a Therapy for the Disable Myotendinous Junctions in Rats.

(1) Aim: The stable gastric pentadecapeptide BPC 157 is known to heal transected muscle, tendon, and ligament. Thereby, in this study, we investigated the effect of BPC 157 on the dissection of the quadriceps tendon from the quadriceps muscle in rats. (2) Materials and Methods: Myotendinous junction defect, which cannot heal spontaneously in rats, as evidenced with consistent macro/microscopic, biomechanical, functional assessments, eNOS, and COX-2 mRNA levels and oxidative stress and NO-levels in the myotendinous junctions. BPC 157 (10 µg/kg, 10 ng/kg) regimen was given (i) intraperitoneally, first application immediately after surgery, last 24 h before sacrifice; (ii) per-orally, in drinking water (0.16 µg/mL, 0.16 ng/mL, 12 mL/rat/day), till the sacrifice at 7, 14, 28 and 42 postoperative days. (3) Results: These BPC 157 regimens document prominent therapy effects (macro/microscopic, biomechanical, functional much like eNOS and COX-2 mRNA levels and counteracted oxidative stress and NO-levels in the myotendinous junctions), while controls have a poor presentation. Especially, in rats with the disabled myotendinous junction, along with full functional recovery, BPC 157 counteracts muscle atrophy that is regularly progressive and brings muscle presentation close to normal. Accordingly, unlike the perilous course in controls, those rats, when receiving BPC 157 therapy, exhibit a smaller defect, and finally defects completely disappear. Microscopically, there are no more inflammatory infiltrate, well-oriented recovered tissue of musculotendon junction appears in BPC 157 treated rats at the 28 days and 42 days. (4) Conclusions: BPC 157 restores myotendinous junction in accordance with the healing of the transected muscle, tendon, and ligament.

Stable Gastric Pentadecapeptide BPC 157 and Wound Healing.

Significance: The antiulcer peptide, stable gastric pentadecapeptide BPC 157 (previously employed in ulcerative colitis and multiple sclerosis trials, no reported toxicity (LD1 not achieved)), is reviewed, focusing on the particular skin wound therapy, incisional/excisional wound, deep burns, diabetic ulcers, and alkali burns, which may be generalized to the other tissues healing. Recent Advances: BPC 157 has practical applicability (given alone, with the same dose range, and same equipotent routes of application, regardless the injury tested). Critical Issues: By simultaneously curing cutaneous and other tissue wounds (colocutaneous, gastrocutaneous, esophagocutaneous, duodenocutaneous, vesicovaginal, and rectovaginal) in rats, the potency of BPC 157 is evident. Healing of the wounds is accomplished by resolution of vessel constriction, the primary platelet plug, the fibrin mesh which acts to stabilize the platelet plug, and resolution of the clot. Thereby, BPC 157 is effective in wound healing much like it is effective in counteracting bleeding disorders, produced by amputation, and/or anticoagulants application. Likewise, BPC 157 may prevent and/or attenuate or eliminate, thus, counteract both arterial and venous thrombosis. Then, confronted with obstructed vessels, there is circumvention of the occlusion, which may be the particular action of BPC 157 in ischemia/reperfusion. Future Directions: BPC 157 rapidly increases various genes expression in rat excision skin wound. This would define the healing in the other tissues, that is, gastrointestinal tract, tendon, ligament, muscle, bone, nerve, spinal cord, cornea (maintained transparency), and blood vessels, seen with BPC 157 therapy.

[ISKRA guidelines for antimicrobial prophylaxis in surgery--Croatian National Guidelines]. / Smjernice ISKRA za antimikrobnu profilaksu u kirurgiji--Hrvatske Nacionalne Smjernice.

Summary. The development of the Guidelines for perioperative prophylactic use of antimicrobial agents (further on Guidelines) was initiated by the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the Croatian Ministry of Health and Social Welfare in accordance with the principles of AGREE (Appraisal of Guidelines for Research and Evaluation) methodology which means that the guidelines are the result of a consensus between all involved professional societies. Guidelines were composed in order to improve antibiotic use in surgical professions. Data obtained from observational studies have shown that the use of antimicrobials in surgical professions is unsatisfactory, and since around 50% of all prescribed drugs in surgical professions refer to perioperative prophylaxis, such guidelines could significantly improve current negative trend and reduce the occurrence of infections in surgical patients as well as slow down the selection of resistant bacteria. In the introductory part of the guidelines, principles of perioperative prophylaxis are presented. The advantages and risks of prophylaxis are listed as well as factors that determine prophylaxis effectiveness. For easier orientation, surgical professions have been divided into basic surgical fields. In each field, the specificity of the field has been described followed by uniform structured tables and with every listed surgical procedure there is the most probable cause of infection, the drug of choice for prophylaxis, alternative drug, remark for particular surgical procedure and finally the grade of recommendation. The Guidelines do not cover perioperative prophylaxis in immunocompromised patients nor perioperative prophylaxis in children. The Guidelines do not cover all possible surgical interventions, but can be used as a basis for most surgical procedures performed in our hospitals. At the very end of these Guidelines, a comprehensive list of references enables all those interested to find further information and details about this topic. The revision of the Guidelines is planned in three years' time.

Oxidative stress and ferritin expression in the skin of patients with rosacea.

BACKGROUND: Rosacea is a common chronic light-sensitive inflammatory skin disease of unknown origin. The purpose of this work was to determine the parameters of oxidative stress, antioxidative capacity, and the pathophysiologic role of ferritin expression in skin cells of patients with rosacea. OBJECTIVES: The investigation consisted of measurements of serum peroxide levels, serum total antioxidative potential levels, and immunohistochemical analyses of ferritin in skin tissue samples. RESULTS: Serum peroxide levels were significantly higher and serum total antioxidative potential levels were significantly lower in patients with rosacea than in healthy control subjects (P < .05). Compared with control subjects, the number of ferritin-positive cells was significantly higher (P < .001) in skin samples from patients with rosacea, especially those with severe disease. LIMITATIONS: Patients with rosacea in the study were aged 30 to 70 years (average age was 56 years). Younger patients with flushing only were not included according to the request of the ethics committee, limiting the use of diagnostic biopsies only to the necessary cases. CONCLUSION: The statistically significant differences in the expression of ferritin, higher peroxide levels, and lower antioxidative potential support the onset of systemic oxidative stress in patients with rosacea.

Fatal toxic epidermal necrolysis and severe granulocytopenia following therapy with cefuroxime.

Toxic epidermal necrolysis (TEN) is one of the most threatening adverse reactions to various drugs. No case of concomitant occurrence TEN and severe granulocytopenia following the treatment with cefuroxime has been reported to date. Herein we present a case of TEN that developed eighteen days of the initiation of cefuroxime axetil therapy for urinary tract infection in a 73-year-old woman with chronic renal failure and no previous history of allergic diathesis. The condition was associated with severe granulocytopenia and followed by gastrointestinal hemorrhage, severe sepsis and multiple organ failure syndrome development. Despite intensive medical treatment the patient died. The present report underlines the potential of cefuroxime to simultaneously induce life threatening adverse effects such as TEN and severe granulocytopenia. Further on, because the patient was also taking furosemide for chronic renal failure, the possible unfavorable interactions between the two drugs could be hypothesized. Therefore, awareness of the possible drug interaction is necessary, especially when given in conditions of their altered pharmacokinetics as in case of chronic renal failure.

Transfixed condylar plate (TCP) provides better biomechanical and weight bearing possibilities for the fixation of trochanteric fracture.

The goal of this research was to find the implant which would provide a better possibility of the fractured osteoporotic bone weight bearing after trochanteric fracture fixation. The authors constructed a new implant based on the conventional condylar plate, as part of a stabile triangular system. Because of the special oblique form of the screw which absolutely stabilizes vertical and horizontal arm of the plate, this plate was named the transfixed condylar plate (TCP). Analysis showed 6 kN of tolerant loading elastic in TCP with a longer horizontal arm, while this value in the conventional condylar plate was 2.5 kN. Also, dynamic resistance was 2.4 times higher in TCP then in the control model. These improved biomechanical results of this plating fixation system are expected to be found in the clinical use of this plate. This would enhance an early rehabilitation and a better functional outcome.