GUNSHOT INJURIES OF THE OROFACIAL REGION.

Between 2000 and 2010, approximately 10,000 gun attacks resulting in death were registered in the EU countries. In the same period and region, approximately 40,000 suicides took place, 1,500 of which were in the Czech Republic. 82% of suicides or suicide attempts using a firearm (or another projectile weapon) led to a head injury. Typically, the shots target the temporal or submental region. The severity of the suffered injuries depends besides the wound site, projectile calibre and energy also on other factors such as the projectile trajectory, formation of secondary projectiles, shot reflection from the skeletal structures, etc. Gunshot wounds aimed at the splanchnocranium usually lead to injuries of the mandible(s), maxilla(e), orbit(s) and nose, i.e. of regions associated with multiple fields of medicine requiring multidisciplinary cooperation. The presented paper aims to explain in detail the destructive effects of gunshot injuries in the orofacial regions and to describe the recommended procedure during primary medical treatment. The team of authors aimed to clearly present important information originating both from literature and practical experience with this type of injury.

Reconstruction of large facial and orbital defects by combining free flap transfer with craniofacial prosthesis.

The reconstruction of complex craniofacial and orbital defects should satisfactorily restore functional and aesthetic integrity. Autologous reconstruction of nasal, periorbital and auricular facial subunits as a whole using a locoregional or a free flap is very challenging and the results are not sometimes ideal. With advanced technologies that are currently available it is possible to plan and produce authentic facial prosthesis that can satisfactory substitute these facial subunits. We demonstrate an alternative reconstructive concept for complex craniofacial defects based on a free flap combined with a facial prosthesis for the replacement of periorbital or auricular facial subunits. This approach was used in two patients with very satisfactory results. Combination of a free flap with a facial prosthesis may become a preferable approach for the reconstruction of complex craniofacial defects. Clinical outcomes of the reconstructions may be enhanced respecting the principle of aesthetic facial subunits.

[Susceptibility to selected coagulase-negative chemotherapeutic agents of methicillin resistant staphylococci isolated from clinical materials in 1997-1998]. / Wrazliwosc na wybrane chemioterapeutyki koagulazo--ujemnych gronkowców opornych na metycyline izolowanych z materialu klinicznego w latach 1997-1998.

The study was aimed at assessment of the sensitivity of methicillin-resistant coagulase-negative staphylococci isolated from clinical material in 1997/1998 to selected chemotherapeutic agents. The investigated material comprised 96 methicillin-resistant coagulase-negative staphylococci from hospital and ambulatory infections isolated during the period from April 1997 to May 1998. Species affiliation was determined by classical identification methods and commercial diagnostic tests for identification of staphylococci. Methicillin resistance was determined by agar disk-diffusion method and screening. Sensitivity to chemotherapeutics was determined by agar disk-diffusion method and agar dilution methods. All the investigated strains were sensitive to nitrofurantoin, furazolidone and vancomycin. To teicoplanin--the second glycopeptide antibiotic--84% strains were sensitive, whereas the percentages of resistant and moderately sensitive strains amounted to 5.2% and 10.4%, respectively. 85% and 82% of coagulase-negative staphylococcal strains were sensitive to fusidic acid and mupirocin. Considerable differences were noted with respect to sensitivity to aminoglycoside group antibiotics. About 35% of strains were sensitive to gentamicin, and 90% sensitive to netilmicin. Ca. 40% of coagulase-negative staphylococci were resistant both to cotrimoxazole and trimethoprim, which, in view of 98% resistance to the second component of cotrimoxazole, may be associated with the activity of only one of the components of the drug--trimethoprim.

[Susceptibility to selected chemotherapeutics of Staphylococcus aureus strains resistant to methycyline isolated from clinical materials in the years 1991-1992 and 1997]. / Wrazliwosc na wybrane chemioterapeutyki szczepów Staphylococcus aureus opornych na metycyline izolowanych z materialu klinicznego w latach 1991-1992 i w roku 1997.

The susceptibility to selected chemotherapeutic agents was determined in 100 strains of Staphylococcus aureus methicillin-resistant (MRSA) isolated from clinical materials in 1991-1992 (50 strains) and in 1997 (50 strains). Two methods were used for the determination: disc method and antibiotic dilution in agar. The minimal inhibitory concentration (MIC) was determined for vancomycin, teicoplanin, furazolidone, nitrofurantoin, ofloxacin, gentamicin, netilmicin and trimethoprim. The concentrations of the chemotherapeutics in the substrate ranged from 0.125 to 512 mg/l. The obtained results served for drawing of the following conclusions: all studied MRSA strains isolated in 1991-1992 and in 1997 were sensitive to glycopeptide antibiotics: vancomycin and teicoplanin, to nitrofurans: nitrofurantoin and furazolidone, and to fusidic acid. MRSA strains isolated in 1991-1992 were sensitive to ofloxacin, but in 1997 about 80% of the strains were resistant to that antibiotic, and this resistance was noted in S. aureus strains with homogeneous resistance to methicillin. Increasing frequency of resistance to mupirocin was found, in 1991-1992 4% of the strains were resistant, and in 1997 the resistance of MRSA to that antibiotic was found in 12%. No changes occurred in the sensitivity of staphylococci to trimethoprim/sulfamethoxazole (cotrimoxazole). About 94% of strains in 1991-1992 and 1997 were sensitive to that drug. The sensitivity to cotrimoxazole is connected with one of its components (trimethoprim), with 94% of MRSA strains sensitive to it.

MR imaging of primary pancreatic leiomyosarcoma.

Primary leiomyosarcoma of the pancreas is a rare neoplasm with only 17 reported cases in the literature. Although the ultrasonic and computed tomographic appearances have been described, the magnetic resonance features of pancreatic leiomyosarcomas have not. In this report, we describe the MR characteristics of a primary pancreatic leiomyosarcoma which was an incidental finding on ultrasound. The unenhanced T1 weighted and T2 weighted images were the most useful in tumour localization whereas the enhanced images actually obscured the tumour within the pancreas. Differentiation from the much more commonly occurring adenocarcinoma was impossible.

[Evaluation of the usefulness of selected commercial systems for identification of Staphylococcus species]. / Ocena przydatnosci wybranych systemów komercyjnych do identyfikowania ziarenkowców z rodzaju Staphylococcus.

The aim of the study was the assessment of the usefulness of commercially available systems for rapid identification of staphylococci. API STAPH (bioMerieux, France), ID 32 STAPH (bioMerieux, France), GPL (HTL, Poland) and Staph-Zym (Rosco, Denmark). The identifications were carried out according to producer's instruction. The material for the study comprised 76 staphylococcal strains, coagulase-positive and coagulase-negative. The strains were isolated from throat, nasal, wound, bone slivers, pus and blood of inpatients and from throat and nasal swabs of outpatients. Besides that, for the study staphylococcal strains were obtained from the American Collection of Typical Cultures (ATCC) and from the Polish Collection of Microorganisms (PCM). All tested strains were identified on the basis of classic biochemical tests. In the light of obtained results it is concluded that the commercial system most suitable for identification of staphylococci was ID 32 STAPH (bioMerieux), which has a wide spectrum of species identifiable with it and the highest percent (95%) of correctly identified species. The least suitable system was the GPL 15 (HTL, Poland).

[Evaluation of the usefulness of selected commercial systems for identification of Streptococcus species]. / Ocena przydatnosci wybranych systemów komercyjnych do identyfikowania ziarenkowców z rodzaju Streptococcus.

The usefulness was assessed of three commercially available systems for rapid identification of streptococcal strains. The studied material comprised 68 strains of streptococci and enterococci (including 24 standard strains) belonging to serological groups: A (14 strains), B (10), C (11), D (10), F (3) and G (10), as well as 10 S. pneumoniae strains. The strains were isolated from throat, nasal, wound swabs, blood, pus of inpatients and throat and nasal swabs of outpatients. For the identification of streptococci 3 commercially available systems were used: API 20 STREP (bioMerieux, France), rapid ID 32 Strep (bioMerieux, France), Streptoplast PPL 18 (HTL, Poland). The determinations were done according to producer's instructions. The highest percent of correctly identified strains was obtained with the rapid ID 32 Strep--80.9%, with the API 20 STREP--76.4% strains were identified correctly and with the PPL 18--61.8%. The study showed that the API 20 STREP and rapid ID 32 STREP are suitable for the identification of streptococcal strains from groups: A, B, C, D, F and enterococci--group D. The proportions of correctly identified strains from these groups with the Streptoplast PPL 18 were lower than those determined with the bioMerieux systems. Using of three identification systems streptococci from group G and S. pneumoniae strains cannot be identified.

[Syndrome of the abdominal rectus muscle monitored ultrasonographically during pregnancy]. / Zespól miesnia prostego brzucha monitorowany ultrasonograficznie w przebiegu ciazy.

It has been presented a case of pregnant woman with rectus muscle hematoma. This woman gave birth spontaneously. It has been pointed on decisive role of ultrasound examination in making diagnosis and decision concerning conservative management.