[Arthroscopic partial resection of the ulnar head for ulnocarpal decompression]. / Die arthroskopische ulnokarpale Dekompression durch Teilresektion des Ulnakopfs.

OBJECTIVE: Arthroscopic decompression (wafer procedure) of the ulnocarpal compartment in patients with ulnar impaction syndrome. INDICATIONS: The arthroscopic wafer procedure is recommended in ulnar-plus situations with up to 3 mm length-excess. To perform this procedure the ulnar head needs to be accessible for the burr through a pre-existing, impaction-related, centroradial lesion of the triangular fibrocartilage complex (TFCC). The additional presence of a distal radioulnar joint (DRUJ) type C confirms the indication. CONTRAINDICATIONS: The wafer procedure is contraindicated if there is no consistent TFCC injury ensuring access to the ulnar head and furthermore in ulna-plus situations of more than 3 mm. Relative contraindications: in young patients due to lack of evidence-based studies. SURGICAL TECHNIQUE: Arthroscopic, semicircular, partial resection of the ulnar head in terms of oblique-helicoidal osteotomy using a 4.2 mm burr, while sparing the DRUJ and the dorsal and the palmar radioulnar ligaments. POSTOPERATIVE MANAGEMENT: Immobilization for 1 week in a palmar splint with immediate intensive exercising of pro- and supination under physiotherapeutic instruction. RESULTS: Between 2008 and 2010, an arthroscopic wafer procedure was performed in 24 patients. The resection of the ulnar head was 2.5 mm on average. After a mean follow-up time of 13.25 months, very good results were archived in 23 of 24 patients; the ulnar impingement test was negative. On a visual analog scale (0-10) average postoperative pain was 1.16 at rest and 4.5 under stress. The mean postoperative DASH score was 13.4.

Fungemia due to Kodamaea ohmeri: First isolating in Italy. Case report and review of literature.

Kodamaea ohmeri, also known as Pichia ohmeri, is a yeast belonging to the Saccharomycetes family. In 2012, our hospital has recorded the first case of fungemia caused by K. ohmeri in an 80-year-old male, admitted to intensive care following an acute anterior-lateral myocardial infarction. K. ohmeri grew in blood cultures. Biochemical identification was confirmed using Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) mass spectrometry and molecular sequencing. Antifungal susceptibility has been performed by broth dilution technique. This case confirms that K. ohmeri is an emergent pathogen even though rarely isolated in human disease. Permanent catheterization is a risk factor and may cause the persistence of a K. ohmeri infection, as well as support treatments (mechanical ventilation, tracheotomy, dialysis). Our therapeutic strategy has been empirical and based exclusively on tested antifungals MIC because EUCAST recommendations does not indicate breakpoints.