Objective: Recent studies indicate that India is an endemic region for Burkholderia pseudomallei infection. We aimed to describe the clinical presentation of B. pseudomallei infection of the musculoskeletal system and summarise the various treatment modalities used in our clinical practice. Subjects and Methods: Patients with confirmed microbiological diagnosis of B. pseudomallei infection involving the musculoskeletal system treated from January 2007 to December 2016 with a minimum follow-up of 1 year were included. A retrospective review of medical records was carried out and patients’ demographic data, co-morbidities, clinical presentation, and details of medical and surgical treatment were documented. Results: Of 342 patients diagnosed with B. pseudomallei infection, 37 (9.2%) had musculoskeletal involvement; 26 patients (23 males) followed up for at least a year were included in the study. Four patients (15%) had multisystem involvement and 10 (37%) had multiple musculoskeletal foci of infection; 15 patients (58%) had osteomyelitis, 10 (38%) had septic arthritis with or without osteomyelitis, and 1 patient (4%) presented with only soft tissue abscess. All patients required surgical intervention in addition to medical management. Surgical treatment varied from soft tissue abscess drainage, arthrotomy for septic arthritis, decompression and curettage for osteomyelitis, and/or use of antibiotic (meropenem or ceftazidime)-loaded polymethylmethacrylate bone cement for local drug delivery. At final follow-up (average: 37 months, range: 12–120), all patients were disease free. Conclusion: We found the rate of musculoskeletal involvement in B. pseudomallei infection to be 9.2%. Appropriate surgical treatment in addition to medical management resulted in resolution of disease in all our patients.
The incidence of mycoses is high in Madras accounting for over 13% of dermatoses diagnosed in a three-year period. Dermatophytoses (tinea corporis and tinea cruris) and pityriasis versicolor were most common in May and October. A correlation was observed between these infections and environmental temperature, humidity and rainfall. Most cases of all dermatophytoses except tinea capitis were recorded between 10 and 30 years of age but the latter was most common between one and 10 years. Males were predominantly affected with all except tinea axillaris, candidiasis and piedra. The incidence of piedra and deep mycoses was low.
Aim: Femoral nerve entrapment during placement of anterior retractors for total hip replacement results in considerable morbidity, although it is uncommon. The aim of this study is to describe a safe zone for placement of anterior retractors during total hip arthroplasty by studying anatomy in cadavers.Materials and Methods: Ten hips from 6 cadavers were dissected and studied. The clock face anatomy of the acetabulum was used as pins were placed at various clock positions before proceeding with the sectioning of the surrounding muscles. For the left hip 6, 5, 3, 1, and 12'o clock positions and for the right hip 6, 7, 9, 11, and 12'o clock positions were pinned along the anterior acetabular wall. The limbs were dissected axially, beginning from the inferior aspect of the acetabulum and proceeding in a proximal sequence with an interval of 1 cm. The plane of the first section passed through the distal end of the acetabulum and was named plane A. The subsequent proximal planes were named planes B, C, and D, respectively. The distance between the femoral nerve and the anterior acetabular wall was measured. Results: The distance from the anterior acetabular rim to the femoral nerve was closest at plane C, measuring 10.76 2.58 mm (which coincides with the 3'o clock position in the left hip and the 9'o clock position in the right hip). The anteroposterior diameter of Iliacus muscle was maximum at plane A, measuring 17.56 3.90 mm (which coincides with the 6'o clock position in both the right and left hips), and mediolateral diameter of iliopsoas was maximum at plane D, measuring 28.50 3.74 mm (which coincides with the 11'o clock position in the right hip and the 1'o clock position in the left hip). Conclusions: The femoral nerve is closest to the anterior acetabular rim at plane C (9'o clock position of the right hip/3'o clock position of the left hip). Hence, the Hohmann retractor should not be placed on this plane. Anterior retractors can be safely placed adjacent the acetabular rim at planes A, B, and D.
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