Introduction: Essential oils have been used since ancient times and are known for their anti-inflammatory, anti-depressive, antiseptic, antifungal and antimicrobial properties. Methodology: in this study the antimicrobial activity of two essential oils from Melaleuca alternifolia and Thymus vulgaris–red thyme geraniol was tested against 16 multidrug-resistant P. aeruginosa strains from infected hip implants as well as the “in vitro” cytotoxic activity on normal human Wong-Kilbourne derivative (WKD) cells. Results: Thymus vulgaris–red thyme geraniol showed lower antimicrobial activity when compared to Melaleuca alternifolia. All tested oils were cytotoxic at concentrations lower than 0.12%. Conclusion: Increase in drug resistance and lack of new antibiotics may encourage the development of natural treatments together with higher concern on environmental issues and natural lifestyle.
Closed suction drainage systems are commonly used in orthopaedic surgery, particularly in joint arthroplasty. The rationale for the use of drains is a theoretical reduction of wound haematomas and infection. However the benefit of using drains after total hip or knee arthroplasty is controversial. Several reports have shown that the use of drains does not reduce infection and morbidity and is an unnecessary and potentially dangerous practice. In fact most studies highlighted that at best their use appears to make no difference to important clinical outcomes. Recently a metaanalysis raised the question about the usefulness of closed suction drainage again, concluding that it has no major benefits. The purpose of this study was to review the evidences available concerning the utility of closed suction drainage outlining that this practice is not supported by clinical evidence.
HighlightsThe incidence of periprosthetic hip infections his just below 2%, and the Enterobacteriaceae are fairly rare, being the cause of infection in 3–6% of cases.A 76 year old woman with multiple comorbidities underwent surgical implantation of endoprosthesis of the left hip.Multidisciplinary diagnosis of a rare periprosthetic infection.
Tuberculosis is a communicable disease that is a major cause of ill health. It is one of the top ten causes of death worldwide and the leading cause of death from a single infectious agent. Its most common clinical presentation is pulmonary involvement. However, approximately 23‐30% of tuberculosis patients have extrapulmonary symptoms. A rare (1%) clinical presentation of tuberculosis is foot and ankle infection. This is complicated by the fact that the diagnosis of osteoarticular tuberculosis is difficult. Our case was a 66-year-old multi-pathological pensioner, who, while working in the countryside, had an ankle sprain on the left foot, with a lacerated wound of about 2 cm diameter. The non-endemic area and the negative chest X-ray made the diagnosis extremely complex. However, a multidisciplinary approach with the radiologists and the infectious disease department led to clinical stabilization of the patient. Therefore, awareness and high index of suspicion of the disease is essential and referral to experts should be made if diagnosis is indeterminate despite extensive investigations. The knowledge allows early identification of the disease and prompt therapy in order to avoid long-standing untreated infections which typically cause bone destruction and loss of function. The knowledge is also mandatory for western physicians due to increasing international travel, immigration from less developed countries and increased use of immunosuppressive medications. We believe that this article can bring awareness around osteoarticular tuberculosis and help with improving outcome and eradication of the infection. Level of clinical evidence: 4.
Le lussazioni perilunari e del semilunare fanno parte delle instabilità carpali complesse (CIC) e costituiscono il 10% di tutte le lesioni del carpo, abbracciando una vasta gamma di lesioni legamentose: dalla semplice distrazione alla lesione completa di uno o più legamenti intrinseci e/o estrinseci sino alla lussazione franca del semilunare. Già nel 1925 fu tradotto dal francese e pubblicato un lavoro di Etienne Destot (1864Destot ( -1918 [1] in cui veniva promosso il concetto di "sistema scafo-lunato": vi si affermava che tale sistema, posto tra capitato e radio, fosse responsabile in larga misura dell'articolarità del polso. Da allora la letteratura scientifica ha prodotto una grande mole di lavori che non solo hanno in parte confermato l'intuizione di Destot, ma hanno migliorato la nostra conoscenza sulla cinematica, la patomeccanica e il trattamento. DefinizionePer lussazioni perilunari si intendono quelle lesioni in cui il semilunare rimane ridotto al radio e all'ulna (grazie alla resistenza dei suoi legamenti) mentre il resto del polso è lussato. Si hanno invece le lussazioni del semilunare quando questo si lussa volarmente o dorsalmente (più raro) e le ossa del carpo rimangono allineate rispetto al radio (Fig. 1). Ambedue fanno parte delle fratture-lussazioni del carpo. AnatomiaCome è stato detto nel capitolo dedicato all'anatomia, i legamenti del polso possono essere divisi in intrinseci (intra-articolari) o estrinseci (capsulari). Questi ultimi altro non sono che un ispessimento della capsula e si dividono in dorsali e palmari. Tra i legamenti intrinseci (quelli che interessano maggiormente que-LO SCALPELLO (2010) 24:21-25 ABSTRACT -PERILUNATE AND LUNATE DISLOCATIONSIn this chapter perilunate carpal dislocations and lunate dislocations are described. Mechanisms of injury are shown in detail and diagnostic criteria are pointed out, emphasizing the concept that only through a timely diagnosis the orthopedic surgeon will restore normal wrist function. Surgical treatment is the only way to regain normal carpal motion and only an early diagnosis and treatment can improve functional outcome. A late diagnosis and a chronic lesion may affect functional outcome and cause long-term disability. Fig.1 -a Scafoide,semilunare e radio si trovano sulla stessa linea.b Esempio di lussazione del semilunare: questo è lussato in senso palmare e il capitato va a occupare lo spazio che era del semilunare. L'allineamento è spezzato. c Esempio di lussazione perilunare: il semilunare rimane in sede e il capitato si sublussa in senso dorsale a b c Aggiornamenti
CARPAL KINEMATICSDiagnosis and treatment of carpal instability require a thorough understanding of the structures involved in the complex carpal motion. After more than a century since the earlier studies on this subject, no unambiguous theory or model can fully explain carpal kinematics. Over the years several authors proposed theoretical models in the attempt to describe the complexity of wrist and carpal motion. The row theory, the column theory, a combination of both and, more recently, the oval ring theory tried to simplify this difficult subject. The study of carpal kinematics has gained renewed interest largely because of the development of newer techniques that have been able to study carpal bone position in vivo without the restrictions related to radio-opaque markers or other bone-tracking devices. Thanks to these threedimensional analysis techniques the idea of complex multiplanar movement of the carpal bones led to the development of the dart's thrower motion concept. This motion is thought to be used in many daily-living activities and involves an obliquely oriented plane of wrist motion ranging from combined radial deviation and extension to combined ulnar deviation and flexion. The ongoing studies on several aspects of normal and pathologic carpal motion probably will lead in the near future to a better understanding of this complex subject that will necessarily influence the treatment and rehabilitation of carpal instability.
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