Ana Kaftandzieva, Zhaklina Cekovska, Igor Kaftandziev, Milena Petrovska and Nikola Panovski
Bacteriology of Wound - Clinical Utility of Gram Stain Microscopy and the Correlation with Culture
Aim: To determine the most common bacteria isolated from wound specimens and to compare those culture results to Gram stain slides.
Material and methods: A total of 1970 specimens from 1788 patients, treated in the University Clinics in Skopje during a one year period were examined by standard microbiology techniques (inoculation onto standard agar media and direct Gram-stained smears). Automatized Vitek system was used for identification of all anaerobes.
Results: Out of a total of 1970 specimens, 1094 (55.5 %) were positive by culture. A total of 1462 strains were isolated: 753 Gram positive (Gram+), 661 Gram negative (Gram-) and 48 anaerobic bacteria. The number of specimens yielding one, two or more different strains was 788, 244 and 62, respectively. Gram + bacteria, in 44.7 % of positive samples were a single isolate. The most commonly isolated potential pathogen was Staphylococcus. In 23.7% samples, Gram negative bacteria were a single isolate (E. coli was the most common isolate). 1094 specimens were positive by culture, 419 (38.3%) were positive by both culture and Gram stain and 675 (61.7%) were negative by Gram stain (leukocytes were present in 276 specimens). 876 specimens were negative by culture, 789 (90%) were negative by both culture and Gram stain (leukocytes were present in 271 specimen) and 87 (9.9%) were positive only by Gram stain.
Conclusion: Our study demonstrated only a 38.3 % of microbiological correlation between Gram stain and culture. This data makes the clinical utility of Gram stain for the microbiological analysis of wounds questionable.
Ilir Hasani, Igor Kaftandziev, Simon Trpeski, Ljupco Nikolov, Alek Saveski and Gjorgji Velkovski
The ilioinguinal approach (IIA) to the acetabulum has been used as a golden standard for fifty years to treat “anterior” acetabular fractures. Since its introduction by Hirvensalo and Cole, the anterior intrapelvic approach (AIPA) has been adopted by some surgeons, whilst others remain devoted to the IIA. IIA is routinely used in the Republic of Macedonia. The aim of this study is to present a review of literature for two different anterior approaches for the treatment of acetabular fractures used in modern day surgery, focussing on AIPA and its priorities and comparing it to IIA. We performed a search, mainly electronically, and retrospective analysis of existing literature. We have identified and selected two representative and well-systematized papers for IIA, and six for AIPA. We presented the advantages and disadvantages, priorities and weaknesses of both approaches separately, comparing complications, risks and results. Based on the facts presented regarding the advantages of AIPA with a focus on visualization, accessibility and biomechanical justification, the approach should be implemented in our everyday practice and we are comfortable in stating this preference, especially due to the fact that upon comparison of the complication rate there is no significant difference between the two approaches.
Igor Kaftandziev, Simon Trepeski, Oliver Arsovski and Marko Spasov
INTRODUCTION: An important feature of distal tibia fractures is the relevance of the soft tissue coverage. In order to maintain good functional outcome, several operative techniques have been established. Among them, percutaneous screw fixation has the advantage of causing less biological damage of the soft tissues with lower rates of complications.
MATERIAL AND METHODS: We reviewed 16 patients with distal tibia fracture. Operative treatment consisted of indirect reduction and percutaneous fixation of the tibia followed by cast immobilization for approximately 3-4 months. Minimum follow up period was 12 months. Functional outcome was evaluated using Olerud-Molander Ankle Score (OMAS) and American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS).
RESULTS: Twelve out of 16 fractures healed within 6 months of the injury. In 3 cases, delayed union was evident, but the fractures healed in less than nine months. There was one case of malunion, two cases of superficial skin infections, two cases of DVT and two cases of gross swelling. According to OMAS score, the functional result was excellent in 7 (43.75%), good in 5 (31.25%) and fair in 4 (25%) patients.
CONCLUSION: Percutaneous screw fixation can be a safe and effective method for operative treatment of distal tibia fractures.
Igor Kaftandziev, Simon Trpeski, Venko Filipce, Oliver Arsovski, Ilir Hasani, Ljupčo Nikolov and Aleko Kaev
Introduction: Management of degenerative lumbosacral spondylolisthesis with spinal stenosis is still controversial. Surgery is widely used, as well as non-surgical treatment. Aim: To evaluate the clinical results and functional outcome after operative treatment in Grade II and III lumbar spine spondylolisthesis.
Material and methods: Twelve patients with symptoms and image-confirmed degenerative spondylolisthesis entered the study. Mean patient age was 57 years. Spondylolisthesis Grade II or III, segment L4-L5 or L5-S1 were evaluated. All patients underwent similar protocols. Operative treatment was decompressive laminectomy, posterior one segment fixation, and fusion with autologous bone grafting. Functional outcome measures were Visual Analog Scale (VAS, 10-point scale) and Oswestry Disability Index (ODI, 100-percent scale) after 6 and 12 months.
Results: Patient follow-up was 12 months. Preoperatively, 7 patients had severe disability according to ODI, 4 had moderate disability. VAS measured 6 and 7 points in 6 patients, lowest score of 4 points and the highest score of 9. After 6 months, ODI showed 5 patients had minimal and 7 had moderate disability; 2 patients had 0 points on the VAS, 2 had a score of 1, 4 had a score of 2, highest score of 4 points. Treatment outcome effects after 1 year were 9 patients with minimal disability, 3 with moderate; VAS - 2 patients with O points, 3 with 1 point, 4 with 2 points.
Conclusion: Patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and functional outcome during a period of 1 year.