Meliodosis is an infection caused by the facultative intracellular gram-negative bacterium; Burkholderia pseudomallei, usually a soil saprophyte. It is a great masquerader of disease presenting in many disguises and mimics. Initially confined to Southeast Asia and Australia

Rapid Palatal Expansion (RPE) is a traditional orthodontic/orthopedic procedure for the skeletal widening of the maxilla according to which the two maxillary bones tear apart and the gap between them is filled in with hemorrhagic tissue which is gradually replaced by new bone formation. Indications for RPE are severe absolute or relative skeletal discrepancies with the maxilla being narrower than normal. This procedure seems to be accompanied by concomitant skeletal changes.

A prospective control clinical trial was designed in an effort to verify these alterations. A treated sample and a control sample consisted of 23 individuals each. The age of the examined patients was 14-16 years. The patients of the treated sample underwent RPE whereas in the control sample they received no treatment at all. Measurements were made before treatment (To), after RPE and 3 months retention with the appliance still in place (T1) and at the end of the orthodontic treatment (T2). Equivalent measurements were made in the control group as well. The variables measured were the lips length, the width of the base of the nose and the Soft Tissue Lower Anterior Face Height (SLAFH).

According to the results of this study, no statistically significant alteration found in the length of the lips due to the RPE procedure. On the contrary, the base of the nose presented statistically significant increase. The SALFH also increased with statistical significance due to RPE. These concomitant changes of the lower part of the face need to be taken into account and to be integrated in a patients’ treatment plan according to his facial type (dolichofacial or brachyfacial).

Further investigation with bigger sample sizes and more long term results can give more insight into this subject.

Background: Femoroacetabular impingement is a common source of hip pain and dysfunction, especially in young and active patients. It is considered to be the main cause of early hip osteoarthritis. We set the purpose to identify poor prognosis factors in the surgical treatment of femoroacetabular impingement.

Methods: We realized a prospective observational study in a case series of 50 hips in 44 patients with femoroacetabular impingement operated with surgical hip dislocation between 2001 and 2006. Clinical, radiologic, surgical and functional factors of whole patients were assessed. Clinical outcomes were determined with a subjective scale. Also, functional assessment was performed with a modified Harris Hip Score (HHS). Both evaluations were applied at 6, 9, and 12 months, and so every year once. Finally, the statistical analysis was done with SPSS 15.0 software.

Results: With an average of 6.2 post-operative years (5-10.1) of follow-up, 35 patients (70%) were “asymptomatic” (HHS=100), 11 patients (22%) “better” (HHS=94.09), and 4 patients (8%) “the same or worse” (HHS=68.25). 40% of patients older than 45 years old were “asymptomatic”, versus 77% younger than 45 years old (p=0.03). 37% of patients with mixed femoroacetabular impingement were “asymptomatic”, 87% of patients with cam-type and 82% with picer-type (p=0.003). The factors related to a poor prognosis were as follows: age >45 and mixed-type impingement; and other factors such as radiological osteoarthritis, labral injury and prolonged symptomatology were also associated to poor prognosis results in our study, without being statistically significant.

Conclusion: Age > 45 years old and mixed type of impingement are significant statistic factors related to a poor prognosis in patients treated with surgical hip dislocation. This data are useful to predict the treatment outcome for each patient.

Peritrochanteric diseases are a recurrent cause of lateral hip pain that usually affects middle age and active women. Despite questionable results, classically they have been treated in a conservative way. Surgical techniques are preferred for those who had unsatisfactory results with conservative treatment. In these patients we have developed an arthroscopic surgical treatment that includes the resection of the bursa and the partial release of the iliotibial band, showing satisfactory results. This article describes the surgical technique.

We report a case on a rare ankle injury which occurred after an opened trauma of the left ankle, associating a lateral subtalar dislocation with a ruptured tibialis posterior tendon. We treated him surgically with a good evolution clinic and radiological.