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Vascular injury in lumbar disk disease is a common complication reviewed in the literature. In our study, we reviewed the rare complication of vascular injury that occurs during lumbar microscopic tubular discectomy. The patient is a 46-year-old male, diabetic, hypertensive and a smoker who presented with a history of backache and right-sided radiculopathy to S1 dermatome for 6 weeks. Conservative measures failed, and we planned and performed microscopic tubular discectomy at the level of L5-S1. Immediately postoperatively, the patient developed acute, sharp, burning pain in the left leg, partially relieved on hip flexion, with diminished distal pulsation of dorsalis pedis, popliteal and femoral. Urgent consultation with a vascular surgeon included a computed tomography angiography which confirmed a vascular injury of the left iliac artery and vein near the bifurcation. The plan involved urgent retroperitoneal exploration of the left iliac vessels, and primary repair with synthetic graft was done with distal embolectomy to regain distal pulsation postoperatively. Further follow-up revealed that the repair was successful.

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Background: Delayed diagnosis and improper treated cases of developmental dysplasia of the hip (DDH) in the presence of excessive anteversion of femoral head may lead to undesirable consequences, including more extensive interventions with severe complications and functional disability. This study aimed to compare the clinical, radiological, and complication outcomes of simultaneously versus two-stage surgical procedures (open reduction and proximal femoral derotation osteotomy) in the treatment of DDH with excessive femoral anteversion among a sample of Iraqi children aged less than three years old.  Methods: A total of 26 DDH cases were treated in two groups (GI, GII) at Al-Wasity Teaching Hospital (Baghdad, Iraq) from January 2014 to March 2015. GI (15 hips) in 13 patients subjected to simultaneous open reduction (with/without salter osteotomy) and proximal femoral derotation osteotomy. GII (18 hips) in 13 patients operated in two stages procedure; open reduction (with/without salter osteotomy) followed by proximal femoral derotation osteotomy six weeks later.  Results: At the time of operation, the average age was 21.79±3.51months (range: 18-30). The mean follow-up period was 10.36 ±1.45 months (range, 8 -12). Statistically, the postoperative clinical, radiological, and complication findings were not significantly different between the two groups. However, in post-operative clinical assessment (McKay's criteria), the satisfying results (excellent and good) were 93% in GI and 88% in GII, respectively. Moreover, in radiological assessment (Severins classification), the satisfying results (excellent and good) were 94% in GI and 83% in GII, respectively. Two cases of re-dislocation and avascular necrosis (AVN) were reported in GII. Conclusion: When the clinical and radiological findings of one and two-stage open reduction and proximal femoral derotation osteotomy procedures are similar, the one-stage is more likely to overcome the two-stage in terms of minimizing the cost, length of stay and the risk of AVN of the femoral head.

Background:This study was conducted to investigate the genetic organization of erm(A)-carrying Tn554 in clinical isolates of Streptococcus pyogenes. Tn554 is a communicable sequence to multiple plasmid sites, it contains erm(A) gene and has the ability to bind the resistance of MLS and spectinomycin. Over the past two decades, erythromycin resistance rates have increased in S. pyogenes in many countries. To obtain information that may be useful in solving the spread of antimicrobial resistance, antibiotic-resistant genes can be identified as well as their association with mobile genetic elements. Material and Methods:A total of 22 isolates of S. pyogenes were obtained from 93 bacterial isolates. These isolates were examinedby detecting their antibiotic susceptibility against two different antibiotics groups (Macrolides and Tetracycline) thengenomic DNA was extracted from each isolate for detection Tn554 by using specific primers to amplify erm(A) gene carried by this transposable element. Results:Results showed that there is a high level of resistance to erythromycin, (90.9%), then to Minocycline (68.1%), Tetracycline (54.5%), Azithromycin and Clarithromycin (36.3%), Doxycycline (31.8%) and then to Oxytetracycline (27.2%). Resultsalso showed that 13 of S. pyogenes isolates were harboring Tn554 transposable element carrying erm(A) gene. On the other hand, results showed that there are another isolates resistant to erythromycin that may possess a chromosomal or plasmid copy of the erythromycin resistance gene, or maybe the resistance was caused by another structural erythromycin gene carried by other type of transposable elements rather than Tn554. Conclusion:Our findings suggest that the isolates of S. pyogenes are harboring chromosomal copy of Tn554 conferring erythromycin resistance. One possible explanation for the presence of genes at different isolates is due to erm gene, which was most likely located on Tn554.