Purpose Pathological fractures of the long bones are common complications of metastatic disease; however, the outcome of different surgical techniques for the treatment of these fractures has not been clearly defined. The aim of this study was to evaluate differences in prophylactic and therapeutic intramedullary nailing in femoral metastasic implants. Methods Sixty-five patients with metastasis of the femur were analysed retrospectively (37 females; 28 males) between 1995 and 2011 (follow-up 15 months). Forty-four presented with pathological fractures and 21 impending fractures (Mirel ≥7). The operative treatments used were intramedullary fixation with reamed long Gamma nails. The studied parameters were survival, radiological and analytical findings, and functional outcomes. Results Prophylactic nailing resulted in immediate postoperative deaths in 5 % vs. 11.4 % in therapeutic, and one technical complication was detected in each group. Among the surviving patients 75.9 % of the fractures and 100 % of impending lesions were able to walk after the operation. The mean survival time was 11 months in the therapeutic (range 1-49) and 14 in the prophylactic group (1-34). The prophylactic intramedullary nails required a lower transfusion rate (1.4 concentrates vs. 3.0), mobilised earlier (day 4.0 vs. 9.7) and needed a shorter hospital stay (eight days vs. 16 days) compared to therapeutic nails (p <0.05). Conclusion Femoral intramedullary nailing of metastasic lesions provides satisfactory results both clinically and radiologically. Early treatment of the metastases prevents fractures and gives better results, improving life quality of these patients.

No abstract

Purpose The optimal management of pyogenic discitis is not agreed on. We conducted a retrospective, cross-sectional, observational study in which all patients with discitis who attended Hospital San Carlos Madrid from January 1999 to January 2009 were included. Methods We identified 108 consecutive adult patients with infectious discitis. There were 49 men and 59 women with an average age of 67,5 (+/-16,89) years in the study group. Mean follow-up interval was 6,06 (12,5-2) years. 78 patients had spontaneous discitis and 30 patients had postoperative discitis. Inclusion criteria for the review were illness compatible with vertebral infection and / or evidence of spinal involvement on magnetic resonance imaging (MRI). Results In 56 percutaneous discal biopsy (52% patients) were positive in 28 cases. A single disc was infected in 100 patients. The segments involved were the cervical spine in four, the thoracic spine in 38 and the lumbar spine in 66. One or more comorbid diseases were present in 73 (68%) of 108 patients. Diabetes mellitus was the most common disease. Comorbid disease was rapidly fatal in four patients, ultimately fatal in seven patients, and nonfatal or not present in 97 patients (90 %). Conclusion Early diagnosis is a major challenge. Heightened awareness and the prompt use of MRI are necessary to avoid diagnostic delay. Prolonged antimicrobial therapy and the judicious application of timely surgical intervention are essential for an optimal outcome. Introduction and epidemiology

Legal and court interpreters require advanced professional skills to perform their demanding tasks. How well does Australia prepare interpreters to fulfil the linguistic needs of its numerous communities, including 'established' migrant, indigenous, 'new and emerging' and Deaf, in a variety of legal settings? Based on the online data and interviews with educators, this study provides an overview of formal legal interpreter training offered by two types of educational institutions, academic and vocational. The survey of the existing courses, curricula, aims and outcomes, content and settings, teaching methods and assessment, identifies the characteristics of these two approaches, considers advantages and disadvantages of each system, and questions their effectiveness for preparing competent graduates for legal settings. Relying on the educators' opinions, we consider what roadblocks Australian educational institutions encounter in meeting the requirements of the legal system and satisfying the needs of communities where qualified legal interpreters are particularly lacking.

No abstract