The brachial artery is rarely injured in closed posterior dislocation of the elbow, unlike the high rate of vascular injury seen after dislocation of the knee. Despite the anatomical proximity of the brachial artery to the elbow joint, most cases of brachial artery injury after dislocation of the elbow are related to an associated fracture, an open injury or high-energy trauma. A high index of suspicion should be maintained as well as a thorough neurovascular examination with regards this potentially disastrous complication. We describe an unusual case of complete thrombosis of the brachial artery presenting with a posterior elbow dislocation following a fall (low energy trauma) that was treated nonoperatively. At three months follow-up, patient had good circulation over the affected limb, no complaints of ischemic pain or cold intolerance, no signs of Volkmann's ischemic contracture, and a range of motion that was comparable to the contralateral limb.

Ganoderma lucidum is a fungus usually used in traditional Chinese medicine. The high value of G. lucidum is related to its polysaccharides content. Crude polysaccharides from G. lucidum (GLCP) were obtained using hot water extraction method. There is about 0.57 g of GLCP in 1 g crude of G. lucidum. The prebiotic potential of GLCP was tested against probiotic bacteria namely: Bifidobacterium longum BB536, Bifidobacterium pseudocatenulatum G4, Lactobacillus acidophilus and Lactobacillus casei Shirota. The prebiotic potentials were studied in 10 mL basal Trypticase Phytone Yeast (abbreviated as bTPY) medium (without glucose) supplemented with various concentrations of GLCP (abbreviated as bTPYglcp) (0.5%, 1.0%, 1.5% and 2.0%). bTPY medium supplemented with glucose (abbreviated as bTPYglu) and inulin (abbreviated bTPYinu) were used as comparison. Viable cell counts of the bacteria and the pH of the medium were determined during anaerobic incubation period of 0 h, 12 h, 24 h and 48 h at 37 °C. In the presence of carbohydrate source, cultures showed various degree of growth increment. With regards to the growth supporting property: bTPYglu, bTPYglu+glcp, bTPYglcp and bTPYinu were ranked first, second, third and fourth respectively. Interestingly, in bTPYglcp medium, bacterial growth increased with increasing GLCP concentrations when incubated until 24 h. B. longum BB536 was ranked first (10.53 log cfu/mL) in term of their growth in this medium. Growth of B.pseudocatenulatum G4 was ranked second with 10.40 log cfu/mL. This study shows that, GLCP could support the growth of the bacteria tested.

Osteomyelitis refers to an infection of the bone characterized by progressive inflammatory destruction caused by infecting microorganism. Open fracture carries the risk of developing osteomyelitis from 3 to 50% with a high amputation rate. Salvage of the limb is always a challenge and needs perseverance. We report the case of a 44-year-old male with chronic osteomyelitis with successful multiple limb salvage surgeries. The curative approach to chronic osteomyelitis has the following goals including arrest of infection, pain reduction and salvage of limb and function. With regard to survival and function, the result obtained in this case is more promising compared to above knee amputation.