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Journal of the Chester Archaeological Society, 87, 61-91, Excavation at Boughton, to the east of the Roman fortress and medieval city, revealed part of an early nineteenth-century tannery in the form of timber-lined tanning pits and other structures connected by lengths of bored timber piping. Small number of earlier ditches, at least one of them probably Roman, were also recorded. Cartographic evidence suggests that in the sixteenth century the site was used to hold possible tenter frames but subsequently consisted of gardens behind the street frontage until the tannery was built. The tannery, possibly shown on a tithe map of 1848, appears to have been short-lived, being replaced by warehouses and then a candle factory by the 1850s. By 1875 the site was occupied by terraced housing, the remains of which were also recorded.

BACKGROUND: Blount's disease is a developmental disorder of the proximal tibia with progressive varus, flexion and internal rotation deformity. It is often seen in overweight children and strongly associated with obesity. As the prevalence of childhood obesity is increasing worldwide, the incidence of Blount's disease has been noted to be on the increase as well. In the South African population, most children are malnourished with high levels of undernutrition compared to other middle-income countries. We hypothesised that in our institution, patients with Blount's disease have a body mass index (BMI) lower than reported in studies from mainly developed countries. The aim of the study was to investigate the relationship between BMI and Blount's disease in a South African academic institution METHODS: All clinical and radiological records of patients with Blount's disease at a tertiary hospital in South Africa over a six-year period were retrospectively reviewed. Five patients did not meet inclusion criteria and were excluded from the study. Data collected included patients' demographics, weight, height and radiological investigations. A control group of randomly selected paediatric orthopaedic patients was studied RESULTS: A total of 39 Blount's patients (19 females, 20 male) were studied. All the Blount's patients were of black ethnicity. There were nine patients with early-onset and 30 patients with late-onset Blount's disease. The mean BMIs for Blount's disease and control groups were 26 kg/m2 and 20 kg/m2 respectively (p

PURPOSE OF THE STUDY: Acute haematogenous septic arthritis is a relatively common condition in the paediatric population. Although Staphylococcus aureus is implicated as the most common causative agent, changes in resistance and the increasing importance of other pathogens have been reported. The purpose of this study is to establish the spectrum of aetiological organisms with their respective sensitivities, and to use this data to evaluate choices in empiric antimicrobial therapy. DESCRIPTION OF METHODS: A retrospective analysis was performed on patients aged 12 years and younger, admitted for suspected septic arthritis, at a tertiary hospital in South Africa from June 2005 to March 2009. All patients with a clinical diagnosis of septic arthritis were included in this study. SUMMARY OF RESULTS: A total of 44 patients from the age of 2 weeks to 12 years were included. Thirty-nine samples were submitted for microbiological investigation. Thirty of these samples yielded bacterial growth; five of these had two microorganisms. Gram-positive organisms were cultured in 79% of isolates. Staphylococcus aureus was cultured in 66% of all isolates. Only three samples were multi-drug resistant. Gram-negative organisms constituted 17% of isolates. Of note is the isolation of a single isolate of Haemophilus influenzae type B, signifying possible vaccine or vaccination failure. CONCLUSION: Gram-positive organisms, in particular Staphylococcus aureus, are still the most prevalent aetiological agent. The current use of cloxacillin as empiric antibiotic therapy will cover 69% of all isolates in this setting; use of coamoxyclav as empiric therapy will increase cover to 80%. Although this 11% difference is seemingly small, opting for co-amoxyclav may significantly reduce morbidity.

PURPOSE OF THE STUDY: Annually, more than a million joint replacements are performed worldwide. The most feared complication is infection. The purpose of this study is to establish the spectrum of organisms and their respective sensitivities, cultured during primary and secondary debridements of staged revision surgery. These findings were then utilised to suggest alternative empiric antimicrobial therapy. DESCRIPTION OF METHODS: A retrospective analysis was performed on patients undergoing revision hip or knee arthroplasty at a tertiary hospital in South Africa from June 2005 to March 2009. Only patients in whom intra-operative deep microbiological cultures had been performed were included. SUMMARY OF RESULTS: Deep microbiological cultures were performed in all cases on either joint synovium, fluid or pus swabs taken from the site intra-operatively. Following primary debridement of staged revision surgery, 38% of samples submitted were culture positive from 61 patients, rendering 29 isolates (six double infections). The spectrum was highly variable. Although no methicillin-resistant Staphylococcus aureus (MRSA) was isolated in the initial cultures, the majority of organisms were Gram positive (62%). Fourteen of these patients (23%) required a second debridement; 12 patients had positive cultures (86%), rendering 20 isolates (four double and two triple infections). Gram-negative organisms played a significant role in these patients with the majority of cases culturing multi-resistant organisms. CONCLUSION: Although no MRSA was cultured, vancomycin is widely used as an empiric postoperative antimicrobial. In this setting, 72% of isolates were sensitive to vancomycin; however, co-amoxyclav also covered 72% of isolates, with the benefit of superior efficiency and fewer side effects. We suggest the possible use of co-amoxyclav with rifampicin as a potential first-line antimicrobial in this clinical setting. Multi-drug resistance is increasingly important in patients requiring secondary debridements. In this setting a combination of carbapenems with vancomycin should be considered as empiric postoperative antibiotics, as it covered 75% of organisms in our clinical setting.

PURPOSE OF THE STUDY: Despite the relatively high incidence of multiple myeloma reported worldwide, South African statistics seem to be significantly lower. Our purpose in doing this study was to determine whether patients with suspected immunosecretory disorders are being appropriately evaluated and followed up. Secondary purposes include an impression of the most common clinical features prompting investigation as well as the stage of disease at time of diagnosis. DESCRIPTION OF METHODS: All patients investigated for immunosecretory disorders by serum or urine electrophoresis over a 4-year period were included in this study. Each patient's laboratory and radiological data were evaluated to determine the true diagnosis, and assess the comprehensiveness of the investigation. SUMMARY OF RESULTS: In total, 582 patients were included - 39 patients had multiple myeloma (6.7%). A single case of plasmacytoma and plasma cell leukaemia was identified. Waldenström's macroglobulinaemia was identified in seven patients (1.2%) and monoclonal gammopathy of undetermined significance (MGUS) in 83 patients (14.3%). Due to the risk of progression from MGUS to multiple myeloma, patients need to be re-evaluated biannually, shown to be the case in only 11% of cases. Of all the malignant disorders (48 cases) the majority of patients were diagnosed in an orthopaedic setting (45%), followed by internal medicine (39%). Radiological abnormalities were the most common clinical finding prompting investigation, with lytic lesions or osteoporosis seen in 50%, pathological fractures in 17% and neurological manifestations noted in 18% of cases. The majority of patients who could be staged were diagnosed at a relatively late stage of disease, rendering the prognosis worse than in early disease. This suggests a relatively low index of suspicion in our clinical setting. CONCLUSION: Multiple myeloma and related disorders are commonly encountered in the orthopaedic setting. Although the sample size is small, this data suggests that patients are diagnosed late in disease progression and often not evaluated appropriately. A clear protocol should be established to actively exclude this diagnosis if it is suspected.

PURPOSE OF THE STUDY: Septic arthritis (SA) constitutes an orthopaedic emergency as it can rapidly lead to progressive and irreversible joint destruction with loss of function. We aim to identify our microbiological spectrum and sensitivity profiles, and compare it to our empirical antimicrobial choice in the management of septic arthritis in the adult population. DESCRIPTION OF METHODS: A retrospective analysis was performed on patients admitted from June 2005 to March 2009. The study population consisted of all patients over the age of 14 years admitted for either arthrotomies or joint aspirations, yielding positive cultures of either joint fluid or pus swabs taken intra-operatively. A data analysis was also done on serum CRP and WCC on all the patients. SUMMARY OF RESULTS: Gram-positive organisms were cultured in only 53% of isolates, and Staphylococcus aureus accounted for only 25% of all isolates. Of all the Gram-positive organisms, 38% were multi-drug resistant, only sensitive to vancomycin. Gram-negative organisms constituted 36% of isolates, showing resistance in 55%. The remainder of isolates consisted of anaerobic organisms. CONCLUSION: Gram-negative and resistant strains are becoming more important as an aetiological agent in adult septic arthritis. The current use of cloxacillin as empiric antibiotic therapy only covers 32% of all isolates in our setting. Based on these findings, use of co-amoxyclav as empiric antibiotic will increase the cover to 46%. The emergence of resistant strains remains a challenge, as evidenced by this study. Patients not responding to initial empiric therapy should be considered for early use of extended spectrum antimicrobials.