Medial collateral knee ligament healing. Combined medial collateral and anterior cruciate ligament injuries studied in rabbits

BACKGROUND: Antineutrophil cytoplasmic antibodies (ANCA), particularly perinuclear ANCA (p-ANCA), have been found more frequently in sera from patients with ulcerative colitis (UC) than in sera from Crohn's disease (CD) or unclassified enterocolitis (UE) patients. This 2-center study examined sera from 102 pediatric patients with inflammatory bowel disease (IBD) to evaluate their diagnostic value and assess their relationship with disease features, distribution, activity and treatment. METHODS: The serum ANCA of 102 children with IBD were measured: 33 UC, 64 CD and 5 UE with various disease locations and degrees of activity. The mean age at the onset of symptoms was 10.7 years (1 to 16.3 years). Sera from 26 unaffected first degree relatives and 20 children without IBD were also investigated. ANCA were detected using indirect immunofluorescence of ethanol-fixed granulocytes. RESULTS: There were ANCA in the sera of 24/33 children with UC (73%), 9/64 with CD (14%) and 4/5 with UE (80%). p-ANCA were more frequent than cytoplasmic-ANCA in positive sera: UC = 67%, CD = 57% and UE = 75%. The presence of ANCA was 73% sensitive and 81% specific for a diagnosis of UC, compared to other IBD (p < 0.001). Three children with proved sclerosing cholangitis associated with UC were all positive. There was no link between ANCA-positive sera and disease activity, or other endoscopic or clinical criteria. ANCA were detected in 4/26 first degree relatives (15%) and in 1/20 control subjects (5%). CONCLUSIONS: Because of their sensitivity and specificity, ANCA may be helpful in the clinical assessment of patients with IBD, and especially those with UC. However, there is no link between the pressure of p-ANCA and the site of UC or its activity, so that it cannot be used to monitor medical treatment or surgical indications.     

Physiological and mechanical adaptations of rabbit medial collateral ligament after anterior cruciate ligament transection

Progressive physiological and mechanical changes in the medial collateral ligament of the adult rabbit were investigated for as long as 48 weeks after disruption of the anterior cruciate ligament. Eighty-one New Zealand White rabbits were separated into experimental, sham-operated control, and normal control groups. The experimental group underwent unilateral transection of the right anterior cruciate ligament, sham-operated animals served as controls for comparison, and normal animals were evaluated as age-matched, undisturbed (no surgery) controls. Blood flow to the medial collateral ligament (as a physiological measure) and mechanical function (structural and material properties) were assessed at 6, 14, and 48 weeks. The results indicated that loss of the anterior cruciate ligament leads to early mechanical deterioration of the medial collateral ligament with a corresponding loss of physiological homeostasis. Six to 14 weeks after the transection, values for cross-sectional area of the medial collateral ligaments rapidly increased to 1.5 times control values. The ligament became twice as large as the control ligament by 48 weeks. Concomitantly, medial collateral ligament stress at failure of the medial collateral ligament complex decreased rapidly 6-14 weeks after the transection and eventually fell to one-half that of controls by 48 weeks. In terms of low-load behaviour, laxity and load relaxation were significantly greater than that of controls 6 weeks after transection and were further increased by 14 weeks. By 48 weeks, laxity values had recovered somewhat and load-relaxation measures had recovered to near control values. At both 6 and 14 weeks, a statistically significant elevation in blood flow was demonstrated compared with controls. By 48 weeks, however, blood flow was no different from that of the sham-operated control. Thus, early after transection of the anterior cruciate ligament, both low-load and high-load mechanical properties of the medial collateral ligament deteriorated and the rate of blood flow was temporarily elevated. By 48 weeks, blood flow declined to near control values, with a corresponding recovery in viscoelastic behaviour. These findings suggest that, after transection of the anterior cruciate ligament, viscoelastic behaviour of the medial collateral ligament may be related to changes in blood flow and that restoration of normal flow patterns and vascular responses may be linked to the recovery of some low-load mechanical properties in the anterior cruciate ligament-deficient medial collateral ligament.     

Injuries of the medial collateral ligament and anterior cruciate ligament of the knee joint and Lemaire surgical functional treatment. Long-term outcome

The present paper reports the results of 112 extraarticular ligamento-plasties performed on the knee with the procedure proposed by Lemaire. The series includes isolated tears of the anterior cruciate and medical collateral ligament as well as combined tears of both ligaments. The clinical and radiological results with a mean follow-up time of 11.5 years are compared with the results obtained in a first assessment 8 years ago. Good clinical results are in contrast with increasing osteoarthrosis in 1/3 of the knees radiologically assessed. The operation for a torn anterior cruciate ligament should be performed as soon as possible to avoid secondary meniscal lesions with subsequent severe osteoarthrosis. Presence or absence of arthrotic signs in the X-rays mainly determine the long-term result after ligamento-plasties of the knee. The Lemaire plasties are well tolerated even by elderly still active people and need little postoperative care.     

Late lateral femoral condyle fracture after anterior cruciate ligament reconstruction. A case report

Inter-individual differences in brain-immune interactions have been demonstrated previously in mice using lateralization as a behavioral trait of population heterogeneity. Lipopolysaccharide (LPS), which is known to induce neurochemical, neuroendocrine, and immune responses depending on lateralization, is also able to induce sickness behavior, via the production of interleukin-1 (IL-1). The objective of this study was to determine whether lateralization can influence the behavioral response to LPS and to IL-1. To test this hypothesis, adult female C3H mice, previously selected for paw preference in a food reaching task, were injected intraperitoneally (i.p.) with 0.75 microg LPS or 0.75 microg recombinant IL-1beta. Sickness induced by these molecules was measured by depressed social behavior, increased immobility, loss of body weight, and reduced food intake during the 6 h following injection. LPS-induced sickness was similar in right- and left-pawed mice. In contrast, IL-1-induced sickness behavior was dependent on behavioral lateralization. IL-1-induced depression of social investigation was more pronounced in right-pawed mice than in left-pawed animals. Likewise, IL-1-induced immobility was more important in right-pawed mice. There was a similar trend for food intake to be lower and loss of body weight to be higher in right-pawed mice than in left-pawed animals. These results demonstrate that right-pawed mice are more sensitive to IL-1-induced sickness than left-pawed animals. They extend our previous data showing a greater susceptibility to stress of right-pawed animals. The existence of inter-individual differences in the reactivity to stress or immune activation may be useful to study the mechanisms of the various strategies used by an individual in response to environmental aggressions.     

Diagnosis and therapy of micromolecular plasmocytomas -- a case report

It is reported on the symptomatology, diagnostics and therapy in a 54-year-old patient with a micromolecular plasmocytoma of kappa-type. Here particularly the impressionable improvement of the clinical picture after an intermitting impact therapy with melphalan (alkeran) - prednisolone in a period of treatment of approximately 2 years is emphasized.     

Knee dislocation without anterior cruciate ligament disruption. A report of three cases

The development of liver transplantation has led to technical refinements such as liver graft reduction or splitting for transplantation in two recipients, the use of living related donors, and the temporary orthotopic transplantation of auxiliary liver grafts. Regarding immuno-suppression, new drugs are currently under evaluation, such as tacrolimus (FK 506) which could be effective on some severe rejections. On the other hand, the indications of liver transplantation have been revisited according to clinical results. In France, the increasing development of organ and tissue transplantation has led to the creation of the Etablissement Fran?ais des Greffes, which has the following missions: managing the waiting lists, supporting organ donation, ensuring sanitary safety, and evaluating transplantation activities. Future alternatives to allogenic liver transplantation are mainly represented by xenografting with monkey or pig livers, hepatic assistance and bioartificial liver, and gene therapy.     

Tears of the medial collateral ligament: magnetic resonance imaging findings and associated injuries

For 23 patients with a surgically proven tear of the medial collateral ligament the findings from magnetic resonance imaging (MRI) of the knee were evaluated retrospectively. MRI revealed the tear in all cases, although when the injury was severe, distinguishing high-grade partial tears from complete tears was difficult. Physical examination had indicated a tear in 22 (96%) of the cases. A high prevalence of associated cruciate and meniscal injuries was seen (in 23 [100%] and 12 [52%] of the cases respectively). Tears of the fibular collateral ligament occurred in 13 (57%) of the patients and at least one bony infraction in 22 (96%); most of the infractions were in the lateral compartment. Infractions of the lateral femoral condyle were frequently geographic (in 14 [70%] of the 20 cases) or impacted (in 5 [25%]). The spectrum of injuries associated with tears of the medial collateral ligament was consistent with the findings of previous studies focusing on cruciate and meniscal abnormalities; the minor variations were likely due to the severity of valgus stress in this sample.     

Isolated sectioning of the medial and posteromedial capsular ligaments in the posterior cruciate ligament-deficient knee. Influence on posterior tibial translation

OBJECTIVES: This study examined whether heightened cardiovascular reactivity and low socioeconomic status had synergistic effects on the progression of carotid atherosclerosis in a population of eastern Finnish men. METHODS: Data from the Kuopio Ischemic Heart Disease Risk Factor Study were used to measure 4-year progression of intima-media thickness in 882 men according to cardiovascular reactivity and socioeconomic status. Associations were examined in relation to risk factors and were stratified by baseline levels of atherosclerosis and prevalent ischemic heart disease. RESULTS: The effect of reactivity on atherosclerotic progression depended on socioeconomic status. Men who had heightened cardiovascular responsiveness to stress and were born into poor families, received little education, or had low incomes had the greatest atherosclerotic progression. CONCLUSIONS: An understanding of associations between individual risk factors and disease should be based on etiologic hypotheses that are conceived at the population level and involve fundamental social and economic causes of disease. This study demonstrates how examining the interaction of an individual biological predisposition will low socioeconomic status over the life course is etiologically informative for understanding the progression of atherosclerotic vascular disease.     

HELLP syndrome: undiagnosed in a case of impending rupture of uterus. A case report

Eleven patients with chronic renal failure who were being treated with haemodialysis three times a week were monitored for a total of 34 haemodialysis sessions. Erythrocyte 2,3-biphosphoglycerate (2,3-BPG) concentration was analysed immediately before initiation of bicarbonate haemodialysis and 1 h afterwards. The 2,3-BPG concentration was expressed relative to the haemoglobin tetramer (Hb4) concentration as the 2,3-BPG/Hb4 ratio and compared with blood gas analyses and biochemical variables important for characterizing uraemia. During the first hour of haemodialysis the 2,3-BPG/Hb4 ratio decreased (p < 0.002), but the magnitude of the decrease did not significantly correlate with the 2,3-BPG/Hb4 ratio measured before haemodialysis (p=0.104). The decrease is most likely to be caused by the haemodialysis procedure itself. Mechanical stress on the erythrocytes is believed to cause the 2,3-BPG to escape; it is then removed by haemodialysis. Physiologically, an increase in 2,3-BPG would be expected to counteract the hypoxia which is frequently observed during haemodialysis. However, the present results show the opposite, a decrease in 2,3-BPG. No significant correlation was shown between the haemoglobin concentration and the 2,3-BPG/Hb4 ratio before dialysis (p=0.414). The pH showed a significant positive correlation with the 2,3-BPG/Hb4 ratio before dialysis, whereas the arterial pO2 and the 2,3-BPG/Hb4 ratio before dialysis were insignificantly negatively correlated. The concentrations of calcium, phosphate, creatinine, urea and albumin did not correlate significantly with the change in 2,3-BPG/Hb4-ratio after 1 h. The 2,3-BPG/Hb4 ratio (p=0.03) sampled just before dialysis correlated significantly and positively with the total weekly dosage of erythropoietin given to the patients.     

Closed rupture of the anterior tibial tendon. A case report

Closed subcutaneous rupture of the anterior tibial tendon is a relatively uncommon injury that requires a thorough clinical examination to diagnose correctly. The authors report a case of this disorder and provide a review of the relevant literature. A method of surgical repair not previously described in the literature is also presented.     

Management of the anterior cruciate ligament rupture: indications, choice of procedure, timing, concomitant and after-care

The indication for operative or conservative treatment of the anterior cruciate ligament remains still difficult. Many years of intensive basic and clinical research and a better knowledge of biology, biomechanics and pathology have not been achieved standards of therapy. Therefore varying treatment options exist. In this paper we give an overview on the main indications and common treatments. Untreated ruptures of the ACL result in severe functional impairment. Therefore we find a wide indication for an operative reconstruction. Patient orientated factors (age, activity level, morphotype) and the range of instability are important for the decision-making between operative and conservative treatment. The time of intervention is determined by the chosen treatment. Multidirectional instabilities, ruptures of meniscus or damage of cartilage need an early, isolated injuries of the ACL an early or later (until 4 weeks) surgical therapy. An anatomical ligament reconstruction (so called "suture") is possible only for selected ruptures near the femoral insertion. Operative treatment needs a special suture technic and autologous or allogenous augmentation. In 15 until 25% of all ACL ruptures good results can be obtained in this way. In all other types of ruptures only a reconstruction using autologous material (lig. patellae, semitendinosous tendon) is recommended. Rehabilitation after ACL ruptures depends on the method of treatment (conservative procedure, reconstruction material, fixation technique, associated lesions) and has to be adapted to the biological healing process. Normally an immobilisation (cast, orthesis) has no benefit for ligament healing.     

Thoracoscopic repair of traumatic diaphragmatic rupture. A case report

A 51-year-old man with a traumatic diaphragmatic rupture is presented. Preoperatively, diaphragmatic rupture and herniation of the stomach into the left thoracic cavity were suspected. Under thoracoscopic guidance, the stomach and omentum were repositioned in the abdominal cavity using Babcock forceps, and then the rupture site was closed using an endoscopic hernia stapler. The postoperative course was uneventful and the patient was discharged from our hospital with no symptoms.     

Reconstruction of the posterior cruciate ligament: preliminary report of a new procedure

The integrity of the posterior cruciate ligament is necessary for the stability of the knee. The popliteus tendon is a promising, practical, and anatomical donor for reconstructing the posterior cruciate ligament. The procedure can be performed relatively easily using a posterolateral Henderson incision in association with the standard anteromedial parapatellar approach. We have performed the operation in 2 patients, produced good results at 4 and 6 month follow-up examination.     

The laparoscopic treatment of splenic rupture, a case report

This retrospective study presents data from 26 women who underwent a reversal of female sterilization. The intrauterine pregnancy rate and ectopic pregnancy rate were 38.5% and 7.7% respectively. The most successful site of tubal anastomosis was isthmic-isthmic anastomosis. The importance of proper patient selection and factors that affect the success rate in attempted reversals are emphasised. The importance of microsurgical approach is highlighted.     

The effects of platelet-derived growth factor-BB on healing of the rabbit medial collateral ligament. An in vivo study

Cigarette smoking poses significant risk to mother and infant during pregnancy and the postpartum period. Recruitment of pregnant smokers to intervention studies has often been reactive and has excluded certain subgroups of women, such as those who have recently quit smoking. In this study, we examined smoking patterns among a proactively recruited sample of women presenting to six urban community maternity clinics. The current report describes the patterns of smoking in this population of ethnoculturally diverse low-income urban pregnant women and examines differences across subgroups. The majority of the total sample in the current study reported that they had never smoked. Of the total, 30% reported having "ever" smoked and 16% were current smokers. Of the group of "ever" smokers, 18% quit greater than 12 months before pregnancy, 5% quit 0-12 months before pregnancy and 23% quit during this pregnancy. On the average, women who quit during pregnancy did so about 5 weeks after diagnosis. Of those women who continued to smoke during pregnancy, the average number of cigarettes smoked per day was 10 +/- 8. Differences were found in smoking patterns across the ethnocultural subgroups. Recruitment represents the first and one of the most important phases in intervening with pregnant women. Inclusion of both current smokers and recent self-quitters takes the fullest advantage of the window of opportunity to help women quit smoking and remain cigarette free for good.     

The use of cold therapy after anterior cruciate ligament reconstruction. A prospective, randomized study and literature review

We performed a randomized, prospective study to assess the effectiveness of postoperative cold therapy in patients who had anterior cruciate ligament reconstructions. Drain output, length of hospital stay, range of motion, and use of pain medication were all assessed. Patients were randomized into one of four groups after surgery. Group 1 patients had a cooling pad applied to the knee postoperatively and set at a temperature of 40 degrees to 50 degrees F, Group 2 had the cooling pad set at 70 degrees to 80 degrees F, Group 3 received ice packs, and Group 4 received no cold therapy of any kind. The skin temperatures in Groups 1 and 3 were significantly lower than the skin temperatures in Groups 2 and 4 (P < 0.001). The length of hospital stay, range of motion at discharge, use of oral and intramuscular pain medicine, and drain output were not significantly different between groups. No complications related to the type of cold therapy were seen in any group. Thus, both ice packs and cooling pads significantly decreased knee temperature, but we found no objective benefits in the early postoperative course due to this decrease in temperature.     

MR appearance of anomalous insertion of the medial meniscus. A case report

We report on the MR imaging of an anomalous medial meniscus with a tear in a 41-year-old man. Anomaly of the medial meniscus is rare and difficult to diagnose clinically. The MR images contributed to the pre-arthroscopic diagnosis and arthroscopy confirmed the lesion. The anomalous meniscus was not related to the symptoms.