Rejoinder to R. scapinelli
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Journal Article↗
Biomedical subjects
W Petersen
Publications and source records attributed to W Petersen.
Combined injuries of the medial collateral ligament and the anterior cruciate ligament. Early ACL reconstruction versus late ACL reconstruction.
Aim of this retrospective study is to evaluate the effect of acute and late anterior cruciate ligament (ACL) reconstruction in patients with a combined injury of the ACL and the medial collateral ligament (MCL). All MCL injuries were treated non-operatively. In 27 patients (group I) we performed early ACL reconstruction (within the first 3 weeks after injury). The postoperative rehabilitation protocol included brace treatment for all patients over a period of 6 weeks. In 37 patients we performed late ACL reconstruction (after a minimum of 10 weeks). In this group initial non-operative MCL treatment (6 weeks brace treatment) was followed by a period of accelerated rehabilitation. Patients with late ACL reconstruction had a lower rate of loss of motion after finishing the postoperative rehabilitation programme and a lower rate of re-arthroscopies for a loss of extension (group I: 4 patients, group II: 1 patient). The difference in the mean quadriceps muscle strength (group I: 83.3%, group II: 86.3%) was not statistically significant. After a mean interval of 22 months, we saw no difference in the frequency of anterior or medial instabilities or in the loss of motion. The Lysholm score was significantly better in the group with late ACL reconstruction (group I: 85.3, group II: 89.9). The position on the Tegner activity scale decreased in both groups, to 5.5 in group I (preoperatively: 6.0) and to 5.6 in group II (preoperatively: 5.9). With regard to the lower rate of motion complications in the early postoperative period, the lower rate of re-arthroscopies, and the significantly better results in the Lysholm score, we prefer late ACL reconstruction in the treatment of combined injuries of the ACL and the MCL.
Adolescent↗
Blood supply of the tibialis anterior tendon.
Injection techniques and immunohistochemical methods (antibodies against laminin) were performed to uncover the vascular pattern of the human tibialis anterior tendon with regard to spontaneous rupture of this tendon. Proximally, the blood supply of the tibialis anterior tendon mainly arises from the anterior tibial artery. Distally, the tendon is supplied by branches of the medial tarsal artery. Blood vessels enter the peritenon via vinculae from the posterior side. From the peritenon, the blood vessels penetrate the tendon and anastomose with a longitudinally orientated intratendinous network. Compared with the surrounding peritenon, the number of vessels in the tendon substance is greatly reduced. The distribution of blood vessels within the anterior tibial tendon is not homogenous. The posterior part of the tendon has a complete vascular network that extends from the musculotendinous junction to the insertion at the bone. In the anterior half of the tendon, there is an avascular zone between 45 and 67 mm in length. The location of the avascular zone correlates well with the location of the most frequent site of spontaneous rupture of the tibialis anterior tendon reported in the literature. Hypovascularity has to be considered as an etiological cofactor for spontaneous rupture of the tibialis anterior tendon.
Aged↗
Structure and vascularization of the cruciate ligaments of the human knee joint.
The structure and vascularization of the human anterior and posterior cruciate ligament were investigated by light microscopy, transmission electron microscopy,, injection techniques and by immunohistochemistry. The major part of the anterior and posterior cruciate ligament is composed of bundles of type I collagen. Type III collagen-positive fibrils separate the bundles. The major cell type is the elongated fibroblast, lying solitarily between the parallel collagen fibrils. The histologic structure of the cruciate ligaments is not homogeneous. In both ligaments there is a zone where the tissue resembles fibrocartilage. In the anterior cruciate ligament the fibrocartilaginous zone is located 5-10 mm proximal of the tibial ligament insertion in the anterior portion of the ligament. In the posterior cruciate ligament the fibrocartilage is located in the central part of the middle third. Within those zones the cells are arranged in columns and the cell shape is round to ovoid. Transmission electron microscopy reveals typical features of chondrocytes. The chondrocytes are surrounded by a felt-like pericellular matrix, a high content of cellular organelles and short processes on the cell surface. The pericellular collagen is positive for type II collagen. The major blood supply of the cruciate ligaments arises from the middle geniculate artery. The distal part of both cruciate ligaments is vascularized by branches of the lateral and medial inferior geniculate artery. Both ligaments are surrounded by a synovial fold where the terminal branches of the middle and inferior arteries form a periligamentous network. From the synovial sheath blood vessels penetrate the ligament in a horizontal direction and anastomose with a longitudinally orientated intraligamentous vascular network. The density of blood vessels within the ligaments is not homogeneous. In the anterior cruciate ligament an avascular zone is located within the fibrocartilage of the anterior part where the ligament faces the anterior rim of the intercondylar fossa. The fibrocartilaginous zone of the middle third of the posterior cruciate ligament is also avascular. According to Pauwel's theory of the "causal histogenesis" (1960) the stimulus for the development of fibrocartilage within dense connective tissue is shearing and compressive stress. In the anterior cruciate ligament this biomechanical situation may occur when the ligament impinges on the anterior rim of the intercondylar fossa when the knee is fully extended. Compressive and shearing stress in the center of the middle third of the posterior cruciate ligament may result from twisting of the fiber bundles.
Adult↗
[Insidious rupture of the Achilles tendon after ciprofloxacin-induced tendopathy. A case report].
A 45 years old female runner developed a bilateral tendinopathy of the Achilles tendon after repeated antimicrobiotical treatment with ciprofloxacin. One month later the right Achilles tendon ruptured without any sudden pain. MRI revealed degenerative changes of the left Achilles tendon; on the right side the tendon was ruptured with a dehiscence of 4 cm between both ends of the tendon. The tendon was reconstructed surgically. The histological analysis showed cystic changes with focal necrosis. This finding differ from findings in non drug induced tendinopathies. After antimicrobiotical treatment with ciprofloxacin the side effect of a tendon disorder must be considered. The impairment of the tendon may be as strong that a tendon rupture may occur at daily living activities without any typical clinical symptoms.
Achilles Tendon↗
Collagenous fibril texture of the human knee joint menisci.
Anatomical and clinical literature describes the arrangement of collagen fibrils in the human meniscus as being "arcade-like". The "arcade-like" orientation, mainly running in a radial direction in the internal circumference and in a circular direction in the external circumference, was found in polarization light microscopic studies. This, however, does not provide a mechanical explanation for the direction of meniscus tears. In view of this contradiction collagen fibrils in the menisci of adults aged from 18 to 85 years were exposed layer-by-layer to study their arrangement by scanning electron microscopy. The results obtained by this procedure were compared to the path of the split lines. Scanning electron microscopy reveals three distinct layers in the meniscus cross section: (1) The tibial and femoral sides of the meniscus surfaces are covered by a meshwork of thin fibrils with a diameter of approximately 30 nm. (2) Beneath the superficial network there is a layer of lamellalike collagen fibril bundles on the tibial and femoral surface. In the area of the external circumference of the anterior and posterior segments the bundles of collagen fibrils are arranged in a radial direction. In all other parts the collagen fibril bundles intersect at various angles. (3) The main portion of the meniscus collagen fibrils are located in the central region between the femoral and the tibial surface layers. Everywhere in the central main portion of the meniscus the bundles of collagen fibrils are orientated in a circular manner. The split lines in the region of the internal circumference of the menisci are arranged in a circular manner, generally running in a radial direction in the portions adjacent to the base. Scanning electron microscopy reveals that the direction of the split lines depends on the orientation of the collagen fibrils in the superficial lamellar layer. The arcade-like path of the collagen fibrils described in the literature can not be confirmed either by scanning electron microscopy or by the course of the split lines. The circular arrangement of collagen fibrils in the central portion of the meniscus provides a functional explanation for the longitudinal orientation of the majority of tears in the meniscus tissue.
Adolescent↗
Sodium cromoglycate as a replacement for inhaled corticosteroids in mild-to-moderate childhood asthma.
We investigated whether sodium cromoglycate 10 mg three times daily, delivered as an aerosol via Nebuhaler (in addition to terbutaline 0.5 mg three times daily), could replace inhaled steroid in children with mild-to-moderate asthma. Children (mean age 10.3 years) were randomly allocated to 12-week treatment with sodium cromoglycate 10 mg plus terbutaline 0.5 mg (group A; n = 30) or placebo plus terbutaline 0.5 mg (group B; n = 32), both taken three times a day. The daily steroid dose was reduced by 50 microg/week for 4 weeks from a starting dose of 200 microg. Fewer patients withdrew owing to worsening asthma from group A (n = 1) than group B (n = 11). Symptom scores, morning and evening peak flows, and additional beta2-agonist usage, recorded on diary cards, were better in group A than group B. Lung function measured at clinic visits was unchanged in either group. Overall opinions of efficacy favoured Group A. Adverse events were similar in the groups. Sodium cromoglycate plus terbutaline substituted effectively for inhaled steroid therapy.
Administration, Inhalation↗
Low-dose caudal morphine for postoperative analgesia in infants and children: a report of 500 cases.
STUDY OBJECTIVE: To determine the effectiveness of morphine 0.03 mg/kg or 0.04 mg/kg administered caudally to children for postoperative pain relief. DESIGN: Retrospective chart review. SETTING: University-affiliated hospital. PATIENTS: The charts of 500 children who had undergone various surgical procedures and who were given caudal morphine 0.03 mg/kg or 0.04 mg/kg either prior to the surgical procedure or immediately at the conclusion of the surgical procedure. MEASUREMENTS AND MAIN RESULTS: Parameters of respiratory rate, oxygen saturation, nausea and vomiting, voiding problems, and pruritus were recorded for each patient. There was no respiratory depression noted in the review of the 500 patients; 23% had nausea and vomiting, 3% had voiding problems needing bladder catheterization, and 7% reported pruritus, which was treated with either diphenhydramine or naloxone. CONCLUSION: Statistically there were no differences between morphine 0.03 mg/kg and morphine 0.04 mg/kg in all the study parameters. There was no respiratory depression in the 500 cases reviewed. The postoperative pain relief ranged from 6 hours to over 24 hours. This method of immediate postoperative pain management proved to be effective and safe.
Adolescent↗
Age-related blood and lymph supply of the knee menisci. A cadaver study.
We investigated 20 human menisci (22 weeks of gestation-80 years) immunohistochemically with an antibody against laminine in the basement membrane. Differentiation of blood vessels and lymphatics was possible with histochemical proof of alkaline phosphatase and 5' nucleotidase in the endothelium. Blood vessels entered the menisci from the joint capsule accompanied by loose connective tissue. In the 22nd gestational week, vessels could only be found in the lateral third. At the time of birth, nearly the whole meniscus was vascularized. In the second year of life, an avascular area developed inside the inner circumference. In the second decennium, blood vessels occurred only in the lateral third. After 50 years of age, only the lateral quarter of the meniscal base was vascularized. The dense connective tissue of the insertion was vascularized, but not the fibrocartilage of the insertion. Blood vessels were accompanied by lymphatics in all areas.
5'-Nucleotidase↗
The logic of severity: outcomes measurement at Minnesota's HealthSpan hospitals.
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Data Interpretation, Statistical↗
PGD Port Elizabeth: a new variant found in South Africa.
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Genetic Variation↗
Sister of organ donor: more education needed to increase donation.
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Humans↗
[Traumatic paraplegia with injury of the upper extremity--effects on the success of rehabilitation].
The evaluation of a greater number of patients with traumatic paraplegia and tetraplegia showed more than 20% of associated injuries of the upper limbs. In view of the fact that arms and shoulders of the paraplegic person take over a decisive weight-bearing function, we were interested in the effects of these special injuries on rehabilitation outcome. Injuries of the distal arm were found to have more serious repercussions for achievement of the rehabilitation aim than the relatively more impressing injuries of the shoulder girdle and the upper arm. Serious limitations were found in the range of motion of the affected joints. Compensation was due only to the skill of the paraplegics in dealing with these deficits in motion and in using the uninjured extremity. This is the main reason why the functional deficits in independence were relatively minor.
Activities of Daily Living↗
Anal tonometry in the neonatal period for the diagnosis of Hirschsprung's disease.
A double balloon technique was used for anal tonometry in 22 infants. The weight was less than 2,500 g in 10 of the infants. Ileus or delayed passage of meconium was seen in 9 infants. Thirteen infants had not revealed any symptoms of intestinal obstruction during the first week of life. In all cases, except one, it was possible to demonstrate reflexes from the internal anal sphincter. In 18 infants normal curves were registered from the internal anal sphincter. None of these developed Hirschsprung's disease. In 3 infants a pathological pattern of contractions of the internal anal sphincter was demonstrated. Two of them proved to have Hirschsprung's disease. In the third case normal reflexes were registered after one year. Possibly the innervation of rectum and the internal anal sphincter was disrupted during the neonatal period in connection with enterocolitis and ileus, thus representing a reversible case of achalasia.
Anal Canal↗
[Positioning techniques for the prevention of shoulder pain in the early phases of tetraplegia].
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Humans↗
Inhaled budesonide for treatment of recurrent wheezing in early childhood.
77 children, aged 11 to 36 months (mean 24) with moderately severe recurrent wheezing, were treated with budesonide pressurised aerosol 400 micrograms twice daily or placebo for 12 weeks in a double-blind, parallel-group trial. Aerosols were inhaled from a spacer with a facemask. Budesonide significantly improved symptom scores of wheezing, sleep disturbance, and patient happiness. The frequency of severe exacerbations that required a course of oral prednisolone was also significantly reduced. The treatment effect appeared to be fully established after 6-8 weeks and no side-effects could be ascribed to the active treatment. The findings indicate that young children below 3 years of age can inhale a pressurised aerosol from a spacer with a facemask. Use of topically active glucocorticosteroids with this simple device may reduce symptoms and distress in young children with moderately severe recurrent wheeze and dyspnoea, and possibly reduce their requirement for oral steroids.
Administration, Inhalation↗
Rapid versus gradual refeeding in acute gastroenteritis in childhood: energy intake and weight gain.
Fifty-two children aged 6-46 months (mean 19 months), hospitalized for acute gastroenteritis (GE), were randomized after oral rehydration to receive 7 days of either traditional gradual refeeding (GR) or rapid refeeding (RR), the latter consisting of a full-strength lactose-limited diet, including lactase-treated whole milk. The study focused on the effect of a high energy intake, excluding possible negative effects of lactose. Both dietary regimens were well tolerated, the only difference in the clinical symptoms between the two regimens being a higher stool frequency within the RR group (p less than 0.02). The total energy intake, as well as energy derived from fat and protein, was significantly higher in the RR than in the GR group (p less than 0.0001). The mean daily energy intake of the latter group never reached recommended daily allowance (RDA) levels, while that of the RR group did on day 5. Moreover, during the whole period of dietary regimen, the RR group exceeded the RDA protein requirements (mean intake ranged 175-252%), while the GR group did not reach this RDA level until day 4. Milk was a major source of energy in the RR group, providing 47-59% of the daily energy intake. The short- and long-term weight gains in the RR group were only a little higher than those of the GR group, the difference being insignificant.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease↗
Glucose tolerance and insulin receptor binding to monocytes and erythrocytes in patients with cystic fibrosis.
Cystic fibrosis (CF) is the most frequent life threatening hereditary disease in the Western World with an incidence of approximately 1:2000. Due to increasing survival rates the high frequency of abnormal glucose tolerance has become an important problem. We compared insulin concentrations during oral glucose tolerance test and insulin receptor binding to both monocytes and erythrocytes from 9 patients with CF, with results from 10 healthy controls of similar body weight. The insulin: glucose ratio was increased in the fasting state (p less than 0.05) in patients with CF compared to controls, indicating an increased insulin resistance in CF-patients. The total insulin secretion during oral glucose tolerance test as judged by the area beneath the insulin curve was similar in the two groups, but insulin secretion was significantly delayed in patients with CF. Insulin receptor binding to monocytes and the number of receptors were significantly increased (p less than 0.01 and 0.02, respectively) in patients with CF whereas the dissociation constant was similar in patients with CF and controls. No difference was observed in insulin receptor binding to erythrocytes between the two groups. No correlations were found between insulin receptor binding to monocytes or erythrocytes and glucose tolerance or insulin concentrations.
Adolescent↗