Anatomic anterior cruciate ligament reconstruction: Freddie Fu's paradigm.

Anterior cruciate ligament (ACL) reconstruction techniques have evolved over the past four decades. There is evidence that non-anatomic reconstruction techniques, such as traditional transtibial drilling, fail to recreate the native anatomy of the ACL, which can lead to increased rotatory knee instability, revision risk, and post-traumatic osteoarthritis. Anatomic ACL reconstruction has emerged as the gold standard, with the goal of restoring the patient's native anatomy and knee kinematics. This review will summarise the relevant anatomy, modern anatomic ACL reconstruction techniques, and literature supporting anatomic ACL reconstruction as the new paradigm. LEVEL OF EVIDENCE: Level V, review article.

The contribution of a pyrethroid insecticide to the massive eel (Anguilla anguilla) devastation, in Lake Balaton, in 1995.

In the summer of 1995, 30 tonnes of eel (Anguilla anguilla) died in Lake Balaton, Hungary. An investigation was carried out to find the causes of this ecocatastrophe. During this investigation, certain biochemical parameters, i.e. the blood sugar level, the acetylcholinesterase (AChE, EC 3.1.1.7), lactate dehydrogenase (LDH, EC 1.1.2.3), glutamic-oxaloacetic transaminase (GOT, EC 2.6.1.1), and glutamic-pyruvic transaminase (GPT, EC 2.6.1.2) activities in the blood serum of the collected surviving and dying eels were examined. Deltamethrin, the active ingredient of the insecticide K-OTHRIN 1 ULV, used against mosquitoes was detected in different animal species, i.e. eel, bream (Abramis brama), pike perch (Stizostedion lucioperca), and the common gull (Larus canus) and in sediment samples from the lake. Additionally, laboratory experiments were carried out to study the effects of deltamethrin on eels. During the investigation in the field it appeared that the AChE activity was significantly lower in the blood serum of the dying eels as compared to that in living animals (P<0.05, Student's t-test). The blood glucose content exhibited a difference, too: it was 2.5 times higher in the dying eels than in the surviving ones. A huge increase in the LDH level was measured in the dying eels. The GOT activities of the serum were twice as high in the dying eels as in the living fish, while the GPT was not significantly changed. Deltamethrin was detected in different tissue samples of the dying eels: 2.70-18.1 microg/kg in the liver, 9.0-31.1 microg/kg in the gill and 3.0 microg/kg wet tissue in the muscle. Deltamethrin residues were found in tissue samples from other animals, in the following concentrations: 0.44 microg/kg in bream, 2.14 microg/kg in pike perch and 1.06 microg/kg wet tissue in dead gulls. The sediment samples collected from the sites of the devastation contained deltamethrin in a concentration of 5.50-30.00 microg/kg wet sediment at the time of the eel deaths, and in a concentration 7.00-8.75 microg/kg wet sediment a month later. Laboratory experiments with the insecticide K-OTHRIN 1 ULV revealed that 1.00 microg/l of its active ingredient, deltamethrin, caused the death of 50% of the eels after an exposure time of 96 h. During this experiments similar trends could be observed in changes of enzyme activities of the treated eels to those that were detected in filed study during the eel devastation in Lake Balaton. At the end of a one-week treatment with the insecticide at the concentration of 0.5 microg/l of its active ingredient the gills of the treated eels contained deltamethrin at 12.6-44.8 microg/kg wet tissue concentration, while at the 24th hour after the treatment (11.2-42.7 microg/kg wet tissue) deltamethrin concentration in the liver of treated eels could be detected. All the above-mentioned changes and the detected deltamethrin residue in the eels appear to demonstrate the contribution of deltamethrin to the severe eel devastation. This information on the ecological risk of pyrethroid insecticides might be useful in their further application.

[Experience with combined interferon alpha-2b and ribavirin in the therapy of chronic hepatitis C. Experience with one-year therapy of 100 patients. Multicenter study]. / Interferon-alfa-2b és ribavirin kombinált kezelés krónikus C hepatitisben. 100 Beteg egy évig tartó kezelése során szerzett tapasztalatok. Multicentrikus Tanulmány Munkacsoport.

It has been established that the long term interferon therapy in patients with chronic hepatitis C is able to produce sustained remission only in about 20 per cent of the cases. According to the newest data the combined interferon and ribavirin therapy significantly increases the remission of patients in naive, non-responder or relapsed cases. Clinical remission was confirmed by enzyme activity of alaninamino transferase (ALT) and HCV-RNA-PCR tests. In order to get exact data of the remission rate and the symptom free period, a prospective multicenter study has been introduced in Hungary. Ten leading hepatologic units have been involved into the trial. Till now the combined therapy with interferon-alfa-2b (3 MU, three times a week) and ribavirin--(1000-1200 mg daily) for one year has been finished in 100 cases with chronic hepatitis C. The mean value of ALT activity decreased near to the normal level, in 58 patients it was in the normal range. Side effects with mild or moderate grades have been found in 31 cases. The interim report of this multicenter study confirm the efficacy of this combined therapy in chronic hepatitis C.

Similarities and differences between the massive eel (Anguilla anguilla L.) devastations that occurred in Lake Balaton in 1991 and 1995.

In the past few years, two massive eel (Anguilla anguilla L.) devastations occurred in Lake Balaton, Hungary. In 1991, 300 tons of eel perished in the western basin of the lake, while in the summer of 1995 30 tons of eel died in the eastern part of the lake. Investigations carried out to find the causes of these ecocatastrophes included measurements of certain biochemical parameters: the blood sugar level, and the acetylcholinesterase (AChE, EC 3.1.1.7), lactate dehydrogenase (LDH, EC 1.1.2.3), glutamic-oxaloacetic transaminase (GOT, EC 2.6.1.1) and glutamic-pyruvic transaminase (GPT, EC 2.6.1.2) activities in the blood serum of the collected eels. In both 1991 and 1995, deltamethrin (DM), the active ingredient of the insecticide K-OTHRIN 1 ULV used against mosquitoes, was detected in the eels; in 1995 it was demonstrated in several other animal species, i.e., bream (Abramis brama L.), pike perch (Stizostedion lucioperca L.), and the common gull (Larus canus), and in sediment samples from the lake. Additionally, laboratory experiments were carried out to study the effects of DM on eels. In 1991, eels were collected from the western (the site of the devastation) and eastern basins of the lake. The eels from the eastern basin were used as controls. At that time, the AChE activity in the blood serum of the eels from the western basin was significantly inhibited compared to that in animals from the eastern basin (P < 0.05, Student t test). Eels from the western part of the lake had GOT and GPT levels 20 and 100%, respectively, higher than those of eels from the eastern part of the lake. The blood glucose level was much higher in the eels from the affected area of the lake as compared to those from the eastern part. The brain and liver of the eels contained DM residues at 20 micrograms/kg wet tissue (Gönczy, 1992). Gönczy suspected that one of the causes of the massive eel loss in 1991 was the presence of DM in the fish. In 1995, when the eel devastation occurred in the eastern basin, moribund and surviving eels were collected from this part of the lake. The AChE activity was significantly inhibited in the blood serum of the dying eels as compared to that in surviving animals (P < 0.05, Student t test). The blood glucose content exhibited a difference too: it was 2.5 times higher in the dying eels than in the surviving ones. A huge increase in the LDH level was measured in the dying eels, indicating damage to different muscle tissues to an extent never observed previously. The GOT activities of the serum were twice as high in the dying eels as in the living fish. The GPT was not significantly changed in the serum of dying eels as compared to the surviving animals. DM was detected in different tissue samples of the dying eels: 2.7-18.5 micrograms/kg in the liver, 9.0-31.1 micrograms/kg in the gill, and 3.0 micrograms/kg wet tissue in the muscle. DM residues were found in tissue samples from other animals, in the following concentrations: 0.4 micrograms/kg in bream, 2.1 micrograms/kg in pike perch, 1.1 micrograms/kg wet tissue in dead gulls. The sediment samples collected from different places and at different times contained DM in a concentration of 5.5-30.0 micrograms/kg wet sediment at the time of the eel deaths, while the sediment samples collected from the same places a month later still contained DM at 7.0-8.8 micrograms/kg wet sediment. Laboratory experiments with the insecticide K-OTHRIN 1 ULV revealed that 1.0 microgram/liter of its active ingredient, DM, caused the death of 50% of the eels after an incubation time of 96 hr. In the liver of the dead eels, DM was detected at 2.9-20.0 micrograms/kg wet tissue. All the above-mentioned changes and the DM residue detected in the eels appear to demonstrate the contribution of DM in the severe eel devastation. This finding on the ecological risk of such types of insecticides might be useful in their further application.

In vivo effects of deltamethrin exposure on activity and distribution of molecular forms of carp AChE.

The in vivo effects of the insecticide deltamethrin (DM) on the activity and molecular forms of acetylcholinesterase (AChE, EC 3.1.1.7) were examined in different organs (brain, blood serum, heart, liver, and skeletal muscle) of carp. The chosen exposure conditions were a DM concentration of 2 micrograms/liter in the water (12 +/- 1 degrees C) for 3 days. All the treated fish survived the experiment, though the effects of the treatment were very visible: the fish always turned on their side, and the skin/scales became infected during the exposure to DM. DM did not result in a significant change in the AChE activity in any of the studied organs except the blood plasma, where the exposure resulted in an AChE activity decrease of as much as 20%. The ratio of membrane-bound to salt-soluble AChE forms was determined in the control fish. This ratio increased in the sequence heart, skeletal muscle, liver, and brain. The distribution of the AChE molecular forms was studied in the above tissues. The brain and liver contained forms G1, G4, and A12, the heart and skeletal muscle G4, A4, and A12, and the blood serum G1 and G4. The exposure to 2 micrograms/liter DM for 3 days caused hardly any changes in the pattern of the different AChE molecular forms. A small, but significant (P < 0.05) increase in the proportion of the G4 form was observed in the liver, while G1 and A12 decreased by a few percent (but insignificantly). No other tissues investigated exhibited any changes in the distribution of the AChE molecular forms.(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo effects of deltamethrin on some biochemical parameters of carp (Cyprinus carpio L.).

Thein vivo effects of deltamethrin (DM) on the blood sugar level, the acetylcholinesterase (AChE, EC 3.1.1.7) activities of the blood serum and various organs (heart, liver and intestine), the lactate dehydrogenase (LDH, EC 1.1.2.3), glutamic-oxaloacetic transaminase (GOT, EC 2.6.1.1), and glutamic-pyruvic transaminase (GPT, EC 2.6.1.2) activities of the blood serum, the adenosine triphosphatases (EC 3.6.1.3; Na(+)/K(+)-ATPase and Mg(2+)-ATPase) activities of the erythrocyte plasma membrane and the catalase (EC 1.11.1.6) activity of the liver were examined throughout 96 h in adult carp (Cyprinus carpio L.) Two sublethal concentrations, 1.0 and 1.5 µg/l of deltamethrin, were used. All fish survived the experiment except one, in an aquarium containing 1.5 ppb of DM, which died after 72 h.The AChE specific activity was significantly inhibited in the heart and intestine after 96 h at both concentrations compared to that in the control animals (P<0.05, Student'st-test), while there was no detectable difference between the two treatment. At the same time there was no detectable change in the liver. In the serum, the AChE activity almost remained unchanged; the only significant decrease could be measured after 96 h at 1.5 µg/l deltamethrin concentration. The blood glucose content exhibited interesting changes: after 24 h fish exposed at 1 µg/l DM seemed to be stressed, although this increase was not significant. When these fish became used to the new conditions (in practice this meant the presence of DM), the glucose level decreased, especially after 72 h. At the same time the control animals kept in similar circumstances showed a small insignificant decrease. Meanwhile fish in aquaria containing 1.5 µg/l DM reacted to the treatment with an increased blood glucose level after 48 h, and this did not change until the end of the treatment. The Na(+)/K(+)-ATPase activity decreased in a dose-dependant manner, while Mg(2+)-ATPase was less affected. A small increase in LDH level was observed, indicating damage of different muscle tissues. However, this phenomenon appeared only with the small dosage after 24 h (P<0.05). It has to be mentioned that the individual values varied to a large extent among of the eight fish.The GOT activities of the serum increased during the treatment. However, significant changes were only expressed after 72 and 96 h at 1 µg/l DM concentrations (P<0.01 andP<0.05), and after a similar long treatment at the high dosage (P<0.05, 72 and 96 h). The GPT did not change significantly in aquaria containing 1 µg/l DM. The only larger increase was measured after 96 h at 1.5 µg/l DM concentration (P<0.05). The catalase activity in the liver of treated carp remained practically at the same level compared to that in control fish.All these changes (concerning the primary effects of this compound) demonstrate the effect of DM on different fish enzymes, at low concentrations under laboratory conditions, which might be useful in practice for biomonitoring using fish.

Changes in thyroid hormones and serum lipids of aged women following thyroidectomy.

Thyrotropin (TSH), thyroxine (T24) 3,5,3403 triiodothyronine (T23), serum lipid levels and ECG findings in females who underwent thyroidectomy 2-44 years earlier, were compared to those of similar controls with intact thyroid. Pathological ECG is more frequent in thyroidectomized persons who also exhibit higher thyrotropin and lower HDL-cholesterol levels. The results indicate that thyroidectomized state should be regarded and controlled as a possible condition of subclinical hypothyreosis, being a risk factor of cardiovascular diseases.

Economic losses caused by paratuberculosis in a dairy herd: case report.

The impact of clinical paratuberculosis in a 500 cow Jersey x Holstein dairy herd of loose housing system was followed up for three years. There was an increasing fall in annual milk production, namely 49, 474, and 1030 litres per cow, a decrease in the average age from 63.9 to 57.0 months, and of feed conversion from 60 to 39%. The effect of certain management deficiencies, existing throughout the study, is discussed.

[Endoscopic transpapillary bile duct drainage in malignant obstructive jaundice]. / Endoskopische transpapilläre Gallengangsdrainage bei tumorbedingtem Verschlussikterus.

Endoscopic biliary duct drainage was performed in 54 patients with obstructive jaundice caused by papillary carcinoma (n = 4), periampullar carcinoma (n = 4), carcinoma of head of pancreas (n = 16), primary biliary duct carcinoma (n = 14), biliary bladder carcinoma (n = 14) and hilar lymph node metastases (n = 2) using a bilioduodenal endoprosthesis. Drainage was successful in 45 cases; serum bilirubin decreased rapidly, well-being improved, appetite and weight increased. The average survival time was 4.8 months. The initially high rate of complications, mainly due to cholangitis, with a mortality rate of 9.3% could be reduced drastically after use of a duodenoscope with a 3.7 mm bore instrumentation canal enabling insertion of well-draining wide-lumen endoprostheses. Drainage should only be used in non-resectable tumours, general inoperability or for preoperative relief of biliary ducts in jaundice and prospective curative surgical intervention. As results improve with mounting experience it may be expected that endoscopic biliary duct drainage will replace palliative surgery, especially in elderly patients at risk.

[Endoscopic stomach polypectomy]. / Endoskopische Polypektomie des Magens.

During 33 months in 45 patients 52 times an endoscopic polypectomy was performed in the stomach or in the duodenum. The polyp or the polyposis of the stomach in every case should be clarified with the help of endoscopic polypectomy and histological examination. The histological type of the polyps got in toto determines the therapeutic methods essentially deviating from each other. After a polypectomy a regular gastroscopic control is necessary. The 10% frequency of postoperative bleedings after endoscopic polypectomy may be reduced by improvement of the technique.

[Gastrointestinal bleeding and emergency endoscopy in portal hypertension (author's transl)]. / Gastrointestinale Blutungen und Notfall-Endoskopie bei portaler Hypertension.

Portal hypertension is found in about one quarter of the cases with upper gastrointestinal bleeding. 57 patients with portal hypertension underwent endoscopy for gastrointestinal haemorrhage. Despite visible varices in all cases varice rupture underlies only 50% of the bleeding episodes. Conditions other than rupture were found to bleed in 50%. Superficial mucosal erosions, which escape radiological detection, were the most frequent other bleeding sources.