Accelerated BEP for metastatic germ cell tumours: a multicenter phase II trial by the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP).

BACKGROUND: This Australian single-arm, multicenter, phase II trial evaluated feasibility, tolerability and activity of accelerated bleomycin, etoposide and cisplatin (BEP) as first-line chemotherapy for metastatic germ cell tumours. PATIENTS AND METHODS: Patients were planned to receive cisplatin 20 mg/m(2) and etoposide 100 mg/m(2) days 1-5, and pegfilgrastim 6 mg day 6, all repeated every 2 weeks for four cycles (three cycles for good prognosis). Bleomycin was given at 30 000 IU weekly to a total of 12 doses (9 doses for good prognosis). Primary end point was feasibility, defined as the proportion of patients able to complete the etoposide and cisplatin components of BEP and be eligible to receive a fourth cycle of BEP by day 50. RESULTS: Twelve poor, 16 intermediate and 15 good prognosis (n = 43) eligible patients were enrolled. Two patients aged >40 years were ineligible and excluded from analyses. The regimen was feasible in 86%, not feasible in 7% and not assessable in 7% of patients. Most common grade 3/4 adverse events were non-neutropenic infection (16%) and febrile neutropenia (12%). Complete response (CR) to chemotherapy and surgery was achieved in 33% poor-prognosis, 81% intermediate-prognosis and 100% good-prognosis patients. At median follow-up of 27 months (range 6-42), the 2-year progression-free survival was 50% for poor-prognosis, 94% for intermediate-prognosis and 92% for good-prognosis patients. CONCLUSION: Accelerated BEP is feasible and tolerable. Efficacy data appear to be promising. This trial and a similar UK study provide the rationale for a randomised trial comparing accelerated versus standard BEP. Australian New Zealand Clinical Trials Registry Registration number. ACTRN 12607000294459.

Development and validation of the international knee documentation committee subjective knee form.

A committee of international knee experts created the International Knee Documentation Committee Subjective Knee Form, which is a knee-specific, rather than a disease-specific, measure of symptoms, function, and sports activity. The purpose of this study was to evaluate the reliability and validity of the new International Knee Documentation Committee Subjective Knee Form. To provide evidence for reliability and validity, we administered the final version of the form, along with the Short Form-36, to 533 patients with a variety of knee problems. Analyses were performed to determine reliability, validity, and differential item function related to age, sex, and diagnosis. Factor analysis revealed a single dominant component, making it reasonable to combine all questions into a single score. Internal consistency and test-retest reliability were 0.92 and 0.95, respectively. Based on test-retest reliability, the value for a true change in the score was 9.0 points. The International Knee Documentation Committee Subjective Knee Form score was related to concurrent measures of physical function (r = 0.47 to 0.66) but not to emotional function (r = 0.16 to 0.26). Analysis of differential item function indicated that the questions functioned similarly for men versus women, young versus old, and for those with different diagnoses. In conclusion, the International Knee Documentation Committee Subjective Knee Form is a reliable and valid knee-specific measure of symptoms, function, and sports activity that is appropriate for patients with a wide variety of knee problems. Use of this instrument will permit comparisons of outcome across groups with different knee problems.

Kinematic CT of the patellofemoral joint.

OBJECTIVE: The purpose of this study was to determine if kinematic CT can be applied to the patellofemoral joint using current slip-ring CT scanner design in patients with anterior knee pain and thus a suspected patellar tracking disorder. SUBJECTS AND METHODS: Twenty knees in 18 patients with anterior knee pain were evaluated with kinematic CT. A single 10-sec exposure of the patellofemoral joint was obtained during active flexion and extension. Static nonkinematic and loaded kinematic examinations were compared with unloaded kinematic studies in a subset of patients. The changes in lateral patellofemoral angle and lateral shift were measured. Video cine viewing of patellofemoral motion was used to subjectively grade image quality and patellofemoral abnormalities by consensus. RESULTS: Kinematic CT was successfully used in all 20 knees. In nine knees studied with static nonkinematic and unloaded kinematic images, the lateral patellofemoral angle improved an average of 4" on the kinematic images. In addition, lateral shift improved by an average of 3%, an improvement that was statistically significant (p = .01). In 10 knees studied with and without loading, the lateral patellofemoral angle decreased an average of 3% with loading. No significant change was seen in lateral shift. In all patients, cine viewing was thought to be more useful than single images. Cine viewing was of good or diagnostic quality in all 20 knees studied. Lateral patellar translation during extension was detected in eight of 20 kinematic studies. Lateral patellar tilting also was detected in eight of 20 kinematic studies. Narrowing of the articular space was detected in 12 of 20 knees. Six knees were determined to be normal. CONCLUSION: Kinematic CT with slip-ring technology is a new technique that can be easily performed on the patellofemoral joint. This technique shows promise as a tool for determining the cause of anterior knee pain.

The effects of donor age and strain rate on the biomechanical properties of bone-patellar tendon-bone allografts.

Over 50% of all knee injuries involve partial or complete tear of the anterior cruciate ligament. Surgical reconstruction of this ligament using an isometrically placed bone-patellar tendon-bone autograft is the current technique of choice; however, harvest of patellar tendon as a free graft can lead to increased morbidity. To address this issue, allogenic patellar tendon grafts have been introduced as alternatives to autogenic graft material. The purpose of this study was to examine effects of age and strain rate on tensile strength, modulus, and failure mode of bone-patellar tendon-bone allografts from a typical population of tissue donors. Eighty-two, fresh-frozen, bone-patellar tendon-bone allografts were harvested from 25 different donors, aged 17 to 54. Paired grafts from individual patellar tendons were assigned randomly to tensile testing at either 10% or 100% elongation per second. Tensile strength, modulus, and failure mode were not significantly different for tests conducted at these 2 strain rates. Correlations between tensile strength and age were not significant for tests conducted at either strain rate. Specimens tested at a strain rate of 100% per second exhibited weak but significant negative correlation between modulus and age, with modulus decreasing 25% over the age range examined.

Rowing and sculling and the older athlete.

Rowing is a strenuous sport that has a significant injury rate among competitive participants. Consequently, older individuals who are anticipating beginning recreational rowing should start with a thorough physical examination by their physician. Because the back and knees are the most frequently injured areas, an orthopedic assessment of these regions is indicated in those individuals who have had previous patellofemoral or low back pain. All prospective rowers should begin with a general conditioning program that addresses lower extremity and abdominal strengthening, flexibility, and aerobic conditioning. A thorough understanding of the proper mechanics of rowing is essential to avoid potential injury. Rowing is a satisfying sport that offers excellent physical exercise and cardiovascular benefits. Older individuals should be encouraged to row, but also should be aware of the variety of injuries this sport may produce.

Three-dimensional dynamic motion analysis of the anterior cruciate ligament deficient knee joint.

Dynamic three-dimensional motion analyses of 15 fresh human knee joints subjected to combinations of flexion velocity and moment, internal and external femoral torque, and horizontal shear before and after sectioning the ACL were performed. ACL deficient specimens demonstrated marked anterior instability without rotational instability. The pivot shift phenomenon occurred with an isolated ACL deficiency and was the result of anterior instability. The pivot shift was accentuated by external femoral torque, decreased by internal femoral torque, and was present in the absence of any applied torque. The pivot shift produced a sudden directional change in the motion of both femoral condyles and may be responsible for the meniscal degeneration that accompanies chronic ACL deficiency.