The anatomy of the ACL and its importance in ACL reconstruction.

The anterior cruciate ligament (ACL) anatomy is very significant if a reconstruction is attempted after its rupture. An anatomic study should have to address, its biomechanical properties, its kinematics, its position and anatomic correlation and its functional properties. In this review, an attempt is made to summarize the most recent and authoritative tendencies as far as the anatomy of the ACL, and its surgical application in its reconstruction are concerned. Also, it is significant to take into account the anatomy as far as the rehabilitation protocol is concerned. Separate placement in the femoral side is known to give better results from transtibial approach. The medial tibial eminence and the intermeniscal ligament may be used as landmarks to guide the correct tunnel placement in anatomic ACL reconstruction. The anatomic centrum of the ACL femoral footprint is 43 % of the proximal-to-distal length of lateral, femoral intercondylar notch wall and femoral socket radius plus 2.5 mm anterior to the posterior articular margin. Some important factors affecting the surgical outcome of ACL reconstruction include graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing. The rehabilitation protocol should come in phases in order to increase range of motion, muscle strength and leg balance, it should protect the graft and weightbearing should come in stages. The cornerstones of such a protocol remain bracing, controlling edema, pain and range of motion. This should be useful and valuable information in achieving full range of motion and stability of the knee postoperatively. In the end, all these advancements will contribute to better patient outcome. Recommendations point toward further experimental work with in vivo and in vitro studies, in order to assist in the development of new surgical procedures that could possibly replicate more closely the natural ACL anatomy and prevent future knee pathology.

Reirradiation of recurrent head and neck cancer using high-dose-rate brachytherapy.

The aim of the present study was to evaluate the results of hypofractionated accelerated CT-guided interstitial HDR-BRT using 2.5 Gy per fraction. From December 2008 to March 2010, 30 patients were treated for recurrence of previously-irradiated head and neck cancer. Thirteen patients underwent surgical resection followed by HDR-BRT to the tumour bed. Seventeen patients were treated with HDR-BRT only. All patients received 2.5 Gy twice per day for a total dosage of 30 Gy. The overall survival rate (OS) for the entire group at 1 and 2-years was 63% and 47%, while local control (LC) was 73% and 67%, and disease-free survival (DFS) was 60% and 53%, respectively. Patients treated with surgical resection and HDR-BRT showed an improvement in both 2-year LC (77% vs. 47%, p = 0.013) and 2-year OS (62% vs. 35%, p = 0.035) compared to patients treated with HDR-BRT only. Median OS for pre-treatment tumour volumes ≤ 36 cm3 was 22 months and 9.2 months for those > 36 cm3 (p = 0.038). Grade III and IV late complications occurred in 3% of patients. There were no grade V complications. The interstitial HDR brachytherapy regimen using 2.5 Gy twice daily fractions at a total dose of 30 Gy offers an effective treatment option for patients with recurrent previously-irradiated head and neck cancer with a low rate of late high grade toxicity. Surgical resection had a positive effect on survival and local control in management of patients with recurrent head and neck cancer.

Using the patient's questionnaire data to screen laryngeal disorders.

This paper is concerned with soft computing techniques for screening laryngeal disorders based on patient's questionnaire data. By applying the genetic search, the most important questionnaire statements are determined and a support vector machine (SVM) classifier is designed for categorizing the questionnaire data into the healthy, nodular and diffuse classes. To explore the obtained automated decisions, the curvilinear component analysis (CCA) in the space of decisions as well as questionnaire statements is applied. When testing the developed tools on the set of data collected from 180 patients, the classification accuracy of 85.0% was obtained. Bearing in mind the subjective nature of the data, the obtained classification accuracy is rather encouraging. The CCA allows obtaining ordered two-dimensional maps of the data in various spaces and facilitates the exploration of automated decisions provided by the system and determination of relevant groups of patients for various comparisons.

Skeletal growth factor involvement in the regulation of fracture healing process.

Skeletal growth factors are peptides that serve as signalling agents for living cells, thereby participating in the autocrine, paracrine, intracrine and endocrine bioregulation of tissues and organs in human physiology. Growth factors elicit their cellular actions after binding to specific receptors, which are large transmembrane proteins located on target cells. These receptors relay signals via specific intracellular signal transduction pathways capable of regulating gene transcription, thereby modifying cell proliferation, cell function, cell differentiation and apoptosis. Notably, growth factors and their specific receptors are expressed in and around a bone fracture repair site, suggesting strongly that they play a significant role in the physio/pathology of fracture healing. Conceivably, fine adjustments of specific growth factor activity during the different stages of the fracture healing process can serve as potential therapeutic targets, enhancing bone repair capacity and reducing irregularities of the healing process.

Wound infections after minor limb lacerations: risk factors and the role of antimicrobial agents.

BACKGROUND: The requirement for antimicrobial agents in patients with minor limb lacerations was prospectively studied. METHODS: The development of wound infections in patients with minor limb lacerations who received amoxicillin plus clavulanate acid treatment (group A, 52 patients) was studied and compared with patients who did not (group B, 48 patients). RESULTS: Wound infection occurred in 6 (11.5%) and 10 (21%) patients in groups A and B, respectively (p>0.10). Statistically significant risk factors for the development of infection were diabetes mellitus (odds ratio [OR], 15.8; p<0.001), lower limb lacerations (OR, 33.5; p<0.001), lacerations caused by compressive forces (OR, 21.6; p = 0.007), laceration length from 5 to 8 cm (OR, 7.04; p = 0.001), ragged laceration edge (OR, 2.55; p = 0.049), and skin tension (OR, 2.00; p = 0.006). CONCLUSION: The use of antimicrobial agents in minor limb injuries was not associated with a significant reduction of infection rate. Routine antimicrobial treatment is discouraged.