¿Qué nos dicen los primates neotropicales bajo la mirada de la citogenética? / What do neotropical primates tell us under the look of cytogenetics?

RESUMEN Los estudios de citogenética en Primates Neotropicales (Primates: Platyrrhini) han demostrado que estos mamíferos comprenden un grupo heterogéneo a nivel cromosómico. La notable variedad de cariotipos descriptos provee evidencia significativa sobre el posible papel de los reordenamientos cromosómicos en su evolución. En el Grupo de Investigación en Biología Evolutiva (GIBE), la línea de investigación sobre el proceso de divergencia evolutiva en Platyrrhini considerando distintos aspectos de la organización del genoma se ha establecido y desarrollado de manera ininterrumpida desde hace más de 30 años. Entre los avances realizados en los últimos años se encuentra la cuantificación del tamaño del genoma en seis especies de monos caí (Cebus sp.) y dos especies de monos aulladores (Alouatta sp.) y la descripción de la composición de pares de bases en las regiones de heterocromatina constitutiva en los géneros Cebus y Ateles. Se concretaron las primeras descripciones del cariotipo y comportamiento meiótico en profase I temprana de dos especies de monos aulladores, Alouatta caraya y A. guariba clamitans. En esta última especie se identificó el primer sistema sexual de tipo pentavalente X1X2X3Y1Y2 en una especie de primate. Se caracterizó la organización de la eucromatina en términos del contenido y distribución de bases nucleotídicas AT y GC en tres especies de aulladores y en dos especies de monos caí. Estas investigaciones, entre otras, permitieron contribuir de forma original al conocimiento sobre la especiación en distintos niveles, así como sobre la arquitectura y dinámica del genoma de estos primates.

ABSTRACT Cytogenetics studies in Neotropical Primates (Primates: Platyrrhini) have shown that these mammals comprise a heterogeneous group at the chromosomal level. The remarkable variety of karyotypes described provides significant evidence on the possible role of chromosomal rearrangements in their evolution. In the Grupo de Investigación en Biología Evolutiva (GIBE), the line of research on the evolutionary divergence process in Platyrrhini considering different aspects of the organization of the genome has been established and developed uninterruptedly for more than 30 years. Among the advances made in recent years is the quantification of the genome size in six species of caí monkeys (Cebus sp.) and two species of howler monkeys (Alouatta sp.) and the description of the composition of base pairs in the constitutive heterochromatin regions in the genera Cebus and Ateles. The first descriptions were made of the karyotype and meiotic behavior in early prophase I of two species of howler monkeys, Alouatta caraya and A. guariba clamitans. In this last species, the first pentavalent-type sexual system X1X2X3Y1Y2 was identified in a primate species. The organization of euchromatin was characterized in terms of the content and distribution of AT and GC nucleotide bases in three species of howlers and in two species of caí monkeys. These, among other investigations, allowed contributing in an original way to the knowledge about speciation at different levels, as well as about the architecture and dynamics of the genome of these primates.

Radio emission from the unbound debris of tidal disruption events.

When a star gets too close to a supermassive black hole, it is torn apart by the tidal forces. Roughly half of the stellar mass becomes unbound and flies away at tremendous velocities - around 104 km s-1. In this work, we explore the idea that the shock produced by the interaction of the unbound debris with the ambient medium gives rise to the synchrotron radio emission observed in several tidal disruption event (TDE). We use a moving mesh numerical simulation to study the evolution of the unbound debris and the bow shock around it. We find that as the periapse distance of the star decreases, the outflow becomes faster and wider. A TDE whose periapse distance is a factor of 7 smaller than the tidal radius can account for the radio emission observed in ASASSN-14li. This model also allows us to obtain a more accurate estimate for the gas density around the centre of the host galaxy of ASASSN-14li.

Surgical site infection in elderly patients with hip fractures, silver-coated versus regular dressings: a randomised prospective trial.

OBJECTIVE: Surgical site infection (SSI) after hip fracture surgery is a well-known complication with serious consequences for both the patient and the medical system. Silver ion treatment is considered an effective antibacterial agent, however, the use of silver dressing (SD) in the primary prevention of SSIs is controversial. The aims of this study were to compare SD with regular dressing (RD) in the prevention of SSI in elderly patients undergoing surgery for hip fractures, and to compare costs. METHOD: A matched group of 55 patients with hip fractures undergoing surgery with dynamic hip screw, cephalomedullary nail or hemiarthroplasty were randomised to either SD or RD groups. The dressings were applied in the operating theatre, and the patients were followed for one week for clinical signs of infection (discharge, erythema and fever). The RDs were replaced daily. The SDs were not removed for 5-7 days and kept moist. Skin swabs were taken from the wound surface on postoperative day 5-7 for bacterial skin colonisation. RESULTS: The SD (n=31) and RD (n=24) groups were similar in age, sex and comorbidities. Infection signs were seen in two (2/31, 6.4%) of the SD patients compared with 2 (2/24, 8.3%) RD patients (p=1.0). Skin colonisation by bacteria at postoperative day 5-7 was tested in 27 patients: it was higher in the SD group (positive skin swab, 12/19, 63.2%) compared to the RD group (4/8, 50%, p=0.67). The use of SD added ~US$5 (UK ~£3.19) per patient. CONCLUSION: The use of SD was associated with higher costs than RD, but not superior in preventing SSIs in elderly patients undergoing hemiarthroplasty or fixation of hip fractures. SD was also not effective in reducing bacterial skin colonisation following hip fracture and surgery.

The role of K2p channels in anaesthesia and sleep.

Tandem two-pore potassium channels (K2Ps) have widespread expression in the central nervous system and periphery where they contribute to background membrane conductance. Some general anaesthetics promote the opening of some of these channels, enhancing potassium currents and thus producing a reduction in neuronal excitability that contributes to the transition to unconsciousness. Similarly, these channels may be recruited during the normal sleep-wake cycle as downstream effectors of wake-promoting neurotransmitters such as noradrenaline, histamine and acetylcholine. These transmitters promote K2P channel closure and thus an increase in neuronal excitability. Our understanding of the roles of these channels in sleep and anaesthesia has been largely informed by the study of mouse K2P knockout lines and what is currently predicted by in vitro electrophysiology and channel structure and gating.

Tibial rotational osteotomy and distal tuberosity transfer for patella subluxation secondary to excessive external tibial torsion: surgical technique and clinical outcome.

PURPOSE: Recurrent patella subluxation may be secondary to excessive external tibial torsion. The purpose of this study is to evaluate the clinical and radiographic outcome of patients undergoing tibial derotation osteotomy and tibial tuberosity transfer for recurrent patella subluxation in association with excessive external tibial torsion. METHODS: A combined tibial derotation osteotomy and tibial tuberosity transfer was performed in 15 knees (12 patients) with recurrent patella subluxation secondary to excessive external tibial torsion. Clinical evaluation was carried out using preoperative and post-operative Knee Society Score (KSS), Kujala Patellofemoral score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, the short form-12 (SF-12) and a visual analogue score (VAS) pain scale. RESULTS: The median follow-up period was 84 months (range 15-156) and median patient age was 34 years (range 19-57 years). The median preoperative external tibial torsion was 62° (range 55°-70°), with a median rotational correction of 36° (range 30°-45°) after surgery. Significant improvement (p < 0.05) was found in the KSS part I (37 ± 14 to 89 ± 11 points), KSS part II (25 ± 26 to 85 ± 14 points), Kujala score, the SF-12 outcome, WOMAC score and VAS score (8.8 ± 1.9 to 2.4 ± 1.5). Two patients had a nonunion of the tibial osteotomy site; one patient required bone grafting, while another patient required revision to total knee arthroplasty. CONCLUSION: Patients presenting with recurrent patella subluxation secondary to excessive external tibial torsion >45° who underwent tibial derotation osteotomy and tibial tuberosity transfer achieved a satisfactory outcome in terms of pain relief and improved function. A significant complication was seen in 2/15 patients. LEVEL OF EVIDENCE: Case series, Level IV.

Meat quality and sensory attributes of a conventional and a Label Rouge-type broiler strain obtained at retail.

Some consumers have reported preferences for meat from alternative broiler strains as compared with meat from conventional broiler strains relative to taste and texture, but relatively few objective measurements have been conducted on these particular strains. To directly compare meat quality from a Label Rouge-type alternative and a conventional broiler strain available at retail, 4 ready-to-cook conventional and 6 alternative strain carcasses were obtained from retail or a processing plant on each of 6 d. Boneless skinless breast fillets and boneless thighs were taken from each carcass and weighed. Raw meat was then assigned to different testing lots for cooking to evaluate yield, objective texture, meat color, sensory profile, and proximate composition (percentage protein, moisture, fat, and ash). Analyses of data revealed no significant difference (P < 0.05) due to broiler strain for percentage protein, moisture, fat, and ash, for either breast or thigh meat. Conventional breast (raw and cooked) weights were significantly higher than the alternative strain, but there was no difference in cooked yield. There were no differences between strain for thigh weights or yield. Both thigh and breast meat from the conventional broilers was more tender than meat from alternative broilers. Cooked conventional breast meat was darker and yellower, whereas cooked thigh was lighter, less red, and more yellow than alternative meat. Sensory analysis found no difference between strains for breast meat attributes. Conventional thigh meat scored higher than alternative for appearance, tenderness, juiciness, and how well the panelist liked the appearance, but there was no difference in aftertaste or overall liking. Although minimal differences were observed for cooked breast meat due to strain, conventional cooked thigh meat scored higher than the thigh meat from the Label Rouge-type alternative for most of the sensory attributes.

Chromosome painting in two genera of South American monkeys: species identification, conservation, and management.

Cytogenetic studies showed that a number of New World primate taxa, particularly the genera Alouatta, Aotus, and Callicebus, have highly derived karyotypes. Cytogenetics in these primates, at every level of analysis, has contributed to the recognition of species and revealed that their number was certainly underestimated by researchers relying solely on traditional morphological data. Further attention was drawn to Alouatta and Aotus because they are characterized by translocations of the Y chromosome to autosomes, generating multiple sex chromosome systems. Here we present a report on the hybridization of human chromosome-specific paints on metaphases from 4 individuals originally assigned to Alouatta caraya and 1 individual of Aotuslemurinus. This is only the third karyotype studied with chromosome painting out of more than 10 known karyomorphs in Aotus. The banded chromosomes matched those of karyotype II as defined by Ma et al. [1976a], and we were able to more precisely assign the origin of the sample to A. l. griseimembra. Our results on the Argentinean Alouatta caraya samples were generally comparable to the banding and hybridization pattern of previous studies of A. caraya including the presence of an X(1)X(1)X(2)X(2)/X(1)X(2)Y(1)Y(2) sex chromosome system. The karyotype of the Brazilian Alouatta sample labeled as A. caraya differs from the 3 Argentinean samples by at least 10 chromosome rearrangements. The diploid number, G banding, and hybridization pattern of this female cell line was almost identical to previous painting results on Alouatta guariba guariba. Therefore we must conclude that this cell line is actually from an A. guariba guariba individual. The contribution of cytogenetic tools in identifying species or in this case assigning individuals or cell lines to their precise taxonomic allocation is stressed. Gathering further molecular cytogenetic data on New World primates should be conservation and management priorities.

The effect of substrate composition and storage time on urine specific gravity in dogs.

OBJECTIVES: The purpose of this study is to evaluate the effects of substrate composition and storage time on urine specific gravity in dogs. METHODS: A descriptive cohort study of 15 dogs. The urine specific gravity of free catch urine samples was analysed during a 5-hour time period using three separate storage methods; a closed syringe, a diaper pad and non-absorbable cat litter. RESULTS: The urine specific gravity increased over time in all three substrates. The syringe sample had the least change from baseline and the diaper sample had the greatest change from baseline. The urine specific gravity for the litter and diaper samples had a statistically significant increase from the 1-hour to the 5-hour time point. CLINICAL SIGNIFICANCE: The urine specific gravity from canine urine stored either on a diaper or in a non-absorbable litter increased over time. Although the change was found to be statistically significant over the 5-hour study period it is unlikely to be clinically significant.

The karyotype of Alouattapigra (Primates: Platyrrhini): mitotic and meiotic analyses.

We describe for the first time the karyotype of the black howler monkey, Alouatta pigra. Conventional staining, G- and C-banding, and fluorescence in situ hybridization (FISH) with a peptide nucleic acid (PNA) pantelomeric probe were performed. Eight free ranging adult individuals, four males and four females, within the natural distribution of the species presented a diploid karyotype with 2n = 58. Mitotic analyses showed an autosomal complement composed of 6 submetacentric, 3 metacentric, and 19 acrocentric chromosome pairs for females, and 6 submetacentric, 3 metacentric, and 18 acrocentric pairs for males. Meiotic analyses in males revealed 27 autosomal bivalents and a quadrivalent composed of a submetacentric X(1) and acrocentric X(2), Y(1), and Y(2). The G-banded karyotype allowed us to identify pair #17 as the autosomal pair involved in the rearrangement and the morphology of the quadrivalent components. C-banding technique in metaphase I corroborated the structure of the quadrivalent showing four C+ centromeres. FISH analysis showed telomeric signals at the terminal regions of all chromosomes. No interstitial signals were detected. DNA sequence data were in accordance with those previously published for this species.

Grading evidence and recommendations for clinical practice guidelines in nephrology. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO).

Considerable variation in grading systems used to rate the strength of guideline recommendations and the quality of the supporting evidence in Nephrology highlights the need for a uniform, internationally accepted, rigorous system. In 2004, Kidney Disease: Improving Global Outcomes (KDIGO) commissioned a methods expert group to recommend an approach for grading in future nephrology guidelines. This position statement by KDIGO recommends adopting the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach for the grading of evidence and guidelines on interventions. The GRADE approach appraises systematic reviews of the benefits and harms of an intervention to determine its net health benefit. The system considers the design, quality, and quantity of studies as well as the consistency and directness of findings when grading the quality of evidence. The strength of the recommendation builds on the quality of the evidence and additional considerations including costs. Adaptations of the GRADE approach are presented to address some issues pertinent to the field of nephrology, including (1) the need to extrapolate from studies performed predominantly in patients without kidney disease, and (2) the need to use qualitative summaries of effects when it is not feasible to quantitatively summarize them. Further refinement of the system will be required for grading of evidence on questions other than those related to intervention effects, such as diagnostic accuracy and prognosis.

Typhoid fever in travelers: who should be targeted for prevention?

To clarify indications for typhoid vaccination, we reviewed laboratory-confirmed cases of typhoid fever reported to the United States Centers for Disease Control and Prevention between 1994 and 1999. To estimate the risk of adverse events associated with typhoid vaccination, we reviewed reports to the Vaccine Adverse Event Reporting System for the same period. Acute Salmonella enterica serotype Typhi infection was reported for 1393 patients. Of these patients, recent travel was reported by 1027 (74%), only 36 (4%) of whom reported having received a vaccination. Six countries accounted for 76% of travel-associated cases (India [30%], Pakistan [13%], Mexico [12%], Bangladesh [8%], The Philippines [8%], and Haiti [5%]). For 626 travelers who traveled to a single country, the length of stay was

A comparative roentgenographic analysis of the lumbar spine in male army recruits with and without lower back pain.

AIM: To determine whether there is an association between lumbar spine radiographic findings and reported current and/or past lower back pain (LBP). MATERIALS AND METHODS: Four hundred and sixty-four age-matched (mean age 18 years+/-2 months) consecutive male army recruits were examined. Half of them had a history of episodes of LBP. An orthopaedic evaluation (including radiographs of the lumbar spine) is part of the routine medical examination for all military recruits. Two senior orthopaedic surgeons and one radiologist who performed the morphological measurements assessed the radiographs. RESULTS: We found an increased frequency of right-sided scoliosis, lumbar lordosis, sacral lumbarization, wedge vertebra, bilateral spondylolysis of L5 and/or a sagittal diameter of less than 12 mm among the recruits with LBP. No such association was found with spina bifida, left-sided scoliosis, hemi-lumbarization, sacralization and hemi-sacralization, Schmorl's nodules or mild degenerative changes. CONCLUSION: Given that radiographic screening shows that LBP is more common in those with spinal deformity it may be a reasonable means of predicting which individuals are more likely to develop LBP.

Sequential compression device with thigh-high sleeves supports mean arterial pressure during Caesarean section under spinal anaesthesia.

BACKGROUND: This study investigated the use of a Sequential Compression Device (SCD) with thigh-high sleeves and a preset pressure of 50 mm Hg that recruits blood from the lower limbs intermittently, as a method to prevent spinal hypotension during elective Caesarean section. Possible association of arterial pressure changes with maternal, fetal, haemodynamic, and anaesthetic factors were studied. METHODS: Fifty healthy parturients undergoing elective Caesarean section under spinal anaesthesia were randomly assigned to either SCD (n=25) or control (n=25) groups. A standardized protocol for pre-hydration and anaesthetic technique was followed. Hypotension was defined as a decrease in any mean arterial pressure (MAP) measurement by more than 20% of the baseline MAP. Systolic (SAP), MAP and diastolic (DAP) arterial pressure, pulse pressure (PP), and heart rate (HR) were noted at baseline and every minute after the spinal block until delivery. RESULTS: A greater than 20% decrease in MAP occurred in 52% of patients in the SCD group vs 92% in the control group (P=0.004, odds ratio 0.094, 95% CI 0.018-0.488). There were no significant differences in SAP, DAP, HR, and PP between the groups. CONCLUSION: SCD use in conjunction with vasopressor significantly reduced the incidence of a 20% reduction of MAP.

VF-14 item specific responses in patients undergoing first eye cataract surgery: can the length of the VF-14 be reduced?

AIMS: To report the item specific responses of the VF-14 in a population of patients undergoing cataract surgery in their first eye and to determine whether or not the VF-14 can be reduced without compromising its performance as an index of cataract related visual impairment. METHODS: The item specific responses to the VF-14 were analysed before (771 patients) and 4 months after (552 patients) cataract surgery in one eye to determine if the VF-14 index can be reduced without compromising its performance. Patients studied were selected from a cross sectional longitudinal study of patients undergoing cataract surgery in 72 ophthalmologist's offices located in three metropolitan regions of the United States. RESULTS: Pairwise correlations between items in the VF-14 were all less than 0.6, indicating that no items could be removed solely on the basis of redundancy. 10 items correlated moderately with change in trouble, and 11 correlated moderately with change in satisfaction (r >0.15) at 4 months after cataract extraction. Eleven items demonstrated an effect size >0.4 at 4 months. These 11 items were either important for detecting cataract related functional disability or for quantifying the extent to which cataract impaired function. Additionally, 11 items were needed to detect adequately individuals with functional impairment. Three items (recognising people, cooking, and reading large print) were less responsive to cataract extraction and were more strongly associated with ocular comorbidities. CONCLUSIONS: While previous reports indicate that the VF-14 can be significantly shortened, our analysis only justifies removing three items. While the resulting VF-11 has properties similar to the VF-14, the limited time savings do not justify altering this already validated instrument.

Dynamic pressures on the diabetic foot.

A retrospective study was conducted in order to investigate the relation between increased plantar pressure and ulcers in the diabetic foot and contribute more information on this subject. Maximal plantar pressure (MPP) is reported on various areas of the plantar aspects of the feet in 328 diabetic patients and 75 healthy subjects. An increase in MPP under all plantar areas except for the heels was found to be related with increasing severity of the diabetes symptoms. There was also a significant decrease in the application of high pressures to the heels, the metatarsal heads II-IV and the toes.

Cholera in the United States, 1995-2000: trends at the end of the twentieth century.

To evaluate recent trends in cholera in the United States, surveillance data from all cases of laboratory-confirmed toxigenic Vibrio cholerae O1 and O139 infection reported to the Centers for Disease Control and Prevention between 1995 and 2000 were reviewed. Sixty-one cases of cholera, all caused by V. cholerae O1, were reported. There was 1 death, and 35 (57%) of the patients were hospitalized. Thirty-seven (61%) infections were acquired outside the United States; 14 (23%) were acquired through undercooked seafood consumed in the United States, 2 (3%) were acquired through sliced cantaloupe contaminated by an asymptomatically infected food handler, and no source was identified for 8 (13%) infections. The proportion of travel-associated infections resistant to trimethoprim-sulfamethoxazole, sulfisoxazole, streptomycin, and furazolidone increased from 7 (8%) of 88 in 1990-1994 to 11 (31%) of 35 in 1995-2000. Foreign travel and undercooked seafood continue to account for most US cholera cases. Antimicrobial resistance has increased among V. cholerae O1 strains isolated from ill travelers.

Prevalence and characteristics of individuals with chronic kidney disease in a large health maintenance organization.

This study is designed to estimate the prevalence of and gain further insight into the characteristics of the chronic kidney disease (CKD) population in a large US health maintenance organization (HMO) to better understand the CKD population in the United States overall. Analyses were performed using data from a staff and network model HMO in the southwestern United States with more than 150,000 members per year during 1994 to 1997. The estimated prevalence of CKD in the HMO population varied from 0.4% to 7.1%, depending on the definition of CKD used. Regardless of the definition, CKD was more common in men compared with women and in patients with diabetes mellitus and/or hypertension. Applying the age- and sex-specific prevalence rates in the HMO to the US population in 1990, we estimate there were approximately 9.1 million Americans with at least one elevated sex-specific creatinine (Cr) value and approximately 4.2 million Americans with at least two elevated Cr values separated by 90 days or greater, a more rigorous definition of CKD. From these results, it is apparent that there are a large number of patients in the United States with CKD. Most have not been identified because screening for CKD generally is not performed. Considering the high prevalence of CKD and the high cost and clinical morbidity associated with end-stage renal disease (ESRD), it is clear that CKD is an important public health problem. Early identification of patients with CKD would allow treatment that could slow the progression to ESRD, improve clinical outcomes, and constrain the growth of costs in the ESRD program. The time has come for a structured public and professional educational program to address this serious condition.

Patient outcomes of refractive surgery. The refractive status and vision profile.

PURPOSE: To evaluate the performance of a questionnaire, the Refractive Status and Vision Profile (RSVP), in the assessment of patient outcomes following refractive surgery. SETTING: Patients recruited from 5 refractive surgery practices. METHODS: The RSVP was self-administered by patients before and 2 to 6 months after bilateral refractive surgery. Information on uncorrected visual acuity (UCVA), refractive error, and self-reported satisfaction with vision was also collected. Changes in total RSVP scores and in the scores of RSVP subscales (concern, functioning, driving, symptoms, optical problems, glare, and trouble with corrective lenses) were assessed. The relationship between change in the RSVP and subscale scores was assessed in relation to change in traditional clinical measures. The responsiveness of the RSVP to clinically meaningful changes in patients' vision was measured by calculating its effect size. RESULTS: One hundred seventy-six patients completed baseline and postoperative RSVPs and had bilateral refractive surgery. Postoperatively, 92.0% of patients had a UCVA of 20/40 or better in at least 1 eye. Fifteen percent had some worsening in the total RSVP score, and there was substantial variation in the proportion of patients who had worsening in particular subscale scores, ranging from 7.0% who reported worsening in trouble with corrective lenses to 41.5% who reported worsening in driving. Change in satisfaction with vision following surgery was correlated with change in the overall RSVP and subscale scores but not with change in refractive error. A significant worsening in 3 or more RSVP subscales was independently associated with an almost 6-fold (odds ratio 5.84, 95% confidence interval: 1.88,18.13) likelihood of patient report of dissatisfaction with vision, after adjusting for age, sex, preoperative refractive error, and postoperative UCVA. Low scores (ie, minimal dysfunction) on 2 of the RSVP subscales (physical functioning and optical problems) at baseline were predictive of poor postoperative patient outcomes. The RSVP was very sensitive to the intervention of refractive surgery (effect size of 1.2 to 1.4). CONCLUSIONS: The RSVP was able to detect clinically relevant changes in functional status and quality of life after refractive surgery. Change in the RSVP score was correlated with change in patient report of satisfaction and was predictive of postoperative patient satisfaction. The RSVP provides a valuable new metric to assess outcomes of refractive surgery.

"Floating tibia-talus complex"--an ipsilateral dislocation of the knee and the subtalar joint in an elderly patient: a case report and review of the literature.

Knee dislocation is defined as a radiographically confirmed total loss of the tibiofemoral articulation. This rare injury is believed to be the result of a high-impact trauma. Knee dislocations are classified according the direction of tibial displacement with respect to the femur. Subtalar dislocation is the simultaneous dislocation of the distal articulations of the talus at both the talocalcaneal and talonavicular joints. These injuries are also quite rare and are mostly (80%-85%) classified as medial subtalar dislocations with the calcaneus lying medially, the head of the talus being prominent dorsolaterally and the navicular located medial and dorsal to the talar head. The authors report the case of an elderly patient who suffered ipsilateral anterior dislocation of his left knee and medial subtalar dislocation of his left foot. The authors believe this to be the first presentation in the English literature of an ipsilateral combination of these two injuries on the same limb.