Anterolateral ligament of the knee: myth or reality?

PURPOSE: A ligament of the knee has recently drawn the attention: the rediscovered anterolateral ligament (ALL) of the knee. The tibial insertion of the ALL is torn off in the Segond fracture, pathognomonic of the anterior cruciate ligament tear. The ALL originates from the lateral femoral epicondyle and has fibers inserting on the lateral meniscus. It attaches distally to the tibial plateau, midway between the tip of the fibular head and Gerdy's tubercle. The purpose of this study was to evaluate the visibility of the ALL using routine MRI (1.5T) protocol. MATERIALS AND METHODS: In the first part of our study 10 cadaveric knee joints were examined using MR imaging to evaluate the visibility of the ALL. These cadaveric knees have been dissected to assess the presence of the ALL and to evaluate the accordance between MRI and anatomic dissection. In the second part of the study, 61 knee MRI of patients were examined to evaluate the visibility of the ALL using axial and coronal DP-FS weighted sequences. RESULTS: In all cadaveric knee MRI, the ALL was visualized (full visualization in 75 % and partial visualization in 25 % of the cases), with 100 % accordance between MRI and anatomic dissection. Two cadaveric knees where the ALL was not viewed were excluded of the radio-anatomic analysis. The ALL was visualized in 93.4 % (95 % CI = 84.1-98.2) of the knee MRI studies of the 61 patients included. The whole ligament was visualized in 82 % (95 % CI = 70-90.6) examinations and it was partially visualized in 11.5 % (95 % CI = 4.7-22.2). CONCLUSION: Our results show that the ALL of the knee can be identified using routine 1.5T MR imaging, which suggest that better radiological description of this underestimated anatomical structure may be beneficial in the preoperative planning of ACL tears.

Mucin-producing tumors of the ovary: MR imaging appearance.

Mucin-producing tumors of the ovary can be either primary epithelial mucin-producing tumors or ovarian metastases from a remote adenocarcinoma usually originating from the gastrointestinal tract. The purpose of this pictorial review is to describe the main types of primary or secondary mucin-producing tumors of the ovary and to provide MR imaging diagnostic criteria in order to guide further therapy.

Evaluating new hypodermic and intradermal injection devices.

The wicking spear gravimetric method was selected as the easier and the most consistent method for fluid leakage collection. The kit uses the glass sample collection tube to store the wicking spears before and after fluid leakage collection. It has been shown to provide reliable equipment for wicking spear intermediate storage and shipment to central laboratories for weight/mass measurements. Weighting the collection tubes with wicking spear inside, in a central laboratory in a batch fashion, before and after fluid collection, contributes to minimising operator and balance errors on method accuracy. The volume detection threshold is below 2 microL and the measurement error, even after 12 days of storage at room temperature, is below 1 microL, which is considered not to be clinically relevant.

Improving needle-point sharpness in prefillable syringes.

Improvement of needle-point sharpness and improved injection comfort for patients remain active areas of research. This article reports on a five-bevel needle for subcutaneous administration with a prefillable syringe, and the results of a clinical trial to verify and validate the bench measure of sharpness.

Pulmonary function and pain after gastroplasty performed via laparotomy or laparoscopy in morbidly obese patients.

We have compared severely obese patients (body mass index > 35 kg m-2) undergoing laparoscopic or open gastroplasty (n = 15 in each group) to determine if laparoscopy results in any benefit in the obese. Postoperative pain, measured on a 100-mm visual analogue scale, and opioid consumption were recorded during the first two days after operation. Tests of pulmonary function were performed and SpO2 was measured 4 h after surgery and on days 1, 2 and 3 after operation. Pain at rest was similar in the two groups, but in the laparoscopy group, requirements for postoperative opioid were 50% less (P < 0.05). Pain intensity during mobilization and on coughing was significantly less after laparoscopy (differences between mean pain scores in both groups ranged from 20 to 32 mm during mobilization and from 32 to 34 mm during coughing). Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were reduced significantly less after laparoscopic gastroplasty than after open gastroplasty (on day 1 forced vital capacity was reduced by 50% compared with 64%, forced expiratory volume in 1 s was reduced by 50% compared with 66% and peak expiratory flow rate by 45% compared with 60%). SpO2 values were significantly greater in the laparoscopy group (day 1: mean 95 (SD 2)% vs 91 (5)%; day 3: 97 (1)% vs 94 (3)%). This study suggests that the beneficial effects observed after laparoscopic gastroplasty in morbidly obese patients were similar to those reported after laparoscopic cholecystectomy in non-obese patients.

Asthma and neuropeptides.

Non-adrenergic non-cholinergic nerves, first described in the gut, were identified in the lung about twenty years ago. These fibers constitute in the airways an extensive network of nerve endings containing a great amount of neuropeptides which can influence bronchi smooth muscle tone and control airway calibre. These mediators can also modulate immune function and cellular responses characteristic of inflammation in the bronchi. It is obvious that they can play an important role in asthma, and it is likely that a better understanding of the mechanisms of action of these substances will lead to new treatments in asthma.

Prolonged increase of corticosterone secretion by chronic social stress does not necessarily impair immune functions.

The influence of a chronic social stress upon immunity was investigated in Wistar rats, submitted for four weeks to two different behavioral situations, balanced in a factorial design: housing with three females and membership rotation. The combination of these two factor led to adrenal enlargement (43.3%), thymus involution (39.5%) and increased basal corticosterone levels, all indices of activation of the hypothalamic-hypophysis-adrenal axis. However, neither natural killer cell activity, splenocyte reactivity to mitogen nor the rate of spontaneous development of antibodies against Mycoplasma pulmonis, a common pathogen of the respiratory tract, were changed in the endocrine activated animals. Analysis of the data on kinetics of stress at 1, 7 and 28 days after the initial mixing of the animals gave the same results. These data question the immunosuppressant activity usually conferred to corticosteroids, at least when adrenal hyperactivity is induced by chronic environmental stressors.

[Induction and regulation of the systemic inflammatory reaction]. / Induction et régulation de la réaction inflammatoire systémique.

The clinical and biological markers of the systemic inflammatory response are reviewed with a special emphasize on acute phase response. Stress and its neuro-endocrine consequences, metabolic changes and hepatic response are particularly detailed. The outcome of systemic inflammatory response is the net result of multiple factors since some agents produce a pro-inflammatory effect and others exert a natural anti-inflammatory influence. Neuro-endocrine involvement, metabolic and hepatic response provide the most effective physiological anti-inflammatory agents.