Antidiabetic activity of Musa x paradisiaca extracts in streptozotocin-induced diabetic rats and chemical characterization by HPLC-DAD-MS.

ETHNOPHARMACOLOGICAL RELEVANCE: The Musa x paradisiaca L. inflorescence, known as banana blossom or banana heart, is used in traditional medicine for the treatment of diabetes mellitus. AIM OF THE STUDY: The aim of the study was to investigate the antidiabetic activity of aqueous extracts and fractions prepared from the bracts and flowers of Musa x paradisiaca in streptozotocin (STZ)-induced diabetic rats and to chemically characterize the extracts. MATERIALS AND METHODS: Standard aqueous extracts of the flowers, bracts, and their fractions were prepared and their chemical composition was determined tentatively by high-performance liquid chromatography coupled to diode-array detection and mass spectrometry (HPLC-DAD-MS). Changes in fasting glycemia and oral glucose tolerance were evaluated in STZ-induced diabetic rats (n = 8) treated with aqueous extracts of Musa x paradisiaca (200 mg/kg) for 20 days. RESULTS: Chemical analyses detected 21 compounds and 17 metabolites were identified, among which were glycosylated and acetylated phenylpropanoids of p-coumaric acid and caffeic acid, as well as a glycosylated flavonol and anthocyanins. Following 15 days of treatment, the bract aqueous extracts and the methanolic fraction of the flower had significant effects on the glycemic profile after glucose load in diabetic rats as compared with the untreated diabetic group. CONCLUSIONS: The results of the present study show the antidiabetic potential of extracts of the flowers and bracts of M. x paradisiaca.

The effect of a tourniquet on intraoperative patellofemoral tracking during total knee arthroplasty.

A prospective investigation was performed on the effect of the tourniquet on intraoperative patellofemoral tracking during primary total knee arthroplasty (TKA). A total of 75 TKAs in 67 patients were performed by 1 surgeon in a consecutive series using the same technique. Using strict criteria, patellar tracking was assessed both before and after tourniquet release. Patients were placed into 1 of 3 groups: Group I were knees that tracked properly both before and after tourniquet release. Group II were knees that maltracked with the tourniquet inflated and subsequently corrected with the tourniquet released. Group III were knees that maltracked both before and after tourniquet release, therefore requiring a lateral release. Knees were categorized as group I, 34 of 75 (45.3%); group II, 36 of 75 (48.0%); and group III, 5 of 75 (6.7%). Using this criterion, lateral release was avoided in all group II knees. Tourniquet application alters intraoperative patellofemoral tracking during TKA. When contemplating lateral release, tourniquet deflation and reevaluation of patellofemoral tracking should be considered.

Early, incapacitating instability of posterior cruciate ligament-retaining total knee arthroplasty.

Numerous studies indicate that total knee arthroplasty (TKA) achieves excellent long-term success whether the posterior cruciate ligament (PCL) is saved or excised. In 13 patients, 16 PCL-retaining TKAs were identified with incapacitating instability secondary to early PCL deficiency. Patients with clinical PCL insufficiency present with a triad of subjective complaints: persistent swelling/effusions, anterior knee pain, and giving-way or instability episodes with activities of daily living. Of 13 patients, 12 had at least three postoperative visits with identical subjective complaints before PCL deficiency was diagnosed. On examination all patients exhibited effusion, posterior sag, positive quadriceps active test, and a visible anterior translation of the tibia on the femur while extending the leg from a seated, 90 degree flexed position. This sign has not been previously described to our knowledge but was present in all of our study patients. No patients had radiographic evidence of loosening or osteolysis. Joint aspiration was negative for infection in all patients. No patient had lateral patellofemoral maltracking. By radiographic measurement, the PCL-deficient knees had an average joint line elevation of 10.3 mm, compared with well-functioning TKAs which had an average joint line elevation of 5.0 mm. There was no correlation of PCL deficiency with excessive proximal tibial resection. Nonsurgical intervention provided no improvement in pain or instability. Six patients had improvement of pain, effusion, and stability after revision to a cruciate-substituting implant. We believe that this complication occurs more frequently than is currently being identified and should be considered in problem TKAs with normal radiographs.

Acute meniscal injury following successful unicompartmental knee arthroplasty.

The case of an active 53-year-old man with a well-functioning unicompartmental knee arthroplasty who suffered an acute athletic injury to the knee is described. A mechanical problem was diagnosed and he was successfully treated by arthroscopic partial lateral meniscectomy for a displaced meniscal tear. This case points to an important difference noted by history and physical examination between an acute injury to the unreplaced compartment of a knee with a unicompartmental knee arthroplasty and progression of the arthritic process.

Skin surface pressures under short leg casts.

Electronic sensors were used to measure skin surface pressures beneath plaster and fiberglass short leg casts. Pressures were recorded after casting, univalving, bivalving, and spreading of casts. Fiberglass resulted in significantly higher pressures than plaster. Beneficial effects of bivalving and cast spreading are confirmed by significant pressure drops. Application of casts by different orthopaedic surgeons and technologists showed pressure differences due to operator technique. However, fiberglass pressures again proved to be significantly greater than those caused by plaster. Excessive pressure beneath casts can cause skin ulceration, and results confirm the need for extreme care, especially when using fiberglass. It is suggested that plaster is safer than fiberglass when significant extremity swelling is likely or when a patient's skin is more vulnerable to breakdown.