Neurological Manifestations of Dengue Infection.

Dengue counts among the most commonly encountered arboviral diseases, representing the fastest spreading tropical illness in the world. It is prevalent in 128 countries, and each year >2.5 billion people are at risk of dengue virus infection worldwide. Neurological signs of dengue infection are increasingly reported. In this review, the main neurological complications of dengue virus infection, such as central nervous system (CNS), peripheral nervous system, and ophthalmic complications were discussed according to clinical features, treatment and possible pathogenesis. In addition, neurological complications in children were assessed due to their atypical clinical features. Finally, dengue infection and Japanese encephalitis were compared for pathogenesis and main clinical manifestations.

Arthroscopic single-bundle reconstruction of posterior cruciate ligament with quadrupled hamstring tendon.

OBJECTIVE: To evaluate the technique and outcome of arthroscopic single-bundle reconstruction of posterior cruciate ligament (PCL) with quadrupled hamstring tendon. METHODS: From April 2001 to October 2004, 49 knees with PCL tears in 49 patients were verified with arthroscope in this department. Of them, 13 were combined with anterior cruciate ligament tears, 14 with disruptions of the posterolateral corner, 6 with ruptures of the posteromedial corner and medial collateral ligament, 9 with lateral meniscus tears, 5 with medial meniscus tears and 2 with popliteal vascular tears. All the damaged PCLs were reconstructed with single-bundle of autogenous quadrupled hamstring tendons under arthroscope. Biodegradable interference screws or blunt titanium interference screws were used for direct anatomic fixation of the reconstructed ligament. RESULTS: After operation, no severe complications occurred at early stage in the 49 patients. All of them were followed up for 10-52 months with an average of 22.0 months+/-10.7 months. Lysholm score was remarkably improved from 30-60 (mean: 47.96+/-8.16) preoperatively to 70-95 (mean: 89.08+/-6.10) at the last postoperative follow-up (P less than 0.01). Furthermore, there was a significant improvement in International Knee Documentation Committee (IKDC) score from abnormal (Grade C) in 10 knees and severely abnormal (Grade D) in 39 preoperatively to normal (Grade A) in 20, nearly normal (Grade B) in 24 and abnormal in 5 at the last follow-up. Of the 49 patients, 40 returned to the same activity level as before and 9 were under the level. CONCLUSIONS: Single-bundle reconstruction of PCL with quadrupled hamstring tendons has the advantage of minimal trauma in surgery and satisfactory outcome.

Multiple-ligament injured knee.

OBJECTIVE: To explore the clinical characteristic of the multiple-ligament injured knee and evaluate the protocol, technique and outcome of treatment for the multiple-ligament injured knee. METHODS: From October 2001 to March 2005, 9 knees with combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in 9 patients were identified with clinical and arthroscopic examinations. Of them, 5 knees were combined with ruptures of posteromedial corner (PMC) and medial collateral ligament (MCL), 4 with disruptions of posterolateral corner (PLC), 2 with popliteal vascular injuries and 1 with peroneal nerve injuries. Six patients were hospitalized in acute phase of trauma, 2 received repairs of popliteal artery and 4 had repairs of PMC and MCL. Reconstructions of ACL and PCL with autografts under arthroscope were performed in all patients at 4 to 10 weeks after trauma, including reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in 4 patients and reconstructions of PMC and MCL with femoral fascia in 1 patient. RESULTS: No severe complications occurred at early stage after operation in the 9 patients. All of them were followed-up for 10-39 months with an average of 23.00 months+/-9.46 months. Lysholm score was 70-95 with an average of 85.00+/-8.29. International Knee Documentation Committee (IKDC) score was from severely abnormal (Grade D) in 9 knees at initial examination to normal (Grade A) in 2 knees, nearly normal (Grade B) in 6 knees and abnormal in 1 knee at the last follow-up. Of the 9 patients, 7 returned to the same activity level before injury and 2 were under the level. CONCLUSIONS: The multiple-ligament injured knee with severe instability is usually combined with other important structure damages. Therefore, careful assessment and treatment of the combined injuries are essential. Reconstructions of ACL and PCL under arthroscope, combined with repairs or reconstructions of the extraarticular ligaments simultaneously or in stages, have advantage of minimal trauma in surgery and satisfactory outcome.