Mepolizumab improves sense of smell in severe chronic rhinosinusitis with nasal polyps: SYNAPSE.

BACKGROUND: Loss of smell is one of the most bothersome and difficult-to-treat symptoms in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP). METHODOLOGY: SYNAPSE was a 52-week Phase III study of 4-weekly mepolizumab (100 mg subcutaneously) plus standard of care in adults with severe bilateral CRSwNP. This post hoc analysis assessed changes from baseline to study end in loss of smell visual analogue scale (VAS) symptom score, in patients stratified by several baseline clinical characteristics. SinoNasal Outcomes Test (SNOT)-22 sense of smell/taste item and University of Pennsylvania Smell Identification Test (UPSIT) scores were also assessed. RESULTS: SYNAPSE enrolled 407 patients (mepolizumab=206; placebo=201) with impaired sense of smell at baseline. Improvements from baseline to study end in loss of smell VAS score were greater with mepolizumab versus placebo (treatment difference: -0.37) and most notable in patients with fewer or more recent prior surgeries (treatment difference: 1 vs 2 vs more than 2 prior surgeries,-1.29 vs -0.23 vs -0.07; =3 years since last surgery, -.89 vs 0.22). Approximately 25% of patients had baseline UPSIT scoresavailable; among those scoring =19 by study end. The SNOT-22 sense of smell/taste item score improved with mepolizumab versus placebo. CONCLUSIONS: Mepolizumab treatment improved patients' perceived sense of smell, as measured by loss of smell VAS score and SNOT-22 sense of smell/taste item score in patients with severe refractory CRSwNP.

Anterolateral ligament of the knee-Cadaver study in a Caucasian population / Ligamento anterolateral de la rodilla. Estudio en cadáver en una población caucásica

Introduction: Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships. Materials and methods: The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured. Results: The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from de tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament. Conclusions: The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.(AU)

Introducción: Aunque ha sido reconocida la importancia del ligamento anterolateral (ALL) en la estabilidad rotacional de la rodilla, algunos estudios siguen negando su existencia. Estudiamos la prevalencia del ALL en una población caucásica, así como sus características y relaciones anatómicas. Métodos: El estudio se realizó en 20 rodillas de 10 cadáveres embalsamados. Se utilizó un abordaje lateral, como lo describe Steven Claes, y se registraron las relaciones del ALL con el epicóndilo lateral, la arteria genicular inferior lateral, el menisco lateral, el tubérculo de Gerdy y la cabeza del peroné. También se midió el ancho y el largo. Resultados: El ALL fue identificado en 16 rodillas. Su origen estaba a una distancia inferior a 1mm posterior y proximal al epicóndilo femoral lateral y su inserción a una distancia media de 2,1±0,6mm de la superficie articular tibial, 20,6±1,3mm de la tuberosidad de Gerdy y 20,3±1,2mm de la cabeza del peroné. En todos los casos se presentaban fibras mutuas con el menisco lateral. El largo fue de 35,8±4,6mm y el ancho fue de 4,2±1,3/4,9±1,0/6,5±1,5mm en su tercio proximal, medio y distal. Conclusiones: El ALL se encontró en el 80% de las rodillas. Su origen está íntimamente relacionado con el ligamento colateral lateral y su inserción se encuentra a media distancia entre la cabeza del peroné y el tubérculo de Gerdy. En todos los casos comprobamos la conexión entre el ALL y el menisco lateral.(AU)

[Artículo traducido] Ligamento anterolateral de la rodilla. Estudio en cadáver en una población caucásica / Anterolateral ligament of the knee-Cadaver study in a Caucasian population

Introduction: Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships. Materials and methods: The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured. Results: The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from de tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament. Conclusions: The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.(AU)

Introducción: Aunque ha sido reconocida la importancia del ligamento anterolateral (ALL) en la estabilidad rotacional de la rodilla, algunos estudios siguen negando su existencia. Estudiamos la prevalencia del ALL en una población caucásica, así como sus características y relaciones anatómicas. Métodos: El estudio se realizó en 20 rodillas de 10 cadáveres embalsamados. Se utilizó un abordaje lateral, como lo describe Steven Claes, y se registraron las relaciones del ALL con el epicóndilo lateral, la arteria genicular inferior lateral, el menisco lateral, el tubérculo de Gerdy y la cabeza del peroné. También se midió el ancho y el largo. Resultados: El ALL fue identificado en 16 rodillas. Su origen estaba a una distancia inferior a 1mm posterior y proximal al epicóndilo femoral lateral y su inserción a una distancia media de 2,1±0,6mm de la superficie articular tibial, 20,6±1,3mm de la tuberosidad de Gerdy y 20,3±1,2mm de la cabeza del peroné. En todos los casos se presentaban fibras mutuas con el menisco lateral. El largo fue de 35,8±4,6mm y el ancho fue de 4,2±1,3/4,9±1,0/6,5±1,5mm en su tercio proximal, medio y distal. Conclusiones: El ALL se encontró en el 80% de las rodillas. Su origen está íntimamente relacionado con el ligamento colateral lateral y su inserción se encuentra a media distancia entre la cabeza del peroné y el tubérculo de Gerdy. En todos los casos comprobamos la conexión entre el ALL y el menisco lateral.(AU)

Anterolateral ligament of the knee-Cadaver study in a Caucasian population.

INTRODUCTION: Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships. MATERIALS AND METHODS: The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured. RESULTS: The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from de tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament. CONCLUSIONS: The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.

Anterolateral ligament of the knee-Cadaver study in a Caucasian population. / [Artículo traducido] Ligamento anterolateral de la rodilla. Estudio en cadáver en una población caucásica.

INTRODUCTION: Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships. MATERIALS AND METHODS: The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured. RESULTS: The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from the tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament. CONCLUSIONS: The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.

Anatomy of the superficial peroneal nerve: Can we predict nerve location and minimize iatrogenic lesion?

OBJECTIVE OF THE STUDY: Knowledge of anatomical variations of the superficial peroneal nerve (SPN) may minimize iatrogenic insults. The aim of the investigation was to perform an anatomical description of the SPN. MATERIALS AND METHODS: Twenty-three embalmed cadaver lower limbs were dissected. RESULTS: The SPN emerged from the crural fascia about 6.3±7.7mm anteromedial to the anterior border of the fibula and 26.8±12.6mm anteromedial and 113.6±43.9mm superior to the tip of the lateral malleolus. The median point of bifurcation into two terminal branches was 13.0mm anteromedial to the anterior border of the fibula and 34.9±14.7mm anteromedial and 81.0±69.0mm superior to the tip of the lateral malleolus. The SPN was found between 5.76% and 7.70% of the individual's height proximal to the tip of the lateral malleolus, with an unpredictable branching pattern over the intermalleolar line. CONCLUSION: A lateral ankle approach over the posterolateral surface of the fibula (posterior to the tip of the lateral malleolus) minimizes the risk of iatrogenic nerve lesion.