Are lesions of the posterior cruciate ligament predictable before knee arthroplasty? A histological study of 434 ligaments in osteoarthritic knees.

Despite the number of publications which have dealt with posterior cruciate ligament (PCL) retaining total knee arthroplasty, few studies have addressed the histology of the PCL. Based on these, the use of some predictive factors for lesions of the PCL has been suggested, as a decisive argument to substitute the ligament or not. The objective of this study was to assess the value of some predictive factors, based on objective findings. We performed histological analysis of 434 PCLs removed during total knee arthroplasty for osteoarthritis. Fifty-eight percent of these ligaments presented histological lesions. The degree of preoperative knee deformity, the intra-operative appearance of both cruciate ligaments, and gender were found to correlate with the severity of the microscopic lesions of the PCL. No such correlation was found with age nor with the type of knee deformity. Calcium pyrophosphate deposits were a frequent and potentially pejorative finding in the PCLs from osteoarthritic knees. Due to their poor sensitivity and specificity, the criteria suggested in previous studies to decide on preserving or substituting the PCL appeared fairly unreliable.

Activity of chemotherapy in the palliative treatment of salivary gland tumors: review of the literature.

Chemotherapy is sometimes used as palliation for patients with salivary gland tumors not amenable to curative treatment. However, if chemotherapy improves survival is unknown. To identify some prognostic parameters in this disease, we conducted an extensive review of the literature. The prognostic value of the baseline clinical characteristics and the different chemotherapy regimens used was assessed using the Cox proportional hazards regression model on the available individual data. In addition, the effect of the different chemotherapy drugs on median survival time was evaluated using meta-weighted linear regression with dummy covariates referring to each chemotherapy drug. The total number of patients included in these studies that fit our inclusion criteria was 264 patients. By reviewing carefully the papers and by contacting the different authors, we were able to retrieve the individual data of 205 patients. In the multivariate Cox analysis, only the use of platinum-based chemotherapy was identified as an independent predictor of an increased survival (P = 0.01). These results were confirmed in a meta-analysis where median survival was increased by 2.5 (95% IC:0.7-4.4) and 4.9 (95% IC:0.45-9.4) months for patients treated with platinum (P = 0.007) and anthracyclin-based (P = 0.03) chemotherapy, respectively. Although exploratory, our analysis suggests that treatment with a platinum-based chemotherapy regimen may be an independent factor of better survival for patients with incurable salivary gland neoplasms.