Spontaneous bilateral quadriceps tendon rupture.

Spontaneous bilateral quadriceps tendon ruptures are uncommon. We present a 30-year-old man with end-stage renal failure, who sustained this injury, and subsequently had surgical repair of both tendons on separate occasions. He has since regained full range of movement of both knees.

Cartilage injury and repair: assessment with magnetic resonance imaging.

Articular cartilage damage plays a major role in joint degeneration and dysfunction. Accurate assessment of the morphology and degree of cartilage wear is important in diagnosis, prognosis and management, particularly as many of these patients are young or participate in high-performance sports. Magnetic resonance imaging is able to directly evaluate such injuries, due to its high spatial resolution and excellent soft-tissue contrast resolution. This pictoral essay aims to demonstrate normal and damaged articular cartilage on MR imaging, as well as surgically-repaired cartilage.

Multiple factors other than p53 influence colon cancer sensitivity to paclitaxel.

PURPOSE: To determine factors which influence the sensitivity of human colorectal carcinoma cell lines to paclitaxel. METHODS: The paclitaxel sensitivity of ten human colorectal carcinoma cell lines, and a panel of RKO colon carcinoma cell lines, isogenic except for p53 status, were studied. The inhibitory concentrations causing a 50% decrease in growth (IC50) were assayed after 3, 24, and 96 h after paclitaxel exposure. The doubling time (DT) and cell cycle parameters of cells were also measured. The expression of the multidrug resistance glycoprotein-1 (MDR-1), bcl-2 and bax was quantitatively assessed by immunoblotting. RESULTS: Mean IC50 values at 24 and 96 h drug exposure were about 1.5 logs lower than the IC50 values at 3 h, regardless of the p53 status. No difference was found between the IC50 values of wild-type and mutant p53 cells, or among the RKO panel of cells. Correlation analysis showed that: (1) resistance was associated with longer DTs, but this was generally abated by a 96-h exposure; (2) with a 3-h exposure, the combination of MDR, bcl-2 and bax parameters with DT (DT + MDR + bcl-2 bax) best correlated with IC50 values (r = 0.77); (3) with a 96-h exposure, in spite of the generally decreased IC50 values, a combination of MDR-1, bcl-2 and bax parameters (MDR + bcl-2-bax) best correlated with the IC50 values (r = 0.71). CONCLUSIONS: These results suggest that the exposure duration, DT, and expression of MDR-1, bcl-2 and bax each contribute to paclitaxel sensitivity of human colorectal carcinoma cells. In assessing paclitaxel drug resistance, multiple factors should always be considered. There may be a therapeutic window for taxanes in colon cancer by optimizing pharmacokinetics and modulating MDR-1 and bcl-2 resistance factors.

The surgical management of colorectal complications from irradiation for carcinoma of the cervix.

Bowel injury from radiation given for carcinoma of the cervix is a complex management problem. Prospectively collected computerized data from April 1989 to June 1997 (8 years) were analysed. There were 84 women with a mean age of 60.6 (standard error 1.2) years. Bleeding from radiation proctitis presented much earlier [mean 19.9 (1.9) months after radiotherapy] than either strictures [mean 81.9 (18.4) months, P = 0.008] or rectovaginal fistula [mean 95.5 (39.0) months]. Topical formalin application successfully controlled bleeding in 49 of 55 patients (89.1%) with radiation proctocolitis. The remaining 6 patients, as well as all 14 patients with symptomatic strictures and all 14 patients with rectovaginal fistula underwent surgery. Rectal strictures were successfully dilated in 2. Bowel resection with reanastomosis (with stoma defunction) was performed in 12 and stoma was created in the remaining 20 because of poor general medical condition or advanced recurrent malignancy. The postoperative mortality was 3% (1 bronchopneumonia) and morbidity was 9% (1 anastomotic leak, 1 urinary infection and 1 wound infection). At a mean follow up of 35 (2.4) months, 7 (21.2%) other postoperative patients have since died (all of these from recurrent cancer). We conclude that topical formalin is effective for controlling bleeding radiation proctitis. When not successful or where other radiation complications occur, judicious surgery dependent upon the patient's general condition can be safely and effectively performed. The longer term results are worthwhile, especially where there is no recurrent cancer.

Management of acute stroke. Ways to minimize damage and maximize recovery.

Brain infarctions due to atherothrombosis or cardiogenic emboli account for most cases of stroke. The remainder are caused by hemorrhages related to hypertension or subarachnoid bleeding. Management includes immediate measures to prevent further damage and rehabilitative measures by a multidisciplinary team. Efforts must also be directed toward preventing future strokes.

Management of acute stroke.

Preview Regardless of cause, acute stroke is a devastating illness that demands immediate treatment to contain neurologic damage, plus long-term management to assure utmost rehabilitation. In this article, the authors describe the features of stroke from various causes and discuss current therapy.