Combined ACL reconstruction and Segond fracture fixation fails to abolish anterolateral rotatory instability

The Segond Fracture (SF) is considered pathognomonic of an anterior cruciate ligament (ACL) tear. However, the precise anatomy of the soft tissue attachments responsible for avulsion of SF’s have been a cause of controversy in the literature with some authors suggesting that they occur due to avulsion of the iliotibial band (ITB) and others reporting that it is the anterolateral ligament (ALL). A thirty-one-year-old male patient presented with a work-related injury to his right knee that resulted in ACL tear and a SF. Open SF fixation and arthroscopic ACL reconstruction were performed. The anatomical dissection performed in order to fix the SF demonstrated that the avulsion had occurred as a result of the tibial attachment of the ALL with a completely intact ITB. At one-year postoperative follow-up, the ACL graft had restored anterior tibial translation to within normal limits. However, residual rotational knee laxity was observed in the absence of any other secondary restraint lesions. This is an important finding because it highlights that patients with SF may be at increased risk of persistent instability after ACL reconstruction even in the presence of an anatomically correctly positioned and well-functioning ACL graft. It also demonstrates that anatomical reduction and fixation of SF at the time of ACLR does not necessarily restore normal knee kinematics and consideration should be given to recession of the fixation or augmentation of the ALL when dealing with this injury pattern. A thirty-one-year-old male patient presented with a work-related injury to his right knee that occurred when he was struck by a truck at low speed. The mechanism of injury involved anterior tibial translation, varus stress and internal rotation. Physical examination revealed the following findings: large joint effusion, range of motion 0-100º, no neurological or vascular deficit, positive Lachman’s test with a soft end-point, a side-to-side anteroposterior laxity difference of 7mm measured by the Rolimeter device (Aircast, Europe), and a grade II pivot-shift (clunk). Plain radiographs demonstrated a fracture of the anterolateral border of the tibial plateau (figure 1A) and MRI showed a complete anterior cruciate ligament (ACL) rupture with a concomitant 3x16x18mm fracture of the anterolateral tibial border (figure 1B). MRI did not demonstrate any other intra- or extra-articular injuries. Specifically, there was no evidence of injury to any other ligamentous structure, chondral injury, lateral condyle notch sign, or any type of meniscal tear

Cell walls of the dimorphic fungal pathogens Sporothrix schenckii and Sporothrix brasiliensis exhibit bilaminate structures and sloughing of extensive and intact layers

This work was supported by the Fundação Carlos Chagas de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), grants E-26/202.974/2015 and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), grants 229755/2013-5, Brazil. LMLB is a senior research fellow of CNPq and Faperj. NG acknowledged support from the Wellcome Trust (Trust (097377, 101873, 200208) and MRC Centre for Medical Mycology (MR/N006364/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

The popliteus tendon provides a safe and reliable location for all-inside meniscal repair device placement

Background: Tears of the posterior horn of the lateral meniscus are challenging to repair because, in contrast to medial meniscal repairs, the capsule and its attachment are thin. Purpose: To evaluate the clinical results of an arthroscopic all-inside repair technique for unstable, vertical, lateral meniscus tears, using a suture anchor device placed directly into the popliteus tendon. Study Design: Case Series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data from the ***** database was performed. All patients who had undergone combined ACL reconstruction with lateral meniscus all-inside repair, using sutures placed in the popliteus tendon, between January 2011 and February 2015, were included. At final follow-up, all patients were contacted by telephone to identify if they underwent further surgery or had pain, locking or effusion. Symptomatic patients were recalled for clinical/imaging evaluation. Operative notes for those undergoing further surgery were reviewed and rates and type of re-operation, including for failed lateral meniscal repair were recorded. Results: Two hundred patients (mean age, 28.6 ± 10.2 years) with a mean follow-up of 45.5 ± 12.8 months (range, 24.7-75.2) were included. The mean Subjective International Knee Documentation Committee (IKDC) at final follow-up was 85.0 ± 11.3. The post-operative mean side-to-side laxity measured at one year was 0.6 ± 1.0 mm. Twenty-six patients underwent re-operation (13%) at a mean follow-up of 14.8 ± 7.8 months. The ACL graft rupture rate was 5.0%. Other causes for re-operation included medial meniscus tear (2.5%), cyclops lesion (1.5%) and septic arthritis (0.5%). The lateral meniscus repair failure rate was 3.5%. No specific complications relating to placement of suture anchors in the popliteusn tendon were identified. Conclusion: Arthroscopic all-inside repair of unstable, vertical, lateral meniscal tears using a suture anchor placed in the popliteus tendon is a safe, efficient and reproducible technique. It is associated with a very low failure rate without specific complications

Tricholithobezoar Causing Gastric Perforation

A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. Trichobezoar is a rare condition seen almost exclusively in young women with trichotillomania and trichotillophagia. When not recognized, the trichobezoar continues to grow, which increases the risk of severe complications such as gastric ulceration and even perforation. Formation of a gallstone within the trichobezoar (tricholithobezoar) is an event that has not yet been described. We report the case of a 22-year-old woman admitted to the emergency room with signals and symptoms of an epigastric mass and perforative acute abdomen. Radiological study revealed bilateral pneumoperitoneum. Personal history revealed depressive syndrome, trichotillomania and trichophagia. With a diagnosis of visceral perforation, an urgent exploratory laparotomy was performed. This confirmed the diagnosis of gastric perforation due to a large trichobezoar with the formation of a gastrolith that was removed by anterior gastrotomy. Biochemical study of the gastric stone revealed that it was composed of bile salts. There were no complications. The patient was discharged on the 5th postoperative day and was referred for psychiatric treatment

Brain and ventricular volume in patients with syndromic and complex craniosynostosis

textabstractPurpose: Brain abnormalities in patients with syndromic craniosynostosis can either be a direct result of the genetic defect or develop secondary to compression due to craniosynostosis, raised ICP or hydrocephalus. Today it is unknown whether children with syndromic craniosynostosis have normal brain volumes. The purpose of this study was to evaluate brain and ventricular volume measurements in patients with syndromic and complex craniosynostosis. This knowledge will improve our understanding of brain development and the origin of raised intracranial pressure in syndromic craniosynostosis. Methods: Brain and ventricular volumes were calculated from MRI scans of patients with craniosynostosis, 0.3 to 18.3 years of age. Brain volume was compared to age matched controls from the literature. All patient charts were reviewed to look for possible predictors of brain and ventricular volume. Results: Total brain volume in syndromic craniosynostosis equals that of normal controls, in the age range of 1 to 12 years. Brain growth occurred particularly in the first 5 years of age, after which it stabilized. Within the studied population, ventricular volume was significantly larger in Apert syndrome compared to all other syndromes and in patients with a Chiari I malformation. Conclusions: Patients with syndromic craniosynostosis have a normal total brain volume compared to normal controls. Increased ventricular volume is associated with Apert syndrome and Chiari I malformations, which is most commonly found in Crouzon syndrome. We advice screening of all patients with Apert and Crouzon syndrome for the development of enlarged ventricle volume and the presence of a Chiari I malformation

All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study

<p>Abstract</p> <p>Background</p> <p>Higher mortality has been found for people with serious mental illness (SMI, including schizophrenia, schizoaffective disorders, and bipolar affective disorder) at all age groups. Our aim was to characterize vulnerable groups for excess mortality among people with SMI, substance use disorders, depressive episode, and recurrent depressive disorder.</p> <p>Methods</p> <p>A case register was developed at the South London and Maudsley National Health Services Foundation Trust (NHS SLAM), accessing full electronic clinical records on over 150,000 mental health service users as a well-defined cohort since 2006. The Case Register Interactive Search (CRIS) system enabled searching and retrieval of anonymised information since 2008. Deaths were identified by regular national tracing returns after 2006. Standardized mortality ratios (SMRs) were calculated for the period 2007 to 2009 using SLAM records for this period and the expected number of deaths from age-specific mortality statistics for the England and Wales population in 2008. Data were stratified by gender, ethnicity, and specific mental disorders.</p> <p>Results</p> <p>A total of 31,719 cases, aged 15 years old or more, active between 2007-2009 and with mental disorders of interest prior to 2009 were detected in the SLAM case register. SMRs were 2.15 (95% CI: 1.95-2.36) for all SMI with genders combined, 1.89 (1.64-2.17) for women and 2.47 (2.17-2.80) for men. In addition, highest mortality risk was found for substance use disorders (SMR = 4.17; 95% CI: 3.75-4.64). Age- and gender-standardised mortality ratios by ethnic group revealed huge fluctuations, and SMRs for all disorders diminished in strength with age. The main limitation was the setting of secondary mental health care provider in SLAM.</p> <p>Conclusions</p> <p>Substantially higher mortality persists in people with serious mental illness, substance use disorders and depressive disorders. Furthermore, mortality risk differs substantially with age, diagnosis, gender and ethnicity. Further research into specific risk groups is required.</p

Detection of diploid males in a natural colony of the cleptobiotic bee Lestrimelitta sp (Hymenoptera, Apidae)

When working at quantifying the genome size of stingless bees, it was observed that males of Lestrimelitta sp possessed the same amount of nuclear DNA as the females. Thus, we used flow cytometry (FCM) and cytogenetic analysis to confirm the ploidy of these individuals. The males analyzed proved to be diploid, since, through cytometric analysis, it was demonstrated that the mean genome size of both males and females was the same (C = 0.463 pg), and, furthermore, cytogenetic analysis demonstrated that both had 2n = 28 chromosomes