High Prevalence of Anterolateral Ligament Abnormalities on MRI in Knees With Acute Anterior Cruciate Ligament Injuries. A Case-Control Series From the SANTI Study Group

Background: Broad variation in the reported rate of magnetic resonance imaging (MRI)–detected abnormalities of the anterolateral structures of the anterior cruciate ligament (ACL)–injured knee suggests a lack of reliability that has limited the use of MRI in clinical decision making. Purpose/Hypothesis: The aim of this study was to use MRI to determine the prevalence and spectrum of abnormalities of the anterolateral structures in acute ACL-injured knees, using the contralateral uninjured knee as a reference. We hypothesized that MRI evaluation of the acutely injured knee (using the uninjured knee as a reference) would allow reliable identification of abnormalities of the anterolateral structures. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with acute ACL injury underwent MRI scan of both knees. Images were evaluated by 3 observers. Inter- and intraobserver reliabilities were determined for MRI parameters of anterolateral ligament (ALL) injury by use of the kappa (κ) test. Univariate and multivariate analyses were conducted to test associations between ALL abnormality and associated injuries. Results: A total of 34 patients were evaluated. Of these, 30 patients (88.2%) had at least 1 ALL abnormality in the ACL-injured knee (increased signal: n = 27[79.4%]; increased thickness: n = 15[44.1%]; tapering: n = 7[20.6%]; irregularities in the path of the ALL fibers: n = 21[61.7%]). Asymmetries of the genicular vessels were observed in 21 patients (61.7%). ALL abnormality was significantly associated with lateral joint capsular tears (P <.001). No correlation was found between ALL lesions and iliotibial band lesions (P =.49). Inter- and intraobserver reliabilities were very good concerning ALL signal changes and femoral and tibial bone bruises (κ coefficient, 0.81-1). Conclusion: MRI evaluation of the ALL was associated with good and very good inter- and intraobserver reliabilities, and it demonstrated abnormalities of the ALL in the majority of acutely ACL-injured knees. The index of suspicion for ALL injury should be elevated by the presence of lesions of the lateral capsule. This suggests that the ALL is part of a wider area of the lateral capsule that is often injured simultaneously in an acute ACL tear

Segond fractures are not a risk factor for anterior cruciate ligament reconstruction failure: Letter to the Editor

Germanium nanowires (NWs) have attractive properties for a variety of applications, including micro- and optoelectronics, memory devices, solar energy conversion, and energy storage, among others. For applications that involve exposure to air, the poor chemical stability and electronic surface passivation of native oxides have remained a long-standing concern. Termination by sulfur-rich surface layers has emerged as a promising strategy for passivation of planar Ge surfaces. Here we discuss experiments on solid-state sulfurization of Ge nanowires in sulfur vapor at near-ambient pressures and at different temperatures. Combined transmission electron microscopy imaging and chemical mapping establishes that Ge NWs remain intact during vapor-phase reaction with S at elevated temperatures, and show the formation of sulfur-rich shells with T-dependent morphology and thickness on the Ge NW surface. Photoluminescence of ensembles of such core-shell nanowires is dominated by strong emission at approximate to 1.85 eV, consistent with luminescence of GeS. Cathodoluminescence spectroscopy on individual NWs establishes that this luminescence originates in thin GeS shells formed by sulfurization of the NWs. Our work establishes direct sulfurization as a viable approach for forming stable, wide-bandgap surface terminations on Ge NWs

Anterolateral ligament reconstruction: a possible option in the therapeutic arsenal for persistent rotatory instability after ACL reconstruction

The results of anterior cruciate ligament reconstruction (ACLR) are widely recognized to be satisfactory on the basis of outcome measures such as the International Knee Documentation Committee (IKDC) and Lysholm scores. However, there is moderate variation among several series of different techniques. For example, Hussein et al showed a range of residual pivot, from 7% to 33%, depending on the technique used. Furthermore, up to 30% of patients in contemporary series can still experience persistent instability, and only 65% to 83% can return to the preinjury level of sport

Quality of life in heart transplant candidates

OBJECTIVE: To assess the quality of life of patients with refractory heart failure disease as candidates for heart transplant. METHODS: A transversal, descriptive and prospective study with 18 adult patients, with mean age of 52 years under pre-transplantation outpatient follow-up at educational and public hospital in São Paulo town. The quality of life was assessed by reference to The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) generic questionnaire in order to assess the aspects in relation to the function, dysfunction, physical and emotional uneasiness. RESULTS: According to this group, 14 (77.8%) of these patients were male and four (22.2%) female; 14 (77.8%) of them were classified as functional class IV and four (22.2%) as functional class III (New York Heart Association); 17 (94.4%) of them were at stage D and one (5.6%) at stage C (American Heart Association/American College of Cardiology). The mean results obtained from the assessment of SF-36 scales were: functional capacity 38%, pain 49%, health general condition 49%, vitality 39%, social aspects 53%, emotional aspects 43% and mental health 54%. CONCLUSION: The quality of life of patients presenting terminal heart failure is considered to be very bad; it is likely to be worse than in many other more common morbid entities. Both mental and social aspects are least affected, on the other hand the vitality and functional capacity are the most affected.OBJETIVO: Aferir a qualidade de vida de pacientes com insuficiência cardíaca refratária, inscritos como candidatos a transplante de coração. MÉTODOS: Estudo prospectivo, descritivo, transversal de 18 pacientes, com média de idade de 52 anos, em acompanhamento ambulatorial pré-transplante, de um hospital público e vinculado ao ensino do Município de São Paulo. A qualidade de vida foi avaliada por meio do questionário genérico The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), com a finalidade de avaliar aspectos relativos a função, disfunção, desconforto físico e emocional. RESULTADOS: Dessa amostra, 14 (77,8%) pacientes eram do sexo masculino e quatro (22,2%), do sexo feminino; 14 (77,8%) dos pacientes foram classificados segundo tipo funcional IV e quatro (22,2%) em tipo funcional III (New York Heart Association); 17 (94,4%) encontravam-se em estágio D e um (5,6%) em estágio C (American Heart Association/ American College of Cardiology). As médias obtidas na avaliação das escalas do SF-36 foram: capacidade funcional 38%, dor 49%, estado geral de saúde 49%, vitalidade 39%, aspectos sociais 53%, aspectos emocionais 43% e saúde mental 54%. CONCLUSÃO: A qualidade de vida dos pacientes com insuficiência cardíaca terminal é considerada muito ruim; provavelmente pior que em muitas outras entidades mórbidas mais comuns. Os aspectos, social e mental são os menos afetados, sendo os mais comprometidos, a vitalidade e a capacidade funcional.UNIFESP-EPM Departamento Cirurgia CardiovascularUNIFESP-EPM Departamento de CirurgiaUNIFESP-EPM Departamento de EnfermagemUniversidade do Vale do Paraíba Curso de EnfermagemUNIFESP, EPM, Depto. Cirurgia CardiovascularUNIFESP, EPM Depto. de CirurgiaUNIFESP, EPM Depto. de EnfermagemSciEL

Total knee arthroplasty with subvastus approach in patient with chronic post-traumatic patellar dislocation

AbstractChronic lateral dislocation of the patella is a rare condition and acquired causes are usually secondary to knee trauma. The neglected chronic dislocation leads to progressive genu valgum and external tibial torsion deformities with subsequent gonarthrosis, which becomes painful and debilitating. There is no consensus regarding treatment of these patients, but total knee arthroplasty (TKA) is a useful therapy in cases of painful symptomatic gonarthrosis. Few reports have shown that subvastus approach and lateral release may be a valid option for TKA, since it allows the correction of valgus deformity and patellar tracking without interrupting vascular blood supply of patella. This article reports a case of TKA and extensor mechanism realignment without patellar resurfacing in a patient with genu valgum and chronic post-traumatic patellar dislocation with satisfactory results after two years of follow-up

High prevalence of anterolateral ligament abnormalities on MRI in knees with acute anterior cruciate ligament injuries: a case-control series from the SANTI study group

Background: Broad variation in the reported rate of magnetic resonance imaging (MRI)–detected abnormalities of the anterolateral structures of the anterior cruciate ligament (ACL)–injured knee suggests a lack of reliability that has limited the use of MRI in clinical decision making. Purpose/Hypothesis: The aim of this study was to use MRI to determine the prevalence and spectrum of abnormalities of the anterolateral structures in acute ACL-injured knees, using the contralateral uninjured knee as a reference. We hypothesized that MRI evaluation of the acutely injured knee (using the uninjured knee as a reference) would allow reliable identification of abnormalities of the anterolateral structures. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with acute ACL injury underwent MRI scan of both knees. Images were evaluated by 3 observers. Inter- and intraobserver reliabilities were determined for MRI parameters of anterolateral ligament (ALL) injury by use of the kappa (κ) test. Univariate and multivariate analyses were conducted to test associations between ALL abnormality and associated injuries. Results: A total of 34 patients were evaluated. Of these, 30 patients (88.2%) had at least 1 ALL abnormality in the ACL-injured knee (increased signal: n = 27[79.4%]; increased thickness: n = 15[44.1%]; tapering: n = 7[20.6%]; irregularities in the path of the ALL fibers: n = 21[61.7%]). Asymmetries of the genicular vessels were observed in 21 patients (61.7%). ALL abnormality was significantly associated with lateral joint capsular tears (P < .001). No correlation was found between ALL lesions and iliotibial band lesions (P = .49). Inter- and intraobserver reliabilities were very good concerning ALL signal changes and femoral and tibial bone bruises (κ coefficient, 0.81-1). Conclusion: MRI evaluation of the ALL was associated with good and very good inter- and intraobserver reliabilities, and it demonstrated abnormalities of the ALL in the majority of acutely ACL-injured knees. The index of suspicion for ALL injury should be elevated by the presence of lesions of the lateral capsule. This suggests that the ALL is part of a wider area of the lateral capsule that is often injured simultaneously in an acute ACL tear

Correlation between magnetic resonance imaging and surgical exploration of the anterolateral structures of the acutely anterior cruciate ligament injured knee

Background: Combined Anterior Cruciate Ligament (ACL) and Anterolateral ligament (ALL) reconstruction is associated with improved clinical outcomes compared to isolated intra-articular reconstruction but the indications are not precisely defined. It may be the case that patients with proven anterolateral injury on pre-operative imaging are most likely to benefit but the accuracy of MRI is not known. Hypothesis/Purpose: To evaluate the correlation between MRI findings and intra-operative anterolateral compartment exploration in acute ACL injured knees. The study hypothesis was that a positive correlation would be identified between imaging and surgical findings for injuries to the ALL/capsule and the iliotibial band and that pre-operative MRI would be associated with high sensitivity, specificity and accuracy for these parameters. Study Design: Case Series. Methods: Between January 2016 to May 2016 patients presenting with an acute ACL injury were considered for study eligibility. A sample size calculation determined the numbers enrolled. Included patients underwent 1.5T MRI and this was evaluated by three investigators who attributed a Ferretti grade of injury to the anterolateral structures. At the time of ACL reconstruction, a lateral exploration was undertaken and macroscopic injuries were identified, classified and repaired. An evaluation of correlation between MRI and surgical exploration findings was performed. Results: 26 patients participated in the study. 96% had an ALL/capsule injury. The sensitivity, specificity and accuracy of MRI in the evaluation of ALL/capsule injury, when using surgical exploration as a gold standard were 88%, 100% and 88.5% respectively. For evaluation of iliotibial band injury these values were 62.5%, 40% and 50%. The percentage agreement between MRI and surgical findings for ALL/capsule injury was 88% but only 65% for the ITB. The sensitivity and specificity of MRI for complete or partial tear of ALL and capsule were 78.6 and 41.7 respectively. The k test for correlation between surgical and MRI findigs was 0.27 for ITB abnormalities, 0.47 for ALL/capsule abnormalities, 0.23 for ALL/capsule determination of partial or complete tear and 0.49 for ALL/capsule determination of anterior or posterior tear. The overall percentage agreement between MRI and the classification based on surgical findings was only 53% and the Altman classification of kappa was fair. This suggests that whilst the classification is useful for description of surgical findings the grade cannot be reliably established from MRI, at least with the parameters used in the current study. Conclusion: Surgical exploration demonstrates that injuries occur to the anterolateral structures in almost all acute ACL injured knees. Pre-operative MRI is highly sensitive, specific and accurate, for detection of abnormalities of the ALL/capsule and shows a high percentage of agreement with surgical findings. In contrast MRI has low sensitivity, specificity, and accuracy for the diagnosis of ITB injury. The agreement between MRI and surgical exploration with respect to ITB abnormality and determination of whether ALL/capsular tears were partial or complete was only fair

Cash transference and food insecurity in Brazil : analysis of national data

OBJETIVO: O objetivo deste trabalho foi analisar, na Pesquisa Nacional por Amostra de Domicílios 2004, a hipótese de que a participação em programas governamentais de Transferência de Renda está associada à situação de segurança alimentar no domicílio. MÉTODOS: Utilizaram-se dados secundários da Pesquisa Nacional por Amostra de Domicílios com entrevistas em 112.716 domicílios. Incluíram-se neste trabalho os domicílios particulares permanentes e improvisados, em que as informações sobre segurança alimentar foram fornecidas por um morador, limitando-se ainda àqueles com rendimento domiciliar per capita de até um salário-mínimo, representando isto 51,2% dos domicílios da amostra. Foram elaborados três modelos de estimativas de transferência de renda com resultados semelhantes; escolheu-se o Modelo 3 por resultar em menor probabilidade de superestimar efeitos. Para estimar o efeito da transferência de renda na prevalência de segurança alimentar, foram incluídos apenas os domicílios que recebiam transferência de renda correspondendo a 14,2% do total de domicílios entrevistados. A associação entre segurança alimentar e transferência de renda, controlando por outras variáveis independentes, foi estimada mediante modelos de regressão logística, método stepwise, para cada uma das três faixas de rendimento domiciliar per capita. RESULTADOS: Os programas de transferência de renda considerados neste estudo apresentaram um valor médio de benefícios de R$81,68 por domicílio. A regressão logística múltipla mostrou aumento em torno de 8,0$81.68 per family. Multiple logistic regression showed an increased chance of food security of 8% per each R$10.00 contributed by social programs. Rural residence, male head of household, and Caucasian head of household were factors that also presented a higher chance of food security. CONCLUSION: The hypothesis was confirmed, showing a positive association between cash transfer and household food security, regardless of the effects of other explanatory factors

Clinical and epidemiological characteristics of septic arthritis of the hip, 2006 to 2012, a seven-year review

OBJECTIVE: To epidemiologically characterize the population treated at our orthopedic clinic with a diagnosis of septic arthritic of the hip between 2006 and 2012. METHODS: Fifteen patients diagnosed with septic arthritis of the hip between 2006 and 2012 were retrospectively evaluated. The patients' clinical and epidemiological characteristics were surveyed; a sensitivity profile relating to the microorganisms that caused the infections and the complications relating to the patients' treatment and evolution were identified. RESULTS: Septic arthritis was more common among males. Most diagnoses were made through positive synovial fluid cultures, after joint drainage was performed using the Smith-Petersen route. Among the comorbidities found, the most prevalent were systemic arterial hypertension, diabetes mellitus, and human immunodeficiency virus. The pathological joint conditions diagnosed prior to joint infection were osteoarthrosis and developmental dysplasia of the hip. The infectious agent most frequently isolated was Staphylococcus aureus. From the clinical and laboratory data investigated, 53.33% of the cases presented with fever, and all except one patient presented with increased measures in inflammation tests. Gram staining was positive in only 26.66% of the synovial fluid samples analyzed. Six patients presented with joint complications after treatment was administered. CONCLUSION: S. aureus is the most common pathogen in acute infections of the hip in our setting. Factors such as clinical comorbidities are associated with septic arthritis of the hip. Because of the relatively small number of patients, given that this is a condition of low prevalence, there was no statistically significant correlation in relation to worse prognosis for the disease