Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis

Nonsimultaneous, bilateral ACL injuries are not uncommon. We studied a group of patients with these injuries to determine possible predisposing factors that could aid in early detection and prevention of contralateral ACL injury. Retrospective analysis of 1,120 patients with ACL ruptures who were treated between 1983 and 1987 revealed 45 patients with bilateral ruptures. Complete follow-up data were available for 41 of these patients. We examined age at initial injury, sex, interval between initial and contralateral ACL injury, mechanism of injury, activity at injury, medical and family histories, treatment of initial injury, and radiographic measurement of intercondylar notch width. The overall incidence of bilaterality was 4.01% in the 28 male and 13 female patients. Their average age was 19 years and 10 months. The average interval between initial and contralateral injury was 47 months. A noncontact cutting maneuver was the most common mechanism of injury. We devised a method to measure and compare intercondylar notch widths on plain radiographs. We compared the mean notch width index (NWI) of the bilateral group to the mean NWI of a group of 50 consecutive patients with "normal" knees and to the mean NWI of 50 consecutive patients with acute ACL ruptures. The mean NWI for the normal group was .2338, for the acute ACL group, .2248, and for the bilateral group, .1961. We noted a statistically significant difference when we compared the bilateral group to the normal and acute groups (P less than 0.0001, respectively). There was no statistically significant difference between the NWI of the normal and acute ACL groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Real-time NMR beam-directed velocity mapping. V-mode NMR.

BACKGROUND. Currently available noninvasive techniques for measuring blood flow velocities are constrained by limited view orientations (Doppler ultrasound) or limited time resolution (magnetic resonance imaging, MRI). We describe an MRI technique for measuring flow velocities in real time at arbitrary orientations within a cylindrical volume or "beam": V-mode nuclear magnetic resonance (NMR). METHODS AND RESULTS. The technique was implemented on a standard 1.5-T clinical NMR imager with no special hardware and was tested on phantoms and human volunteers. The beam can be fired at rates up to 60 times per second, allowing measurements on a time scale that is appropriate for ungated cardiac studies. In phantoms, steady flow velocities were measured with the beam aligned along the direction of flow, and the measured velocities correlated well with the actual velocities (r > 0.99). The radial distribution of velocities in phantoms under constant flow conditions was also determined. In humans, flow of blood in the descending aortas of normal and aortic insufficiency subjects was measured. Distinctive backflow of blood because of aortic insufficiency was readily apparent. CONCLUSIONS. The V-mode NMR technique is capable of acquiring clinically relevant real-time blood flow information from any desired angle of view with no attenuation at bone or air-tissue interfaces.     

Depression of lymphocyte response to phytohaemagglutinin in the presence of plasma from children with acute protein energy malnutrition.

Phytohaemagglutinin-induced lymphocyte transformation of four healthy adults and a child with kwashiorkor was performed in the presence of plasma from nineteen patients with protein energy malnutrition and a nutritionally normal child. Marked inhibition occurred in the presence of plasma from six patients who subsequently died, moderate inhibition occurred in six other patients in the acute stage and in two of these six in the convalescent stage, whilst in the remaining seven there was no effect. Reduction in response did not appear to be due to plasma cytotoxicity. Plasma factors in some cases of malnutrition, associated with certain infections appear to inhibit the lymphocyte response and this may have prognostic implications.     

Psychosocial factors in medical and psychological treatment avoidance: the role of the doctor-patient relationship

A community sample of 1106 adults was examined to assess the impact of the doctor-patient relationship on participants' avoidance of treatment for a recognized medical or psychological problem. Of five aspects of participants' previous experience with their physicians, all but waiting time predicted participants' self-reported treatment avoidance. In two logistic regression models participants who felt their physicians listened more to their concerns were less likely to avoid treatment for both medical and psychological problems during the previous 12 months. These findings suggest that patients' perceptions of how they are treated by physicians may help explain why many people delay or avoid healthcare treatment, even when faced with a significant health problem.     

Crosslink formation in porcine valves stabilized by dye-mediated photooxidation

Bovine pericardial and porcine valve materials stabilized by dye-mediated photooxidation have shown potential for bioprosthetic valve use. Previously, in vitro and in vivo stability of these materials was demonstrated through enzymatic, chemical, extraction, rat subcutaneous, and functional challenges. Here, we examine the stability of photooxidized porcine aortic valves through amino acid, crosslink, and hydrothermal isometric tension analysis. Photooxidation reduced intact histidine residues from 17.0 to 0 residues per 1000, indicating the photooxidative alteration of this amino acid. Diphenyl borinic acid-derivitized hydrolyzates of proteins were separated by high-performance liquid chromatography, which identified several amino acid crosslinks that appeared with photooxidation that were absent in untreated controls. Thermal relaxation analysis indicated a significantly higher (p < 0.0002) thermal stability for photooxidized porcine cusps than that of untreated controls, with mean relaxation times for untreated cusps of 14,000 +/- 4650 versus 22,900 +/- 2480 s for photooxidized cusps. In summary, porcine aortic valve tissue treated by dye-mediated photooxidation contains new chemical species and exhibits properties consistent with intermolecular crosslink formation, which explain the increased biostability of this material and its potential for use in bioprosthetic devices.     

Abnormal IL-2 receptor levels in non-pregnant women with a history of recurrent miscarriage

BACKGROUND: Immunological abnormalities have been found in pregnant women with a history of recurrent miscarriage. This study compared interleukin-2 receptor (IL-2R) levels in non-pregnant women with a history of recurrent miscarriage with those found in serum from a non-pregnant group with no such history. METHODS: Group 1 comprised 49 non-pregnant women with a history of recurrent miscarriage (at least three consecutive miscarriages). Group 2 comprised 22 non-pregnant women with no history of miscarriage. Serum IL-2R levels were measured in all patients. RESULTS: The results obtained showed that although all women were not pregnant at the time of sampling, IL-2R levels were significantly higher in women in Group 1 compared with those in Group 2 (1589 +/- 1289 versus 1082 +/- 823 pg/ml; P < 0.05). Follow-up data were available for 21 women from Group 1. The next pregnancy ended successfully for 14 of these women, while seven miscarried again. The IL-2R levels obtained pre-pregnancy were not significantly different between the two groups (1480 +/- 910 versus 1356 +/- 716 pg/ml). CONCLUSION: This study has shown that non-pregnant women with a history of recurrent miscarriage have raised IL-2R levels. These increased pre-pregnancy IL-2R levels did not necessarily predict miscarriage for the next pregnancy.