Navigated anterior cruciate ligament replacement: an experimental validation study

We wanted to test the following hypothesis: the location of the tibial and femoral ACL attachments measured by a navigation system differs from their actual anatomic location. A total of 10 gross specimens were studied. The standard navigated procedure was used. Metallic reference pins were implanted around the tibial and femoral ACL attachments and palpated with a navigated stylus. Their position was recorded in comparison with the same tibial or femoral reference point. All measurements were repeated with a caliper. Caliper and navigated measurements were compared with appropriate statistical tests at a 0.05 level of significance. There was a significant difference between caliper and navigated measurements at the tibia in absolute value (maximal range of 4 mm, mean difference about 2 mm), but the difference ratio was low (about 3%); there was no significant difference between caliper and navigated measurements at the femur. There was a strong correlation and a good agreement between caliper and navigated measurements. It is likely that these differences have few, if any, clinical relevance. We demonstrated that the navigation system used during the present study has the potential to enhance the precision of the intra-operative measurement of the tunnel placement during ACL replacement.     

Systematic review of manual therapies for nonspecific neck pain

ObjectiveTo evaluate the effectiveness of manual therapies in the treatment of nonspecific neck pain.Materials and methodsMedline and the Cochrane Library were searched for randomized controlled trials of manual therapy or mobilization, used alone or with exercises to treat pain and functional impairment related to nonspecific neck pain. Cochrane Back Review Group criteria were used to assess the quality of the trials and the level of evidence (unclear, limited, moderate, or high) for short-, medium-, and long-term effects.ResultsOf 27 identified trials, 18 were of high quality. In acute neck pain, effective treatments were thoracic manipulation combined with electrothermal therapy in the short term and cervical manipulation in the long term. In chronic neck pain and neck pain of variable duration, both pain and function improved consistently at all follow-up time points. None of the manual therapies used alone or in combination was superior over the others. In the long term, exercises alone or combined with manual therapies were superior over manual therapies used alone.ConclusionManual therapies contribute usefully to the management of nonspecific neck pain. The level of evidence is moderate for short-term effects of upper thoracic manipulation in acute neck pain, limited for long-term effects of neck manipulation, and limited for all techniques and follow-up durations in chronic neck pain.     

A Phase II,open-label,randomised study to assess the efficacy and safety of the MEK1/2 inhibitor AZD6244 (ARRY-142886) versus capecitabine monotherapy in patients with colorectal cancer who have failed one or two prior chemotherapeutic regimens

Objectives To assess the efficacy and safety of the MEK1/2 inhibitor AZD6244 (ARRY-142886) in patients with metastatic colorectal cancer who had failed one or two previous chemotherapeutic regimens that included oxaliplatin and/or irinotecan. Methods This was a Phase II, multicentre, open-label, randomised, two-arm, parallel-group study comparing AZD6244 with capecitabine monotherapy. Patients received either 100 mg twice daily oral AZD6244 free-base suspension every day or 1,250 mg/m² twice daily oral capecitabine, for 2 weeks, followed by a 1-week rest period, in 3-weekly cycles. The primary endpoint was the number of patients experiencing disease progression events. Results Sixty-nine patients were randomised in the study (34 and 35 patients in the AZD6244 and capecitabine groups, respectively). Disease progression events were experienced by 28 patients (∼80%) in both the AZD6244 and capecitabine treatment groups. Median progression-free survival was 81 days and 88 days in the AZD6244 and capecitabine groups, respectively. Ten patients in the AZD6244 treatment arm had a best response of stable disease. For capecitabine, best response was a partial response in one patient, with stable disease in a further 15 patients. The most frequently observed adverse events reported with AZD6244 were acneiform dermatitis, diarrhoea, asthenia and peripheral oedema, compared with hand-foot syndrome, diarrhoea, nausea and abdominal pain with capecitabine. Conclusions AZD6244 showed similar efficacy to capecitabine in terms of the number of patients with a disease progression event and of progression-free survival. AZD6244 is currently undergoing evaluation in Phase II trials in combination with other chemotherapeutic agents.     

Enterolith ileus due to jejunal diverticulosis

Jejunal diverticulosis is a rare malformation that is often asymptomatic. Complications might be similar to those occurring in large-bowel diverticula but also include a much more particular event: intestinal obstruction due to migration and impaction of enterolith formed inside diverticula. This is a very uncommon entity; diagnosis and management are thus often delayed. Mostly surgical exploration is necessary because obstruction symptoms are unresponsive to medical treatment. The authors report a new case of enterolith ileus in a 74-year-old man, due to jejunal diverticulosis, and its successful surgical management in emergency. Only 39 similar cases have ever been reported in the literature.     

Predicting maximal grip strength using hand circumference

The objective of this study was to analyze the correlations between anthropometric data and maximal grip strength (MGS) in order to establish a simple model to predict “normal” MGS. Randomized bilateral measurement of MGS was performed on a homogeneous population of 100 subjects. MGS was measured according to a standardized protocol with three dynamometers (Jamar, Myogrip and Martin Vigorimeter) for both dominant and non-dominant sides. Several anthropometric data were also measured: height; weight; hand, wrist and forearm circumference; hand and palm length. Among these data, hand circumference had the strongest correlation with MGS for all three dynamometers and for both hands (0.789 and 0.782 for Jamar; 0.829 and 0.824 for Myogrip; 0.663 and 0.730 for Vigorimeter). In addition, the only anthropometric variable systematically selected by a stepwise multiple linear regression analysis was also hand circumference. Based on this parameter alone, a predictive regression model presented good results (r² = 0.624 for Jamar; r² = 0.683 for Myogrip and r² = 0.473 for Vigorimeter; all adjusted r²). Moreover a single equation was predictive of MGS for both men and women and for both non-dominant and dominant hands. “Normal” MGS can be predicted using hand circumference alone.