Patellofemoral joint: kinematic MR imaging to assess tracking abnormalities

The patellofemoral joint was imaged with magnetic resonance (MR) in the axial plane while the knee was positioned from 0 degrees to 32 degrees of flexion (nine positions). These multiple sequential images obtained within the early phases of flexion of the knee were viewed in a "cine-loop" format, producing a kinematic study that clearly demonstrated the relationship of the patella to the trochlear groove. Four healthy subjects and one patient with known bilateral subluxing patellae were studied. The preliminary results suggest that kinematic MR imaging of the patellofemoral joint is potentially useful for the evaluation of patellar tracking abnormalities.     

Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

PurposeThe purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method.MethodsThe panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached.ResultsConsensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade.ConclusionThis study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP.Level of evidenceV     

Marrow regeneration after mechanical depletion

The origin of marrow regeneration after mechanical depletion was reinvestigated in mouse chimeras. The results were compatible with the local origin of stem cells from remnants of incompletely removed marrow, but not with their origin from a common precursor of both bone and hemopoietic cell lines. In transplanted femurs depleted by a modified technique of in vivo evacuation of marrow, hemopoietic regeneration failed to occur. The presence of hemopoietic stem cells in the Haversian canals was thus excluded. The demonstration of ample hemopoiesis with minimal bone formation in nondepleted controls in which bone marrow initially became necrotic provided new evidence that osteogenesis was not a prerequisite of hemopoietic regeneration.     

Severe malabsorption in autoimmune polyendocrinopathy-candidosis-ectodermal dystrophy syndrome successfully treated with immunosuppression

A 15 year old boy with autoimmune polyendocrinopathy-candidosis-ectodermal dystrophy syndrome suffered recurrent episodes of severe intractable diarrhoea, steatorrhoea, and hypocalcaemia. The only treatment modality, which controlled the malabsorption syndrome, was immunosuppression with intravenous high dose methylprednisolone and oral methotrexate maintenance therapy.     

Toxic cardiogenic shock in a patient receiving weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin

A 54-year-old man was treated with weekly 24-h infusion of high-dose 5-fluorouracil (2600 mg/m2) and leucovorin (100 mg/m2) for metastatic colon cancer. At first, he tolerated the treatment well and no significant toxicity was identified. After a total of eight courses of treatment, a stable disease was observed, but mild shortness of breath was found on occasion. The patient had no previous history of cardiac disease and the heart performance assessed by left ventricular ejection fraction before treatment was normal. Unfortunately, acute pulmonary edema with lethal cardiogenic shock occurred during the ninth course of treatment, in spite of intensive medical treatment. The chest X-ray showed extreme cardiomegaly. Repeated assessment of his heart function by echocardiogram and ventricular ejection fraction revealed a very poor cardiac performance. Toxic cardiogenic shock during weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin is extremely rare. To the best of our knowledge, no case has been reported in the English literature. We report a case and the relevant literature about the incidence, clinical picture and possible pathophysiology on 5-fluorouracil-related cardioxicity is reviewed.      

Distal femoral extension osteotomy and patellar tendon advancement or shortening in ambulatory children with cerebral palsy: A modified Delphi consensus study and literature review

Purpose:In children with cerebral palsy, flexion deformities of the knee can be treated with a distal femoral extension osteotomy combined with either patellar tendon advancement or patellar tendon shortening. The purpose of this study was to establish a consensus through expert orthopedic opinion, using a modified Delphi process to describe the surgical indications for distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening. A literature review was also conducted to summarize the recent literature on distal femoral extension osteotomy and patellar tendon shortening/patellar tendon advancement.Method:A group of 16 pediatric orthopedic surgeons, with more than 10 years of experience in the surgical management of children with cerebral palsy, was established. The group used a 5-level Likert-type scale to record agreement or disagreement with statements regarding distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening. Consensus for the surgical indications for distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening was achieved through a modified Delphi process. The literature review, summarized studies of clinical outcomes of distal femoral extension osteotomy/patellar tendon shortening/patellar tendon advancement, published between 2008 and 2022.Results:There was a high level of agreement with consensus for 31 out of 44 (70%) statements on distal femoral extension osteotomy. Agreement was lower for patellar tendon advancement/patellar tendon shortening with consensus reached for 8 of 21 (38%) of statements. The literature review included 25 studies which revealed variation in operative technique for distal femoral extension osteotomy, patellar tendon advancement, and patellar tendon shortening. Distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening were generally effective in correcting knee flexion deformities and extensor lag, but there was marked variation in outcomes and complication rates.Conclusion:The results from this study will provide guidelines for surgeons who care for children with cerebral palsy and point to unresolved questions for further research.Level of evidence:level V.     

Comparative studies on the phosphatides of normal rat liver and primary hepatoma

Summary A low phosphatide content was found in primary hepatoma of rat when compared with normal rat liver. Chromatographic analyses did not reveal, however, remarkable differences in the phosphatide composition of the normal and neoplastic tissue. The ratio of the ³²P incorporation in vitro into phosphatidylcholine and phosphatidylethanolamine was lower in normal rat liver than in primary liver tumour. Gas chromatographic analyses of fatty acids performed on total lipid and its different components disclosed also notable differences between hepatoma and normal liver. A significant difference was observed in the stearic acid-oleic acid proportions between phosphatides of rat liver and primary hepatoma. The plasmalogen content of hepatoma was relatively rather high. The comparative analysis of phosphatides was extended to cell fractions obtained by differential centrifugation and to a mitochondrial membrane fragment. Within one tissue the fatty acid composition appeared to be characteristic for the lipid component and was independent of the cell fraction. A similar ³²P pattern of the phosphatides from all cell fractions of one tissue was found after an incubation of slices with radioactive phosphate. Consequently the observed differences between phosphatides of normal rat liver and hepatoma are distributed throughout the cells.

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Zusammenfassung Im primären Hepatom der Ratte (Verfütterung von Dimethylaminoazobenzol) wurde im Vergleich zu normaler Rattenleber ein erniedrigter Gehalt an Phosphatiden bei weitgehend gleichartiger Zusammensetzung gefunden. Während in normaler Leber die in vitro-Einbaurate von ³²P-Phosphat in Phosphatidylcholin und in Phosphatidyläthanolamin etwa gleichartig hoch war, zeigte das Hepatom einen bevorzugten Einbau in Phosphatidylcholin. In der Zusammensetzung der Fettsäuren der Gesamt-Lipide und ihrer verschiedenen Komponenten (gaschromatographische Analysen) bestanden deutliche Unterschiede zwischen Leber und Hepatom, wobei besonders bemerkenswert im Hepatom die signifikante Zunahme der Ölsäure auf Kosten der Stearinsäure in der Phosphatidfraktion war. Der Plasmalogen-Gehalt im Hepatom war relativ erhöht. —Die vergleichende Analyse der Phosphatide wurde auch auf durch differentielle Zentrifugation erhaltene Zellfraktionen und auf Mitochondrienmembran-Fragmente ausgedehnt. Innerhalb eines Gewebes (Leber bzw. Hepatom) schien die Zusammensetzung der Fettsäuren charakteristisch für die Lipid-Komponente aber unabhängig, von der Zellfraktion zu sein. Nach Inkubation von Gewebsschnitten mit ³²P-Phosphat wurde in allen Zellfraktionen eine ähnliche und dem Gesamtgewebe entsprechende ³²P-Verteilung bei den Phosphatiden gefunden. Die beobachteten Unterschiede zwischen den Phosphatiden der normalen Rattenleber und des Hepatoms sind demnach bei beiden Geweben in der ganzen Zelle gleichmäßig vorhanden.

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Contribution No 14 in the series: Metabolism and functions of phosphatides. This work is part of the thesis of J. H. Veerkamp, Utrecht 1960.