[Radiographic evaluation of femoral and tibial tunnel position in anterior cruciate ligament reconstruction with anatomic technique]. / Evaluación radiográfica de la posición del túnel femoral y tibial en reconstrucción de ligamento cruzado anterior con técnica anatómica.

INTRODUCTION: Reconstruction of the anterior cruciate ligament attempts to reproduce the native ligament; make independent tunnels optimize the entry points and effectiveness the anatomy. Perform radiographic measurements of the knee, identify position of femoral and tibial tunnels in patients operated for reconstruction of anterior cruciate ligament with anatomical technique. MATERIAL AND METHODS: Patients were identified in the period January 2018 to December 2019. 98 patients were retrospectively evaluated. Radiographic measurements in the femur, the inclination angle of the tunnel, the insertion site with respect to the Blumensaat line and the transosseous distance were determined. In tibia, the location in percentage of the tibial plateau location in anteroposterior and lateral view, tibial tunnel angle. RESULTS: Postoperative patients were 98. (75.5%) male, female (24.5%). Postoperative in 2018 (57.15%) and 2019 (42.85%) Age range: affected group was 21-25 years, right side affected in 57.15%; Radiographic measurements in femur, the angle of inclination of the tunnel was 45o, percentage in the Blumensaat line was 20%, and the transosseous distance was 3.43 cm. In tibia the percentage distance in anteroposterior projection was 44%, and lateral 28%, The angle in tibial tunnel anteroposterior projection of 73 degrees, and lateral 114. CONCLUSION: The anatomical technique is a good option to perform tunnels with an optimal anatomical position. By making independent tunnels it allows to improve coverage of normal antomic footprint. Increases degrees and inclination of tunnels, causes added injuries.

INTRODUCCIÓN: En la reconstrucción de ligamento cruzado anterior se intenta reproducir ligamento nativo, realizar túneles independientes, optimizar los puntos de entrada y la efectividad de la anatomía; hacer mediciones radiográficas de rodilla, identificar la posición del túnel femoral y tibial en pacientes operados de reconstrucción de ligamento cruzado anterior con técnica anatómica. MATERIAL Y MÉTODOS: Se identificaron pacientes en el período de Enero de 2018 a Diciembre de 2019. Se evaluaron de manera retrospectiva 98 pacientes. Mediciones radiográficas en fémur: se determinó el ángulo de inclinación del túnel, el sitio de inserción con respecto a la línea de Blumensaat y la distancia transósea. En tibia: la ubicación en porcentaje de la localización de platillo tibial en proyección anteroposterior y lateral, ángulo de túnel tibial. RESULTADOS: Los pacientes postoperados fueron 98, masculinos (75.5%) y femeninos (24.5%). Postoperados en el año 2018 (57.15%) y en 2019 (42.85%). Rango de edad: el grupo afectado fue de 21-25 años, lado afectado: derecho en 57.15%. Mediciones radiográficas en fémur: el ángulo de inclinación del túnel fue de 45o, el porcentaje en la línea de Blumensaat fue de 20% y la distancia transósea fue 3.43 cm. En tibia la distancia porcentual en proyección anteroposterior fue de 44% y lateral de 28%. El ángulo en túnel tibial en proyección anteroposterior fue de 73º y lateral de 114º. CONCLUSIÓN: La técnica anatómica es una buena opción para efectuar túneles con posición anatómica óptima. Realizar túneles independientes permite mejorar la cobertura de la huella anatómica normal, aumenta los grados y la inclinación de túneles y provoca lesiones agregadas.

Superovulatory response and embryo development in ewes treated with two doses of bovine somatotropin.

This study evaluated whether the administration of 50 and 100mg bovine somatotropin (bST) at the start of synchronization and at the time of natural mating in ewes improves the ovulation rate, embryonic development and pregnancy rate of transferred embryos. Forty-eight donors were assigned to three treatments: the bST-100 treatment (n=15) received 100mg bST at the start of synchronization and at natural mating, the bST-50 treatment (n=15) received 50mg bST on the same schedule as the previous group, and the control (n=18) did not receive any bST. Two embryos were transferred to each recipient (n=121): 35 received embryos from bST-100; 50 received embryos from bST-50, and 36 received embryos from the control. The superovulatory rate, percentage of recovered structures, cleavage rate, percentage of transferable embryos, embryo quality and development and pregnancy rate were analyzed using the GENMOD procedure of SAS. The number of corpora lutea and the cell number were analyzed using the GLM procedure of SAS. The insulin and IGF-1 concentrations were analyzed with ANOVA for repeated measures. The bST application did not affect the superovulatory rate, number of corpora lutea and recovered structures (P>0.05). The numbers of transferable embryos and embryos reaching the blastocyst were higher (P≤0.01) in the bST-50 (96.4±3.6% and 69.0±7.8%) than the bST-100 (93.0±4.5% and 27.2±38.9%) and control (87.7±5.4% and 50.4±6.4%) groups. The insulin and IGF-1 concentrations were higher (P<0.05) in the bST-treated groups, but the insulin concentration was higher (P<0.05) in the bST-100 group than in the bST-50 group. The pregnancy rate was similar (P=0.21) in ewes receiving embryos from the two treatments [bST-50, (70.0%); bST-100, (62.5%), and control, (56.6%)]. The administration of 50mg bST at the start of synchronization and at natural mating in superovulated ewes was concluded to enhance the proportion and development of transferable embryos. However, bST did not affect the pregnancy rate of transferred embryos.

Delivery of Flt3 ligand (Flt3L) using a poloxamer-based formulation increases biological activity in mice.

Fms-like tyrosine kinase (Flt3L) is a potent stimulator of hematopoietic progenitor cell (HPC) expansion and mobilization; however, this requires 7-10 days of administration. We investigated whether sustained delivery of Flt3L using a poloxamer-based matrix (PG) could accelerate and/or improve the hematopoietic activity of Flt3L in mice. A single injection of PG-Flt3L stimulated significantly more rapid and greater HPC mobilization to the spleen and peripheral blood than the daily injection of Flt3L formulated in saline. Pharmacokinetic analysis demonstrated that the formulation of Flt3L in PG prolonged its elimination (Tbeta) half-life (2.3-fold) and increased its bioavailability (>two fold) and the time to maximum serum concentration (T(max)) (2.7-fold). Further, coadministration of G-CSF and PG-Flt3L allowed lower doses of Flt3L to be active, with significantly greater hematopoietic and mobilization activity, compared to the same total dose of G-CSF, Flt3L or G-CSF and Flt3L formulated in saline. These data demonstrate that formulation of Flt3L in PG significantly accelerates and increases HPC expansion and mobilization. The observation of increased bioactivity by PG-Flt3L in rodents suggests the potential for improved clinical efficacy of Flt3L by reducing the time required for HPC mobilization.

Percutaneous biopsy of cavernous sinus tumors through the foramen ovale.

OBJECTIVE: We present a new application to the widely used Hartel percutaneous route through the foramen ovale to the parasellar region to obtain aspiration biopsies of lesions arising from or invading the posterolateral part of the cavernous sinus. METHODS: Thirteen patients with cavernous sinus lesions that were diagnosed using imaging underwent aspiration biopsy by this route. Nine of them were subsequently operated on, and two will undergo surgery in the near future. For the remaining two, surgical removal of the tumor was not indicated. One of these two patients had a meningioma without any related symptoms and no growth revealed by repeated computed tomographic scans, and the other was diagnosed as having a nasopharyngeal carcinoma and consequently received radiotherapy. RESULTS: The accuracy of diagnosis with this technique was 84%. There was no complication related to the procedure. Having knowledge of the pathological diagnosis before determining the correct treatment helped to define the most appropriate strategy. CONCLUSION: We suggest that aspiration biopsy procedures through the foramen ovale be performed in cavernous sinus tumors before making any decision to indicate open surgical, radiosurgical, and/or radiotherapeutic treatments.

The epidemiology of sharps injuries and splash exposures at a military medical center.

Health care workers (HCWs) are subject to sharps injuries and splash exposures on a daily basis, and are therefore at risk for infection with a number of bloodborne pathogens. We conducted a review of sharps injuries and splash exposures at our institution. Although nursing personnel most often sustained sharps injuries, many HCWs from different patient care occupations are involved, and underreporting obscures the magnitude of the problem. Sharps injuries are most commonly caused by hollow-bore needles, although many devices in the hospital environment are capable of causing injury. Most sharps injuries occur after the device is used, but before disposal. Reducing the number of sharps injuries will require a multifaceted approach including reducing the need for using sharps, better HCW instruction in preventing injuries, and improved instrument design.

Effects of antiepileptic drugs on reaction time, attention, and impulsivity in children.

Simple, choice, and complex reaction times, attention (variability of responses and omission errors), and impulsivity (commission and wrong-hand errors on choice and complex reaction time) were repeatedly measured in 111 epileptic children, aged 5 to 13 years, tested a total of 232 times. Antiepileptic drugs (AEDs) were started, stopped, and adjusted throughout the study period, for a variety of clinical indications, and AED serum levels were monitored. The relationship of performance to AED serum level was examined. Overall the nonspecific effect of AEDs was minimal: higher total serum levels of AEDs correlated with more impulsive errors on complex reaction time testing only. In contrast, in 54 children receiving carbamazepine monotherapy, we found a dose-related beneficial effect upon reaction time, with higher serum levels associated with faster responses and fewer omission errors, particularly on complex reaction time. Phenobarbital caused minimal dose-related effects: only variability and impulsive errors increased with increasing serum levels, and only on one segment of the test (73 subjects).

Reaction time, attention, and impulsivity in epilepsy.

Reaction time, attention, and impulsivity were studied in 112 children with epilepsy (4.5-13 years) using a computerized test. We measured simple reaction time (response with each hand separately to a single stimulus), forced choice reaction time (two stimuli presented in random order, one designated for each hand), and choice reaction time with distraction (two response stimuli, one for each hand, with two additional distracting stimuli randomly inserted). We also measured variability of speed of response and errors of omission and commission. Controls were unaffected children of similar age, ethnic, and socioeconomic backgrounds. Children with epilepsy were significantly slower, more variable, and made more omission errors than control children, even when analysis was limited to epileptic patients with IQ greater than 90, but they did not make more commission (i.e., impulsive) errors. Reaction times were related to IQ, but in general were not related to seizure severity, duration of seizure disorder, or duration of medication use. Untreated patients (N = 13) did not differ from those with antiepileptic drug levels in the therapeutic range on the day of testing (N = 52), but differed significantly from normal patients. Epileptic patients demonstrated significant slowing of reaction time and inattention, but not significant impulsivity, compared to normal children; however, these deficits do not appear to be related specifically to seizure history or treatment.

Academic underachievement in children with epilepsy.

Academic achievement was studied in 78 children with epilepsy, ages 5 to 13 years, to determine how seizures, treatment of seizures, and sociocultural factors influence academic achievement. Cognitive abilities were assessed with either the McCarthy Scales of Children's Abilities or the Wechsler Intelligence Scale for Children--Revised. Achievement was measured with the Peabody Individual Achievement Tests. Achievement scores were corrected for cognitive ability (IQ), and underachievement was defined as achievement score 1/2 standard deviation or more below IQ. Information regarding seizure history (severity, duration) and treatment with anticonvulsant drugs was obtained. In addition, the family was extensively interviewed regarding the child's environment, behavior, and demographic background. The Home Observation for Measurement of the Environment (HOME) scale was completed on a home visit. Underachievement was frequent, ranging from 16% (Reading Recognition) to 50% (General Knowledge), but there was no relationship between severity or duration of seizure disorder or total exposure to anticonvulsant medications and achievement. Major determinants of achievement included subscales of the HOME scale, age (older children more likely to be underachieving), and parental education. An equal proportion of newly diagnosed and/or untreated subjects were underachieving compared to those with longstanding epilepsy and anticonvulsant drug treatment.

Reaction time, impulsivity, and attention in hyperactive children and controls: a video game technique.

Maturation of sustained attention was studied in a group of 52 hyperactive elementary school children and 152 controls using a microcomputer-based test formatted to resemble a video game. In nonhyperactive children, both simple and complex reaction time decreased with age, as did variability of response time. Omission errors were extremely infrequent on simple reaction time and decreased with age on the more complex tasks. Commission errors had an inconsistent relationship with age. Hyperactive children were slower, more variable, and made more errors on all segments of the game than did controls. Both motor speed and calculated mental speed were slower in hyperactive children, with greater discrepancy for responses directed to the nondominant hand, suggesting that a selective right hemisphere deficit may be present in hyperactives. A summary score (number of individual game scores above the 95th percentile) of 4 or more detected 60% of hyperactive subjects with a false positive rate of 5%. Agreement with the Matching Familiar Figures Test was 75% in the hyperactive group.

Carbamazepine versus phenobarbital for partial onset seizures in children.

Thirty-nine children were treated with either phenobarbital (PB) or carbamazepine (CBZ) for newly diagnosed partial onset seizures. Drug selection was randomized in 33 subjects. Parents and the psychologist evaluating the child were blind to drug identity. Psychometric and behavioral evaluations were done at intake and at 6- and 12-month follow-ups. There were no significant differences between drugs in effect on behavior or cognitive function. CBZ caused more systemic problems. There was a trend toward better seizure control with CBZ, but this was not statistically significant. Although individual children in each group had changes in behavior or cognitive status, neither group changed significantly, in either acute or chronic follow-up.