A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction.

PURPOSE: The aim of this study is to describe and validate a simple and reliable method to pre-operatively predict the size of the ACL graft in the double strand technique with autologous semitendinosus-gracilis tendons on the same MRI used for ACL rupture diagnosis. METHODS: The study included 92 patients, with a median age of 31 years (IQR 26-41 years), 73/92 (79%) of whom were males. All patients that underwent an ACL reconstruction with doubled ST + GT between 2017 and 2022 were counted in the study. RESULTS: Overall, the median predicted graft diameter from MR imaging was similar to the actual graft diameter with no significant differences (n.s.). Regarding the comparison between predicted and actual graft size, concordance was 78/92 (85%, 95% CI 76-91%), with κ = 0.797 which corresponds to a level of agreement defined as "Strong". Tendon sizes calculated on pre-operative MRI were evaluated both with intra-observer and inter-observer reliability demonstrating a statistically reproducible method. The predicted graft was then compared to the reported one with a statistically significant reliability found. CONCLUSION: This study can help the surgeons to perform a fast pre-operative planning of an ACL reconstruction for graft selection. If the planned graft with ST and GT is smaller than 8 mm, the clinician can decide to switch to a different type of graft or plan a different graft preparing technique and, therefore, reduce the risk of post-operative ligament re-rupture. The method proposed is reliable and reproducible. The major strength of the planning technique proposed is that it relies on data that are already available for the clinician before surgery, without the need of further analysis. LEVEL OF EVIDENCE: IV.

Identification and Characterization of Citrus Chlorotic Spot Virus, a New Dichorhavirus Associated with Citrus Leprosis-Like Symptoms.

Local chlorotic spots resembling early lesions characteristic of citrus leprosis (CL) were observed in leaves of two sweet orange (Citrus sinensis L.) trees in Teresina, State of Piauí, Brazil, in early 2017. However, despite the similarities, these spots were generally larger than those of a typical CL and showed rare or no necrosis symptoms. In symptomatic tissues, transmission electron microscopy revealed the presence of viroplasms in the nuclei of the infected parenchymal cells and rod-shaped particles with an average size of approximately 40 × 100 nm, resembling those typically observed during infection by dichorhaviruses. A bipartite genome of the putative novel virus, tentatively named citrus chlorotic spot virus (CiCSV) (RNA1 = 6,518 nucleotides [nt] and RNA2 = 5,987 nt), revealed the highest nucleotide sequence identity values with the dichorhaviruses coffee ringspot virus strain Lavras (73.8%), citrus leprosis virus N strain Ibi1 (58.6%), and orchid fleck virus strain So (56.9%). In addition to citrus, CiCSV was also found in local chlorotic lesions on leaves of the ornamental plant beach hibiscus (Talipariti tiliaceum (L.) Fryxell). Morphological characterization of mites recovered from the infected plants revealed at least two different types of Brevipalpus. One of them corresponds to Brevipalpus yothersi. The other is slightly different from B. yothersi mites but comprises traits that possibly place it as another species. A mix of the two mite types collected on beach hibiscus successfully transmitted CiCSV to arabidopsis plants but additional work is required to verify whether both types of flat mite may act as viral vectors. The current study reveals a newly described dichorhavirus associated with a citrus disease in the northeastern region of Brazil.

Risk factors for post-operative shoulder stiffness: are there new candidates?

The aim of this study was to document the incidence of postoperative shoulder stiffness (SS) after arthroscopic rotator cuff repair and evaluate the role of risk factors for its development. Seventy-five consecutive patients that underwent arthroscopic rotator cuff repair were included. The incidence of postoperative SS was prospectively investigated and the presence of 20 potential risk factors was documented retrospectively. The incidence of post-operative SS was 10.4%. All patients were women, and sex was significantly associated to pathology development (p=0.0067). The presence of gastroesophageal diseases was found to be significantly associated with post-operative SS development (p=0.0046). A significant association between the occurrence of post-operative SS and the presence of gastroesophageal diseases was identified. This finding, not yet reported in literature, deserves further investigation. The incidence of postoperative SS fell among previously reported ranges, with females significantly more affected than men.

Traditional lateral ileostomy versus percutaneous ileostomy by exclusion probe for the protection of extraperitoneal colo-rectal anastomosis: the ALPPI (Anastomotic Leak Prevention by Probe Ileostomy) trial. A randomized controlled trial.

BACKGROUND: Low colo-rectal anastomoses have a relevant risk of leakage. The protective stomas (ileostomy or colostomy) have always been utilized to reduce the complications due to anastomotic leakage. The stoma not only causes relevant morbidity but also needs a second operation to be closed, with an added risk of complications. PURPOSE: For this reason we planed and carried out a temporary percutaneous ileostomy by a jejunal probe introduced in the distal ileum, that can be removed without a surgical procedure and with negligible complications. METHODS: The ALPPI trial is a randomized controlled, open, parallel, equivalence multicenter study. Patients undergoing elective laparoscopic or laparotomic surgery for rectal cancer with extraperitoneal anastomosis, will be randomly allocated to undergo either lateral ileostomy or percutaneous ileostomy by exclusion probe. RESULTS: The primary endpoint is the protection of the extraperitoneal colo-rectal anastomosis in terms of incidence of symptomatic and asymptomatic anastomotic leakages. The secondary endpoints are the evaluation of complications due to the placement and the removal of the exclusion probe for percutaneous ileostomy. CONCLUSIONS: The ALPPI trial is designed to provide the surgical community with an evidence based new technique in the protection of low colo-rectal anastomosis, alternative to the conventional stomas. TRIAL REGISTRATION: The ALPPI trial was approved by the Ethical Committee of Regional Public Health System of Umbria, Italy, (Protocol Number 28657/11/AV, study code RO-MA 01) and it is registered in the International Standard Randomised Controlled Trial Number (ISRCTN) Register with identification number ISRCTN99356919.

Common Bean: Experimental Indicator Plant for Citrus leprosis virus C and Some Other Cytoplasmic-Type Brevipalpus-Transmitted Viruses.

Citrus leprosis (CL) caused by Citrus leprosis virus C (CiLV-C) is present in Latin America from Mexico to Argentina, where citrus plants are grown. CiLV-C is transmitted by the tenuipalpid mite, Brevipalpus phoenicis, causing localized lesions on citrus leaves, fruit, and stems. One limitation to study of the virus-vector-host relationship in this pathosystem is the lack of a suitable assay plant. On Citrus spp. used as susceptible hosts, symptoms may take weeks or months to appear after experimental inoculation by viruliferous mites. Common bean (Phaseolus vulgaris) was found to respond with localized necrotic lesions after inoculation with viruliferous B. phoenicis in 5 days. Thus far, 113 tested common bean varieties and lines and some recent accessions of varied genetic background behaved in a similar way. Black bean 'IAC Una' was adopted as a standard test variety. When inoculated leaves were left at 28 to 30°C, the period for the lesion appearance was reduced to only 2 days. Confirmation that the lesions on common bean leaves are caused by CiLV-C were made by transmission electron microscopy, immunofluorescence, enzyme-linked immunosorbent assay, and reverse-transcription polymerase chain reaction specific for CiLV-C. Common bean plants mite-inoculated with some other cytoplasmic-type Brevipalpus-transmitted viruses (BrTVs) (Passion fruit green spot virus, Solanum violaefolium ringspot virus, Ligustrum ringspot virus, and Hibiscus green spot virus) also responded with necrotic local lesions and may serve as test plants for these viruses. Two nuclear types of BrTV (Coffee ringspot virus and Clerodendrum chlorotic spot virus) were unable to produce symptoms on common bean.

Best indications for local anaesthetics: bupivacaine.

Bupivacaine is a local anaesthetic of great potency and long duration but has also well known cardio-and CNS toxic side-effects. For many years it was nearby the only local anaesthetic with these characteristics, making it applicable to almost all kind of loco-regional anaesthetic techniques, and still nowadays, for economical reasons it is in many occasions the only alternative available. In this review, departing from analysis of the physical, chemical and pharmacological properties of this molecule and considering also its toxic potencies we wanted to analyze all clinical situations in which it is used. But above all we have reviewed the most recent international literature, which are actually the best indications for this drug, that in the last years with the appearance of first ropivacaine and then levobupivacaine, seemed to have lost its field of elective application. According to these analysis we concluded that this drug, though still remaining a good alternative in many fields of loco-regional anaesthesia (like peripheral blocks), as well as an efficient drug equal to the above mentioned ones in any sector like epidural analgesia in caesarean section, its best indication is subarachnoideal anaesthesia (combined and not) where it is the best available drug in hyperbaric solution without doubts. It might be interesting in the next future the comparison with hyperbaric solutions of levobupivacaine (not yet available).

Problems with quality monitoring for Medicaid managed care: perceptions of institutional and private providers in New York City.

The study objective was to examine quality oversight efforts by Medicaid managed care organizations (MCOs) for children in a sample of ambulatory care institutions and private practices in New York City. This was a cross-sectional study of quality assurance priorities and strategies of MCOs and their impact date in institutions in New York City. Data were from structured interviews administered in 1997 to medical directors in the eight largest MCOs; and medical directors, heads of ambulatory pediatrics, and institutional pediatricians in a random sample of 15 institutions and 20 private office-based providers. Medical directors in MCOs reported that their main priority areas were the preventive care measures (e.g., immunization and lead screening) that they must report to the state. Knowledge of these MCO priority areas and monitoring activities was high for medical directors in the random sample, but decreased from these medical directors to heads of ambulatory pediatrics to institutional pediatricians, with the differences between the medical directors and institutional pediatricians significant (P < .05). However, 96% of the institutional pediatricians reported knowing their own institution's priorities and monitoring activities. In contrast, most private pediatricians reported they knew MCO priorities and monitoring activities (80%). Less than 33% of any group reported activities as "very effective" or felt any incentive to improve performance. There was a high level of overlap in provider networks, with institutions and private providers having children in many MCOs, and MCOs having children in many sites. Conclusions. The current model of quality oversight is producing reports for the state, but is not translating into effective strategies at the provider level. The need to work through the leadership in institutions to influence quality is highlighted. The level of overlap in provider networks suggests the need for collaboration among MCOs in quality monitoring.

Thoracoscopic truncal vagotomy.

BACKGROUND: Nowadays the only indications to truncal vagotomy is recurrent ulceration after previous gastric surgery. Truncal vagotomy allows us to obtain a reduction in acid production and to promote ulcer healing, but this technique causes pylorospasm in about 20% of cases and this requires further synchronous or metachronous pyloric drainage procedure. For this reason, videothoracoscopic truncal vagotomy is reserved to patients with gastroresection. METHODS: The authors describe 15 patients treated with videothoracoscopic truncal vagotomy. In 12 patients, a gastrojejunostomy was done according to Roux technique in 2 patients, a reconstruction according Billroth II technique and in 1 patient, a gastroduodenostomy according to Billroth I technique. RESULTS: Videothoracoscopic bilateral truncal vagotomy was done in all patients; operation time was 45 minutes. During the postoperative period there were no complications. No patients underwent medical therapy for peptic ulcer. Only in 12 patients was it possible to execute an endoscopic follow-up in a period of 3 to 4 years. In all patients the ulcer was completely healed. CONCLUSIONS: Complete vagotomy in patients who present with recurrent gastrointestinal bleeding after previous gastroresection, is associated with significant risks. Videothoracoscopic bilateral truncal vagotomy as a simple and efficient procedure seems to be an alternative treatment for the management of recurrent ulceration after previous gastric surgery for peptic disease.

[Colo-anal anastomosis in tumors of the lower rectum]. / L'anastomosi colo-anale nei tumori del retto basso.

The Authors report their experience about totally mechanical coloanal anastomoses. Seven patients affected by rectal cancer and submitted to proctosigmoidectomy and, following totally mechanical coloanal anastomoses as described by Goligher are taken in consideration. The distance of the neoplasm from the anal verge goes from 5 to 7 cm. Using Dukes classification 6 patients were classified in B stage, only 1 in A stage and nobody in C stage. No patient received adjuvant radiotherapy. In the patients in B stage has been performed an extended ilio-pelvic lynfoadenectomy. Particular attention was put on the complete remotion of the mesorectum. In no case has been provided with a creation of a diverting colostomy. No mortality in the post-operative period nor anastomotic leakages haven't been recorded. The follow-up goes from a minimum of 8 months to a maximum of 7 years. Have been reported 2 cases of recurrence, at pelvic level after 18 months and at empathic level after 8 months from intervention. In 6 of the 7 patients have been valued the functional results that have put in evidence a satisfying gas and fecal continence. Only during the first months following the intervention has been recorded an increasing of the number of defecation that have reduced in the long term.

Seasonal variations in the rupture of abdominal aortic aneurysms.

From 1982 to 1994, 54 patients (47 men; mean age 72 years) were referred to the Hospital of Ferrara, Italy for spontaneous rupture of abdominal aortic aneurysm. Sixteen died in the emergency department and 38 underwent urgent surgery. Day and month of onset of acute symptoms leading to urgent surgery were recorded. A seasonal variation with significant peaks in spring and autumn was found. These findings are likely influenced by local environmental, social and epidemiological factors, but may be relevant for the appropriate timing of the follow-up and therapeutic strategies for abdominal aortic aneurysms.

Chronobiologic aspects of ischemic coronary artery disease.

Convincing evidence is now available suggesting that several unfavorable cardiovascular events respect a well-defined diurnal pattern in their occurrence. In particular, ischemic heart disease has been widely investigated, and many data indicate a constellation of underlying risk factors whose temporal coincidence might act as triggering factors in the occurrence of acute events. In this paper, the recent knowledge concerning both epidemiology of ischemic heart disease and potentially favoring factors are reviewed from a chronobiological point of view.

[Primary cancer of the gastric stump. Apropos of 8 cases]. / Cancer primitif du moignon gastrique. A propos de huit observations.

The authors review their experience of 8 cases of primary carcinoma of the gastric stump during the period 1989-1992. During the same period, 164 gastric cancers were treated in the same department. Mean duration between primary gastric resection and diagnosis of gastric stump carcinoma was 30 years (6 to 42 years). All patients underwent a Billroth II primary gastric resection. Only 4 patients underwent radical surgical resection of their gastric stump carcinoma; 2 patients underwent only explorative laparotomy for very advanced and unresectable gastric stump carcinoma; 2 patients were inoperable because of their general status. This series of 8 cases of gastric stump carcinoma emphases the importance of endoscopic investigations during follow-up of patients with gastric resection, in order to diagnose and treat resectable gastric stump carcinoma.

Preoperative evaluation of inferior vena cava involvement secondary to malignant abdominal neoplasms.

The authors report their experience of different imaging techniques (US, CT, MRI, and cavography) used to evaluate inferior vena cava involvement due to abdominal malignant neoplasms. The study is a retrospective analysis of preoperative data on 15 patients of both sexes in comparison with intraoperative and/or pathological findings. All patients underwent ultrasonography, with good results in all the venous segments studied, as for the CT scan; the limitation of both techniques is the unsafe evaluation of venous wall involvement when the neoplastic tissue is confined inside the vessel. The results obtained using MRI seem to be very encouraging, but we only studied three cases with this technique, and so cannot assess the real value of the method. In nine patients we performed inferior cava phlebography: we believe this to be a very reliable exam to demonstrate vessel wall invasion, even if it is a very invasive procedure, its limits being the inability to observe proximal thrombotic extension when the vein is completely obstructed by the tumor. On the basis of their experience the authors suggest a multi-technique imaging diagnostic procedure for preoperative staging with a view to obtaining as much information as possible to correctly program surgical procedure.