Patrón de revascularización de injertos de tendones flexores rotos en reconstrucción de ligamento cruzado anterior: un estudio histológico / Revascularisation pattern of ruptured flexor tendon grafts in anterior cruciate ligament reconstruction: a histological study

Introducción. Para la reconstrucción exitosa del ligamento cruzado anterior (LCA) son necesarias la revascularización y la maduración histológica del injerto. Fallos en este proceso pueden causar la rotura del neoligamento. Objetivo. Describir las diferencias en la maduración histológica de plastias fallidas precoces (menos de 12 meses poscirugía) y tardías (más de 12 meses poscirugía) en pacientes con rerrotura de reconstrucción de LCA con tendones flexores. Materiales y métodos. Estudio observacional descriptivo. Serie consecutiva de 20 pacientes con fallo en la reconstrucción de LCA con tendones flexores. Muestras obtenidas mediante biopsia de los remanentes del injerto (porción proximal, corporal y distal) durante la cirugía de revisión. Las muestras fueron evaluadas por microscopia de luz y la vascularización y la maduración fueron establecidas mediante un puntaje histológico descrito en la literatura. Resultados. La causa más común de fallo de reconstrucción (86,6%) fue un evento identificable sin mediar traumatismo directo. Los pacientes con rotura precoz de la plastia del LCA presentaron vasos sanguíneos más superficiales en comparación con los con rotura tardía. El segmento distal del injerto en los pacientes con roturas precoces mostró una menor maduración histológica con menor número de fibras de colágeno. Conclusión. En los pacientes que presentaron fallos en las reconstrucciones de LCA precoces (dentro de los 12 meses poscirugía) encontramos una distribución menor de vasos sanguíneos y fibras de colágeno en la región distal del injerto. Estos resultados indican un retraso en la maduración, pudiendo generar mayor riesgo de fallo del injerto (AU)

Introduction. For successful anterior cruciate ligament (ACL) reconstruction, revascularisation and histological maturation are necessary, as their failure can cause graft rupture. Purpose. The purpose of this study was to describe differences in the histological maturation of early failed plasty (less than 12 months after surgery) and late failed plasty (more than 12 months after surgery) in patients with re-rupture after ACL reconstruction with hamstring tendons. Material and methods. A descriptive observational study was conducted on a consecutive series of 20 patients whose ACL reconstruction had failed. Graft biopsy samples were obtained during the revision surgery from the proximal, medial, and distal graft remnants. The samples were evaluated by light microscopy, and the vascularity and maturation of the samples were established by histological scoring. Results. The most common aetiology of reconstruction failure (86.6%) was a specific event with non-contact mechanism. The patients with re-rupture of their ACL plasty less than 12 months after surgery had substance vessels that were less deep. The distal segment of the graft in those patients showed a delay in histological maturation with fewer collagen fibres. Conclusion. In patients whose ACL grafts failed less than 12 months after surgery, a lower distribution of blood vessels and collagen fibres was found that were less ordered in the distal graft. These results indicate a delay in maturation, which leads to a higher risk of graft failure (AU)

Revascularisation pattern of ruptured flexor tendon grafts in anterior cruciate ligament reconstruction: A histological study. / Patrón de revascularización de injertos de tendones flexores rotos en reconstrucción de ligamento cruzado anterior: un estudio histológico.

INTRODUCTION: For successful anterior cruciate ligament (ACL) reconstruction, revascularisation and histological maturation are necessary, as their failure can cause graft rupture. PURPOSE: The purpose of this study was to describe differences in the histological maturation of early failed plasty (less than 12 months after surgery) and late failed plasty (more than 12 months after surgery) in patients with re-rupture after ACL reconstruction with hamstring tendons. MATERIAL AND METHODS: A descriptive observational study was conducted on a consecutive series of 20 patients whose ACL reconstruction had failed. Graft biopsy samples were obtained during the revision surgery from the proximal, medial, and distal graft remnants. The samples were evaluated by light microscopy, and the vascularity and maturation of the samples were established by histological scoring. RESULTS: The most common aetiology of reconstruction failure (86.6%) was a specific event with non-contact mechanism. The patients with re-rupture of their ACL plasty less than 12 months after surgery had substance vessels that were less deep. The distal segment of the graft in those patients showed a delay in histological maturation with fewer collagen fibres. CONCLUSION: In patients whose ACL grafts failed less than 12 months after surgery, a lower distribution of blood vessels and collagen fibres was found that were less ordered in the distal graft. These results indicate a delay in maturation, which leads to a higher risk of graft failure.

Utilidad de la resonancia magnética en la evaluación del mal alineamiento patelar / Usefulness of magnetic resonance imaging in the evaluation of patellar malalignment

Objetivos. Evaluar la utilidad de la resonancia magnética (RM) tomada en 20° de flexión de rodilla en el diagnóstico del dolor patelofemoral (DPF) causado por mal alineamiento patelar (MAP). Material y método. Se realizaron 25 RM en pacientes con DPF en los cuales se sospechó de MAP como causa y 25 en pacientes sin DPF (grupo control). Se midieron: distancia surco intertroclear-tuberosidad anterior tibial (SIT-TAT) y los ángulos de: Laurin modificado, Merchant y Troclear. Análisis estadístico con los test de ANOVA, Fischer y Pearson. Resultados. Hubo diferencias significativas entre los pacientes con DPF vs. grupo control en relación a: distancia SIT-TAT (11,79 mm vs. 9,35 mm, p = 0,002), ángulo de Laurin modificado (12,17° vs. 15,56°, p = 0,05) y ángulo Troclear (139° vs. 130,02°, p = 0,049). Respecto al ángulo de Merchant no hubo diferencias significativas. La distancia SIT-TAT tuvo un valor predictivo positivo (VPP) del 70% para DPF, con una sensibilidad del 51,61% y una especificidad del 53,33%. El ángulo de Laurin modificado tuvo un VPP del 77,78% para DPF, con una sensibilidad del 28% y una especificidad del 92%. El ángulo Troclear tuvo un VPP del 85,71% para DPF, con una sensibilidad del 24% y una especificidad del 96%. Conclusiones. La RM en 20° de flexión puede confirmar el MAP como causa de DPF. La determinación de alteraciones de la distancia SIT-TAT, báscula patelar y ángulo Troclear se correlaciona positivamente con la presencia del DPF, sugiriendo que este es causado por un mal alineamiento leve (AU)

Objectives. The aim of this study is to evaluate the usefulness of Magnetic Resonance Imaging (MRI) at 20° of knee flexion in patients with patellofemoral pain syndrome (PFPS) caused by suspected patellofemoral malalignment (PFM). Material and method. Fifty MRIs were performed on 25 patients with PFPS secondary to suspected PFM based on clinical examination, and on 25 patients without PFPS (control group). Measurements were made of tibial tuberosity-trochlear groove distance (TTTG) and modified Laurin, Merchant and trochlear angles. The results were analyzed with ANOVA and Fischer tests. Pearson correlation coefficients were used to analyze differences between PFPS and control cases. Specificity, sensitivity, positive predictive value and negative predictive value for knee pain were documented. Results. Significant differences were observed between PFPS and control groups in TTTG (11.79 mm vs. 9.35 mm; P=.002), Laurin angle (12.17° vs. 15.56°; P=.05), and trochlear angle (139° vs. 130.02°; P=.049). No differences were found between groups as regards the Merchant angle (P=.5). TTTG was 70% predictive of PFPS; however, it was only 53.33% specific, with a sensitivity of 51.61% for PFPS. Laurin angle was 77.78% predictive of PFPS, with a specificity of 92% and a sensitivity of 28%. Trochlear angle was 85.71% predictive of PFPS, with a specificity of 96% and a sensitivity of 24%. Conclusions. MRI can confirm clinically suspected PFPS secondary to malalignment. MRI determination of TTTG, patellar tilt, and trochlear angle correlates positively with clinical diagnosis of PFPS, suggesting that PFPS is caused by subtle malalignment (AU)

[Usefulness of magnetic resonance imaging in the evaluation of patellar malalignment]. / Utilidad de la resonancia magnética en la evaluación del mal alineamiento patelar.

OBJECTIVES: The aim of this study is to evaluate the usefulness of Magnetic Resonance Imaging (MRI) at 20° of knee flexion in patients with patellofemoral pain syndrome (PFPS) caused by suspected patellofemoral malalignment (PFM). MATERIAL AND METHOD: Fifty MRIs were performed on 25 patients with PFPS secondary to suspected PFM based on clinical examination, and on 25 patients without PFPS (control group). Measurements were made of tibial tuberosity-trochlear groove distance (TTTG) and modified Laurin, Merchant and trochlear angles. The results were analyzed with ANOVA and Fischer tests. Pearson correlation coefficients were used to analyze differences between PFPS and control cases. Specificity, sensitivity, positive predictive value and negative predictive value for knee pain were documented. RESULTS: Significant differences were observed between PFPS and control groups in TTTG (11.79 mm vs. 9.35 mm; P=.002), Laurin angle (12.17° vs. 15.56°; P=.05), and trochlear angle (139° vs. 130.02°; P=.049). No differences were found between groups as regards the Merchant angle (P=.5). TTTG was 70% predictive of PFPS; however, it was only 53.33% specific, with a sensitivity of 51.61% for PFPS. Laurin angle was 77.78% predictive of PFPS, with a specificity of 92% and a sensitivity of 28%. Trochlear angle was 85.71% predictive of PFPS, with a specificity of 96% and a sensitivity of 24%. CONCLUSIONS: MRI can confirm clinically suspected PFPS secondary to malalignment. MRI determination of TTTG, patellar tilt, and trochlear angle correlates positively with clinical diagnosis of PFPS, suggesting that PFPS is caused by subtle malalignment.

Factores clínicos y hallazgos en la artroscopia de pacientes con artrosis de rodilla que favorecen la conversión a artroplastia total / Clinical factors and findings in knee arthroscopy of patients with knee arthrosis candidates for conversion to total replacement

Objetivos. Identificar los hallazgos artroscópicos y las características clínicas de los pacientes con artrosis de rodilla sometidos a lavado articular artroscópico, que se correlacionaron con una mala evolución de su enfermedad y su consecuente conversión a artroplastia total de rodilla (ATR). Método. Estudio retrospectivo-descriptivo de una serie de 78 pacientes (88 rodillas) sometidos a artroscopia de rodilla por artrosis. Cuarenta y cuatro mujeres y 34 varones, con promedio de edad de 58,9 años (rango: 37-78) en el momento de la artroscopia, ingresaron al estudio. Tras un seguimiento promedio de 50,4 meses (rango: 12-96) se identificaron aquellos pacientes que evolucionaron a una ATR. Para el análisis estadístico se utilizó un modelo de regresión logística para identificar aquellos elementos asociados a la evolución hacía una ATR. Resultados. En el seguimiento, a 24 rodillas se les implantó una ATR (27,3%) a los 13,5 meses de promedio (rango: 13-29). Las características clínicas de los pacientes que mostraron una asociación estadísticamente significativa hacia una mala evolución fueron: el género femenino (0,02) y clasificación de Ahlbäck 2 (p = 0,04). Los hallazgos artroscópicos asociados significativamente a evolución hacia ATR fueron lesiones meniscales mediales y laterales en cuerno posterior (p = 0,02), cuando se realizó una meniscectomia mayor o igual a un 60% (p = 0,03) y la presencia de lesiones condrales grado 2 en la zona de carga de cóndilo femoral medial (p = 0,01). Conclusión. En este grupo estudiado, las variables asociadas a una mayor posibilidad de terminar en una ATR tras una artroscopia de lavado articular fueron del género femenino, artrosis radiológica grado 2, lesiones meniscales en cuerno posterior, meniscectomia mayor al 60% y lesiones condrales en cóndilo femoral medial grado 2 en zona de carga(AU)

Objectives. To identify those clinical characteristic and arthroscopic findings in patients with knee arthrosis that are associated with worsening of the disease and subsequent total knee arthroplasty (TKA). Method. A retrospective, descriptive study was conducted on 78 consecutive patients (88 knees) who underwent knee arthroscopy for arthrosis. The study included 44 women and 34 men, with a mean age of 58.9 years (range: 37-78 years). After a mean follow-up of 50.4 months (range: 12-96 months), those patients who progressed towards TKA were identified. A logistic regression model was applied to recognise the factors associated with deterioration of the arthrosis, with consequent progression towards a TKA. Results. Twenty-four out of the 88 knees progressed towards a TKA (27.3%) within a mean time of 13.5 months after arthroscopy (range: 13-29 months). The clinical characteristics that showed a significant association with poor progression of the arthrosis were: female gender (0.02) and Ahlbäck 2 (P=.04). Arthroscopic finding that proved significant correlation with worsening of the arthrosis towards TKA were: meniscal tears of the posterior horn (P=.02), meniscectomies above 60% (P=.03), and 2 nd degree chondral lesions in loading areas of the medial femoral condyle (P=.02). Conclusion. The variables associated with a greater chance of progressing towards a TKA after a knee arthroscopy due to arthrosis in this study were, female gender, grade 2 radiographic arthrosis, posterior horn meniscal lesions, meniscectomies over 60%, and chondral lesions in loading area of the medial femoral condyle(AU)

[Clinical factors and findings in knee arthroscopy of patients with knee arthrosis candidates for conversion to total replacement]. / Factores clínicos y hallazgos en la artroscopia de pacientes con artrosis de rodilla que favorecen la conversión a artroplastia total.

OBJECTIVES: To identify those clinical characteristic and arthroscopic findings in patients with knee arthrosis that are associated with worsening of the disease and subsequent total knee arthroplasty (TKA). METHOD: A retrospective, descriptive study was conducted on 78 consecutive patients (88 knees) who underwent knee arthroscopy for arthrosis. The study included 44 women and 34 men, with a mean age of 58.9 years (range: 37-78 years). After a mean follow-up of 50.4 months (range: 12-96 months), those patients who progressed towards TKA were identified. A logistic regression model was applied to recognise the factors associated with deterioration of the arthrosis, with consequent progression towards a TKA. RESULTS: Twenty-four out of the 88 knees progressed towards a TKA (27.3%) within a mean time of 13.5 months after arthroscopy (range: 13-29 months). The clinical characteristics that showed a significant association with poor progression of the arthrosis were: female gender (0.02) and Ahlbäck 2 (P=.04). Arthroscopic finding that proved significant correlation with worsening of the arthrosis towards TKA were: meniscal tears of the posterior horn (P=.02), meniscectomies above 60% (P=.03), and 2nd degree chondral lesions in loading areas of the medial femoral condyle (P=.02). CONCLUSION: The variables associated with a greater chance of progressing towards a TKA after a knee arthroscopy due to arthrosis in this study were, female gender, grade 2 radiographic arthrosis, posterior horn meniscal lesions, meniscectomies over 60%, and chondral lesions in loading area of the medial femoral condyle.

¿Existe correlación entre el peso y la talla del paciente con el largo y diámetro del injerto semitendinoso? / Does patient weight and height correlate with the length and diameter of the semitendinosus graft?

Objetivo. Describir correlación entre largo y ancho del tendón semitendinoso (ST) con peso, talla y edad en la población hispana. Método. Estudio prospectivo de una serie consecutiva de 61 pacientes sometidos a reconstrucción del ligamento cruzado anterior (LCA) con tendones semitendinoso y gracilis; 40 varones (67,2%) y 21 mujeres (32,8%). La edad media fue de 28,3±10,2 años (17-55). En pabellón se midieron el largo del ST y el diámetro del ST cuádruple (ST4). Se correlacionaron los hallazgos con peso, talla y edad, agrupando y separando por género, y se documentaron las diferencias entre variables. Resultados. El diámetro medio del ST4 fue de 9,0±1,3mm, siendo en pacientes masculinos de 9,3±0,8mm y en pacientes de sexo femenino de 8,3±0,6mm (p<0,05). La longitud media del ST fue de 28,1±3,4cm, siendo en pacientes masculinos de 28,5±2,3cm y en pacientes de sexo femenino de 26,0±2,5cm (p<0,05). El peso se correlacionó positivamente con el largo ST (0,47, p<0,001) y el diámetro ST4 (0,51, p<0,001). Asimismo la talla del paciente se correlacionó positivamente con el largo ST (0,57, p<0,001) y diámetro ST4 (0,34, p=0,008). No se encontró correlación significativa entre la edad de los pacientes y las medidas del tendón estudiadas. Conclusión. En el grupo general de pacientes estudiado existía una correlación positiva entre la longitud del ST con talla y peso del paciente. Asimismo, se objetivaba una correlación positiva entre el diámetro del ST4 con talla y peso del paciente(AU)

Objective. To describe the correlation between the length and diameter of semitendinosus tendon (ST), and weight, height and age in Hispanic population. Methods. Prospective study of a consecutive series of 61 patients that underwent anterior cruciate ligament (ACL) reconstruction with hamstrings; 40 (67.2%) males and 21 (32.8%) females. The average age was 28.3±10.2 years (range 17-55). In the operating room, length and diameter of ST folded in four bundles (ST4) were measured. Correlations were calculated using patient weight, height and age, including males and females and separating them by gender. Results. Mean ST4 diameter: 9.0±1,3mm. Males ST4 diameter: 9.3±0.8mm; females ST4 diameter 8.3±0.6mm (p<0.05). Average ST length: 28.1±3.4cm. Males mean length 28.5±2.3cm; females mean length 26.0±2.5cm (p<0.05). Weight was correlated directly with ST length (c=0.47; p<0.001) and ST4 diameter (c=0.51; p<0.001). Patient height was directly correlated with ST length (c=0.57; p<0.001) and ST4 diameter (c=0.34; p=0.008). There was no correlation between patient age and tendon measurements. Conclusion. A positive correlation was found between ST length and patient weight and height for the general population. A direct correlation was also observed between ST4 diameter and patient weight and height for the general population (AU)

Reparación meniscal con tornillos absorbibles: resultados de seguimiento a medio plazo / Meniscal repair with absorbable screws: medium-term follow-up

Introducción: El objetivo del presente estudio es analizar a los pacientes que reciben sutura meniscal con tornillos absorbibles y las características de las lesiones. Pacientes y metodología: Evaluación clínica prospectiva de una serie consecutiva de 35 pacientes con lesiones meniscales tratadas solamente con tornillos absorbibles durante 8 años. Evaluamos la evolución con los criterios de Barrett, la escala Lysholm, el International Knee Documentation Committee (IKDC) y Tegner. El seguimiento medio fue de 35 meses y la edad de 26 años; el 73% de pacientes varones. Un 62% de los pacientes presentó asociada una rotura del ligamento cruzado anterior reconstruida en el mismo acto quirúrgico. Se colocaron 1,8 tornillos por paciente. Un 62,9% de las suturas fueron en el menisco interno y el 37,14% en el menisco externo. El 69% de los tornillos se colocó en el cuerno posterior, el 21% en el tercio medio y el cuerno posterior, el 8% en el tercio medio y el 2% en el cuerno anterior, el tercio medio y el cuerno posterior. Resultados: El porcentaje de rerrotura confirmado con resonancia magnética fue del 10%. Las puntuaciones postoperatorias fueron Lysholm de 95,9 puntos, IKDC de 90,8 puntos y Tegner de 6,09 puntos. Conclusiones: La reparación meniscal con tornillos reabsorbibles ofrece de buenos a excelentes resultados clínicos en un alto porcentaje de casos (AU)

The purpose of the present study is to analyze the results obtained by patients subjected to meniscal suturing with absorbable screws as well as the characteristics of the meniscal lesions present. Patients and methodology: This is a prospective clinical assessment of a consecutive series of 35 patients with meniscal lesions treated exclusively with absorbable screws over an 8 year period. We assessed patient evolution on the basis of the Barrett, Lysholm, IKDC and Tegner rating scales. Mean follow-up was 35 months and mean age 26 years. 73% of our patients were male; 62% of patients presented with a tear in their anterior cruciate ligament, which was reconstructed during the same surgical procedure. 1.8 screws were placed in each patient. 62.9% of sutures were applied in the medial meniscus and 37.14% in the lateral meniscus. 69% of the screws were placed in the posterior horn, 21% in the middle third and the posterior horn, 8% in the middle third and 2% in the anterior horn, middle third and posterior horn. Results: The percentage of retears confirmed by MRi was 10%. Post-operative scores were: Lysholm 95.9 points, IKDC 90.8 and Tegner 6.09 points. Conclusions: Meniscal repair with resorbable screws offers good to excellent clinical results in a high proportion of cases (AU)

Paraesophageal hiatal hernia. Open vs. laparoscopic surgery.

BACKGROUND: paraesophageal hiatal hernia represents 5-10% of hiatal hernias. Its importance is based on the severe complications it may have, including gastric volvulus, and surgical treatment is recommended when a diagnosis is established. MATERIAL AND METHODS: a retrospective study of all patients who underwent surgery for paresophageal hernia between 1985 and 2007. RESULTS: we studied 90 cases, 68 females and 22 males with a median age of 67.6 years (37-96). Forty-five patients reported pyrosis, 34 epigastric postprandial pain, and 15 dysphagia; eight patients were diagnosed with gastric volvulus. Eighty-one patients underwent elective surgery and 9 emergency surgery. Forty-seven cases underwent an open procedure and 43 a laparoscopic one; 5 (11.6%) of them required conversion. The techniques performed were D Or fundoplication in 35 cases, Nissen in 35, Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complication rate for open procedure was 10.6 and 9.5% for the laparoscopic one (p > 0.05). Median hospital stay was 9.1 days for the open procedure and 3.4 for the laparoscopic one (p < 0.05). As follow-up, we analyzed 84 patients. After a median follow-up of 12 years (1-19), 15 patients were still symptomatic (17.8%), with recurrence in 8 cases (5 required reoperation). The satisfaction rate was 95.5%. CONCLUSION: equivalent results were observed after laparoscopic and open surgery and a significant shorter hospital stay in the laparoscopic one. Therefore, we think that laparoscopic surgery should be considered as the election procedure for paraesophageal hiatal hernia.

Hernia de hiato paraesofágica: cirugía laparoscópica vs. cirugía abierta / Paraesophageal hiatal hernia. Open vs. laparoscopic surgery

Introducción: la hernia hiatal paraesofágica representa el 5-10% de las hernias hiatales. Su importancia radica en las gravescomplicaciones que pueden presentar, como el vólvulo gástrico, yse recomienda el tratamiento quirúrgico una vez establecido eldiagnóstico.Material y métodos: estudio retrospectivo de los pacientesintervenidos en nuestro centro de hernia hiatal paraesofágica entre1985 y 2007.Resultados: estudiamos 90 casos, 68 mujeres y 22 varones,con edad media de 67,6 años (37-96). Cuarenta y cinco pacientespresentaban pirosis, 34 dolor epigástrico postprandial y 15 disfagia;ocho pacientes fueron diagnosticados como vólvulo gástrico.Se realizaron 81 intervenciones programadas y 9 urgentes. En 47casos el abordaje fue abierto y en 43 laparoscópico, de los cuales5 se convirtieron a cirugía abierta. Se realizó funduplicatura D´Oren 35 casos, Nissen en 35, Toupet en 14, cierre simple de pilaresen 2, Narbona en 1 y Lortat-Jakob en 1; en 10 pacientes se colocaronmallas. La tasa de complicaciones en cirugía abierta fue10,6% y en laparoscópica 9,5% (p > 0,05). La estancia media fue9,1 días en cirugía abierta y 3,4 en laparoscópica (p < 0,05). Enel seguimiento, analizamos 84 pacientes, con una mediana de 12años (1-19): 15 continuaban sintomáticos, objetivándose recidivaen 8 (5 fueron reintervenidos). El 95,5% de los pacientes estabansatisfechos con los resultados.Conclusión: se obtuvieron resultados equivalentes tras cirugíalaparoscópica y abierta, con estancia hospitalaria significativamentemenor en los primeros. Por ello creemos que se debe considerarla cirugía laparoscópica como abordaje de elección paratratar la hernia hiatal paraesofágica(AU)

Background: paraesophageal hiatal hernia represents 5-10%of hiatal hernias. Its importance is based on the severe complicationsit may have, including gastric volvulus, and surgical treatmentis recommended when a diagnosis is established.Material and methods: a retrospective study of all patientswho underwent surgery for paresophageal hernia between 1985and 2007.Results: we studied 90 cases, 68 females and 22 males with amedian age of 67.6 years (37-96). Forty-five patients reported pyrosis,34 epigastric postprandial pain, and 15 dysphagia; eightpatients were diagnosed with gastric volvulus. Eighty-one patientsunderwent elective surgery and 9 emergency surgery. Forty-sevencases underwent an open procedure and 43 a laparoscopicone; 5 (11.6%) of them required conversion. The techniques performedwere D´Or fundoplication in 35 cases, Nissen in 35,Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complicationrate for open procedure was 10.6 and 9.5% for the laparoscopicone (p > 0.05). Median hospital stay was 9.1 days for theopen procedure and 3.4 for the laparoscopic one (p < 0.05). Asfollow-up, we analyzed 84 patients. After a median follow-up of12 years (1-19), 15 patients were still symptomatic (17.8%), withrecurrence in 8 cases (5 required reoperation). The satisfactionrate was 95.5%Conclusion: equivalent results were observed after laparoscopicand open surgery and a significant shorter hospital stay inthe laparoscopic one. Therefore, we think that laparoscopicsurgery should be considered as the election procedure for paraesophagealhiatal hernia(AU)

Construction of a first genetic map of distylous Turnera and a fine-scale map of the S-locus region.

As a prelude to discovery of genes involved in floral dimorphism and incompatibility, a genetic map of distylous Turnera was constructed along with a fine-scale map of the S-locus region. The genetic map consists of 79 PCR-based molecular markers (48 AFLP, 18 RAPD, 9 ISSR, 4 RAMP), 5 isozyme loci, one additional gene, and the S-locus, spanning a total distance of 683.3 cM. The 86 markers are distributed in 5 linkage groups, corresponding to the haploid chromosome number. Molecular markers tightly linked or co-segregating with the S-locus in an initial mapping population of 94 individuals were used to assay an additional 642 progeny to construct a map of the S-locus region. The fine-scale map consists of 2 markers (IS864a and RP45E9) flanking the S-locus at distances of 0.41 and 0.54 cM, respectively, and 3 additional markers (OPK14c, RP45G18, and RP81E18) co-segregating with the S-locus in the total mapping population of 736 individuals. The genetic map constructed will serve as a framework for localization of genes outside the S-locus affecting distyly, while molecular markers of the fine-scale map will be used to initiate chromosome walking to find the genes residing at the S-locus.

Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: clinical and electrophysiological study.

The incidence of IBSN injury to the infrapatellar branch of the saphenous nerve (IBSN) in ACL surgery using the hamstrings technique has been reported to be between 30 and 59%. The purpose of this study was to evaluate the incidence of IBSN injury in ACL surgery with the hamstrings technique through clinical and electrophysiological evaluation, and also to evaluate potential risk factors of IBSN injury related to the surgical incision. Between November 2003-September 2004, 21 consecutive patients (22 knees) with an acute ACL rupture suitable for reconstruction were included. Patients with previous surgeries or scars around the knee and those with any degree of osteoarthritis were excluded. Clinical and electrophysiological evaluations were performed in all the cases. Hypoesthesia of the IBSN territory was found in 17 knees (77%) with an average area of 36 cm(2) (1-120 cm(2)). Injury to the IBSN was electrophysiologically detected in 15 knees (68%). Two patients also had an injury to the saphenous nerve (9%). The presence of sensory loss associated with damage to the IBSN did not correlate with the size of the incision or the distance to the tibial tubercle. This injury probably occurs during tendon harvesting as found by an injury to the saphenous nerve in two of our patients. However the sensory loss does not impair normal daily activities in these patients.

Bipolar radiofrequency in the human meniscus. Comparative study between patients younger and older than 40 years of age.

PURPOSE: To morphohistologically evaluate the effect of four increasing intensities of bipolar radiofrequency (RF) on the human meniscus and to compare the changes seen in the menisci from patients younger and older than 40 years old. METHODS: Thirty fresh menisci were divided in two groups. Group 1: 12 menisci from patients younger than 40 y.o.; Group 2: 18 menisci from patients older than 40 y.o. Groups 1 and 2 were divided in four zones and subjected in vitro, for 3 s, to four intensities of bipolar RF energy. The samples were studied macroscopically, and microscopically. RESULTS: Thermal changes were present between 0 and 4000 microm from the meniscal surface, with an average of 1699 microm (S.D. 740), and was significantly higher on the ablation than the coagulation group (p<0.001). We found a significant difference between the depth of thermal changes in the menisci from patients younger and older than 40 years old at medium intensities of RF energy (p=0.038 and p=0.044). CONCLUSIONS: Although bipolar RF can cause deep thermal changes (up to 4000 microm) on the human meniscus, this effect depends on the magnitude of the energy applied. When comparing the effect between younger and older patients, the changes were deeper in the older group when RF was applied at medium intensities. CLINICAL RELEVANCE: Based on our findings, we recommend to exert precaution when applying RF energy at medium intensities in the degenerative meniscus, due to a deeper thermal effect in this group.

Unique misinsertion specificity of poliota may decrease the mutagenic potential of deaminated cytosines.

DNA polymerase iota (poliota) is a distributive error-prone enzyme that can incorporate nucleotides opposite a variety of DNA lesions. Further elongation is, however, either substantially inhibited or completely abolished. Here, we provide evidence that poliota can facilitate the efficient bypass of uracil and its derivatives as well as oxidized cytosine and guanine residues. The fidelity of translesion replication depends upon the lesion encountered. Correct nucleotides were inserted preferentially opposite 7,8-dihydro-8-oxoguanine (8-oxoG) and 5-hydroxycytosine (5-OHC). However, when bypassing uracil, 5-hydroxyuracil (5-OHU) or 5,6-dihydrouracil (5,6-DHU), poliota inserted T and G with a 4- to 26-fold preference over the Watson-Crick base, A. While the T:U, T:5-OHU and T:5,6-DHU mispairs were extended poorly, the G:U, G:5-OHU and G:5,6-DHU mispairs were extended with equal or greater efficiency than the correctly paired primer termini. Thus, poliota-dependent misinsertion of G opposite uracil and its derivatives may actually provide a mechanism whereby mammalian cells can decrease the mutagenic potential of lesions formed via the deamination of cytosine.

Human DNA polymerase iota promiscuous mismatch extension.

Human DNA polymerase iota is a low-fidelity template copier that preferentially catalyzes the incorporation of the wobble base G, rather than the Watson-Crick base A, opposite template T (Tissier, A., McDonald, J. P., Frank, E. G., and Woodgate, R. (2000) Genes Dev. 14, 1642-1650; Johnson, R. E., Washington, M. T., Haracska, L., Prakash, S., and Prakash, L. (2000) Nature 406, 1015-1019; Zhang, Y., Yuan, F., Wu, X., and Wang, Z. (2000) Mol. Cell. Biol. 20, 7099-7108). Here, we report on its ability to extend all 12 possible mispairs and 4 correct pairs in different sequence contexts. Extension from both matched and mismatched primer termini is generally most efficient and accurate when A is the next template base. In contrast, extension occurs less efficiently and accurately when T is the target template base. A striking exception occurs during extension of a G:T mispair, where the enzyme switches specificity, "preferring" to make a correct A:T base pair immediately downstream from an originally favored G:T mispair. Polymerase iota generates a variety of single and tandem mispairs with high frequency, implying that it may act as a strong mutator when copying undamaged DNA templates in vivo. Even so, its limited ability to catalyze extension from a relatively stable primer/template containing a "buried" mismatch suggests that polymerase iota-catalyzed errors are confined to short template regions.

Biochemical characterization of human DNA polymerase iota provides clues to its biological function.

The human RAD30B gene has recently been shown to encode a novel DNA polymerase, DNA polymerase iota (poliota). The role of poliota within the cell is presently unknown, and the only clues to its cellular function come from its biochemical characterization in vitro. The aim of this short review is, therefore, to summarize the known enzymic activities of poliota and to speculate as to how these biochemical properties might relate to its in vivo function.

The effect of DNA structure on the catalytic efficiency and fidelity of human DNA polymerase beta on templates with platinum-DNA adducts.

DNA adducts formed by platinum-based anticancer drugs interfere with DNA replication. The carrier ligand of the platinum compound is likely to affect the conformation of the Pt-DNA adducts. In addition, the conformation of the adduct can also change upon binding of damaged DNA to the active site of DNA polymerase. From the crystal structures of pol beta ternary complexes it is evident that undamaged gapped and primed single-stranded (non-gapped) DNA templates exist in very different conformations when bound to pol beta. Therefore, one might expect that the constraints imposed on the damaged templates by binding to the polymerase active site should also affect the conformation of the Pt-DNA adducts and their ability to inhibit DNA replication. In support of this hypothesis we have found that the efficiency, carrier ligand specificity, site of discrimination (3'-G versus 5'-G of the Pt-GG adducts), and fidelity of translesion synthesis past Pt-DNA adducts by pol beta are strongly affected by the structure of the DNA template. Previous studies have suggested that the conformation of Pt-DNA adducts may be affected by the sequence context of the adduct. In support of this hypothesis, our data show that sequence context affects the efficiency, fidelity, and pattern of misincorporation by pol beta.