Meniscal ossicle in a professional soccer player.

Meniscal ossicles are an unusual finding and a rare cause for knee pain. They are often initially diagnosed as a loose body, chondrocalcinosis or meniscal calcification within the knee joint. Few cases have been reported in the literature. We present a case of a meniscal ossicle with an associated femoral cartilage lesion in a healthy 26-year-old male professional soccer player who presented with swelling and pain. The purpose of this article is to discuss the origins, radiological features, clinical symptoms and prognosis of meniscal ossicles.

Match injuries in professional soccer: inter-seasonal variation and effects of competition type, match congestion and positional role.

In this prospective observational study, injuries sustained in official match-play in players belonging to a professional soccer club were investigated. Incidence and patterns of injury were compared across four-seasons (2005-2006: S1, 2006-2007: S2, 2007-2008: S3 and 2008-2009: S4) and 3 match formats (domestic League/Cup games and European club competition). In addition, the effects of both fixture congestion and the positional role of players were investigated. Injury incidence (per 1 000 match-hours) did not vary between seasons (range 31.2-59.2 observed in S2 and S4, respectively, p=0.12) or fixture formats (range 32.6-40.8 observed in European and League matches, respectively, p=0.49). In contrast, rates varied in players (n=7) who participated in all four seasons as more injuries were sustained in S1 compared to S2 and S3, respectively (88.4 vs. 49.0 vs. 49.2, both p<0.05). The incidence of muscle strains was higher in S4 versus S3 (24.7 vs. 9.9, p<0.05) as were injuries sustained to the ankle region in S4 versus S2 (15.1 vs. 4.5, p<0.05). The incidence of joint sprains differed between fixture formats with a higher rate observed in League versus both Cup and European competition, respectively (10.1 vs. 3.0 vs. 3.0, both p<0.05). Injury incidence was not associated to the time delay (number of days) separating games (r=0.04, p=0.58). A very short interval (< or = 3 days) between fixtures did not result in a greater injury rate (p=0.40) or number of days lost to injury (p=0.73) compared to a longer interval (> or = 4 days). Finally, the incidence of injury and muscle strains (both p<0.001) varied across positional roles with the highest rates observed in centre-forwards. These findings provide further knowledge on the risk of injury in contemporary professional soccer match-play and may aid in the care and management of playing resources.

[Adenoid cystic carcinoma of the breast]. / Le carcinome adénoïde kystique du sein.

One the basis of personal observation and a review of recent literature (which is somewhat sparse), the authors describe the characteristics of adenoid cystic carcinoma of the breast which is a very unusual tumor. They stress the diagnostic difficulties which frequently make it necessary to use histochemical or immuno-histochemical diagnostic techniques which have been widely developed.

Myocardial uptake of bupivacaine: I. Pharmacokinetics and pharmacodynamics of lidocaine and bupivacaine in the isolated perfused rabbit heart.

Bupivacaine, but not lidocaine, may cause severe cardiac dysrrhythmias in case of accidental intravascular injection. In an attempt to discriminate between a pharmacokinetic and a pharmacodynamic (or both) origin to these differences, we used an isolated rabbit heart model with constant coronary inflow to compare the myocardial uptake and disposition kinetics of lidocaine and bupivacaine. Drug concentration in the outflow perfusate was assayed and surface electrocardiogram was recorded. Drug uptake and disposition kinetics were modeled with a two-compartment open model. An Emax model was used to describe the increase in QRS duration in relation with drug concentration in the central compartment. Lidocaine and bupivacaine exhibited similar myocardial pharmacokinetics (i.e., a rapid decrease in the outflow concentration upon drug administration discontinuation). Bupivacaine-induced maximum increase in QRS duration (Emax) was 15 times superior to lidocaine Emax. The steady-state perfusate concentration producing half Emax was the same for both drugs. We conclude that bupivacaine-induced QRS widening decreases almost at the same rate as does lidocaine-induced QRS widening when drug administration is terminated. Therefore, the different cardiac effects of lidocaine and bupivacaine are not due to differences in myocardial uptake and disposition kinetics.

Neonatal pattern of breathing during active and quiet sleep after maternal administration of meperidine.

The aim of this study was to reappraise the effects of maternal meperidine administration on breathing pattern during the first hours of life taking into account the state of alertness. Because breathing instability is more pronounced during active sleep, we hypothesized that meperidine administration might create a greater risk for respiratory instability during active sleep, the prominent sleep state in newborns. We studied eight full-term, healthy newborns whose mothers had received a continuous i.v. infusion of meperidine (81 +/- 9 mg) that was terminated 5.5 +/- 2.1 h before delivery. These infants were compared with a control group of eight full-term newborns whose mothers did not receive any opioids. In both groups, all babies were delivered vaginally after a normal labor and had Apgar scores of 9 or 10 at 1 and 5 min. Neonatal gastric secretion and maternal venous and umbilical venous blood were sampled at delivery for determination of meperidine concentration. From 60 to 300 min after delivery, behavioral sleep states and thoracic and abdominal movement as well as transcutaneous arterial oxygen saturation (SaO2) were monitored continuously. The number of apneic spells lasting more than 3 s during 100 min of recording and the percentage of time with SaO2 below 90% in each sleep state were recorded. During quiet sleep, all respiratory variables were similar in both groups. During active sleep, there were significantly more apneic episodes (37.1 +/- 25.1 versus 11.2 +/- 13.9) and a higher percentage of time with SaO2 less than 90% (14.3 +/- 16.7% versus 1.3 +/- 1.5%) in the meperidine group than in the control group (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Myocardial uptake of lignocaine: pharmacokinetics and pharmacodynamics in the isolated perfused heart of the rabbit.

1. The uptake kinetics and pharmacodynamics of lignocaine were studied in isolated perfused heart of the rabbit. 2. Six hearts were perfused with increasing concentrations of lignocaine in a modified Krebs-Henseleit buffer. The effluent concentration together with the increase in QRS duration were measured during lignocaine infusion and during 20 min after cessation of lignocaine infusion. 3. Lignocaine disposition and elimination were best described by a two-compartment open model. Terminal half-life was 11.0 +/- 2.9 min. The unidirectional transfer was slower from central to peripheral compartment than from peripheral to central compartment (T1/2.12 = 42.6 +/- 10.5 min whereas T1/2.21 = 10.7 +/- 2.8 min). The myocardium/perfusate concentration-ratio was 4.7 +/- 0.4. 4. The pharmacodynamic effect was best described in the central compartment by using the Hill equation. Calculated maximum QRS duration (Emax) was 77 +/- 8 ms. Emax was also directly measured in four additional rabbits by infusing ten times the dose of lignocaine used in the main experiment: the value of Emax measured in these conditions was 92.5 +/- 9.6 ms, i.e. a QRS widening of 150%. The steady-state perfusate concentration producing half the effect (C50) was 15.7 +/- 7.6 micrograms ml-1. 6. In conclusion, the specific lignocaine binding leading to increase in QRS duration appeared to be more closely related to the vascular stream than non specific binding leading to a deeper accumulation process.

Continuous intercostal blockade with lidocaine after thoracic surgery. Clinical and pharmacokinetic study.

The efficacy and the side effects of a continuous infusion of lidocaine in the fifth intercostal space for the management of postoperative pain after lateral thoracotomy were evaluated in 20 adults. An indwelling catheter was inserted in the appropriate intercostal space before thoracotomy closure. After recovery from general anesthesia, a loading dose of 3 mg/kg of 1.5% lidocaine with epinephrine 1:160,000 was injected through the catheter, followed by a continuous infusion of 1% lidocaine without epinephrine at a rate of 1 mg.kg-1.h-1 for 54 h. In seven patients pharmacokinetic data were obtained. Pain, assessed by visual continuous analog scale, decreased from a median score of 8 (range, 7-10) to a score of 5 (range, 2-7) 20 min after the loading dose of lidocaine and continued to decrease until the end of the study (P = 0.0001). Complete cutaneous analgesia, assessed by pinprick test, was seen in a median of three thoracic spinal segments (range, 0-6) with partial cutaneous analgesia in seven segments (range, 6-9) 40 min after the loading dose, and levels that remained unchanged for 54 h (P = 0.0001). Peak lidocaine serum concentrations, 1.9 +/- 0.7 micrograms/mL, were present 9 +/- 3 min after injection of the loading dose. Serum concentrations of lidocaine under steady state conditions averaged 4.8 +/- 0.9 micrograms/mL (range, 3.5-5.8 micrograms/mL). This level under steady state conditions, though below the toxic level, suggests that additional bolus injection of lidocaine during the course of infusion might result in potentially toxic serum levels of lidocaine.(ABSTRACT TRUNCATED AT 250 WORDS)

[Continuous block of the femoral nerve after surgery of the knee: pharmacokinetics of bupivacaine]. / Bloc crural continu après chirurgie du genou: pharmacocinétique de la bupivacaïne.

Ten ASA Class 1 and 2 patients, aged from 16 to 56 years (mean +/- SD: 37 +/- 17 years), scheduled for knee surgery were studied. At the end of the surgical procedure under general anesthesia, an epidural catheter was inserted in the femoral space. After X-ray opacification, a bolus of 2.5 mg.kg-1 of 0.5% bupivacaine with epinephrine was injected. A maintenance infusion was performed during 48 hours with 0.25 mg.kg-1.h-1 of 0.125% bupivacaine without epinephrine. Pain score recorded with an visual analogue scale was 5.0 +/- 1.9 before femoral block. Pain score decreased significantly from 6 to 48 hours. Plasma bupivacaine levels at 24, 36 and 48 hours were significantly higher than the levels obtained at 30 min, 1, 6 and 12 hours. Mean plasma bupivacaine level at steady state was 1.78 +/- 0.59 micrograms.ml-1. Clearance of bupivacaine was 2.59 +/- 0.91 ml.min-1.kg-1. No neurologic complications have been recorded.