[Complex multiligament knee injury associated with patellar tendon rupture]. / Lesiones multiligamentarias de rodilla asociadas a ruptura de tendón rotuliano.

INTRODUCTION: Multi-ligament injury of the knee joint is defined as damage to two or more major ligaments. They are uncommon, with an incidence of ? 10:10,000. They constitute less than 0.02% of all orthopedic lesions. It is even less frequent to find an association of these with a complete rupture of the patellar tendon which presents with a prevalence of 2.4%. CASE REPORT: 22 year old male; he presented a high-speed accident with a diagnosis of multi-ligament left knee injury stage V of Schenck associated with complete patellar tendon rupture treated in a single surgical time with ligament reconstruction, four weeks after traumatic event. A score of 88.5 was obtained after eight months with the IKDC 2000 form for the subjective functional evaluation of the knee. DISCUSSION: The definitive surgical treatment is performed four weeks after the injury. This reduces the risk of instability. In our clinical case, the patient is integrated into the activities of his daily life after eight months. To validate this technique as effective or good for its use, a greater number of patients treated in the same way is required. It is, however, suggested to contemplate as a management option. CONCLUSION: These types of lesions are infrequent with a prognosis reserved.

INTRODUCCIÓN: La lesión multiligamentaria de la articulación de rodilla se define como el daño a dos o más ligamentos principales. Estas lesiones son poco comunes, con una incidencia de ? 10:10,000. Constituyen menos de 0.02% de todas las lesiones ortopédicas. Es aún menos frecuente encontrar asociación de éstas a una ruptura completa del tendón patelar, la cual se presenta con una prevalencia 2.4%. CASO CLÍNICO: Masculino de 22 años sufrió accidente de alta velocidad, con diagnóstico de lesión multiligamentaria de rodilla izquierda estadio V de Schenck asociada a ruptura completa de tendón patelar, fue tratado en un solo tiempo quirúrgico con reconstrucción ligamentaria cuatro semanas después de evento traumático. Se obtuvo a los ocho meses un puntaje de 88.5 con el formulario IKDC 2000 para la evaluación funcional subjetiva de la rodilla. DISCUSIÓN: El tratamiento quirúrgico definitivo se realiza a las cuatro semanas de la lesión. Con esto se disminuye el riesgo de inestabilidad. En nuestro caso clínico el paciente se logra integrar a las actividades de su vida diaria después de ocho meses. Para validar esta técnica como efectiva o buena para su uso, se requiere un mayor número de pacientes tratados de la misma forma. Sin embargo, se sugiere contemplar como una opción de manejo. CONCLUSIÓN: Lesión poco frecuente, de tratamiento quirúrgico con un pronóstico reservado.

[Lumbar herniated disks treated with a dynamic interspacer]. / Hernias discales lumbares tratadas con interespaciador dinámico.

UNLABELLED: Lumbar herniated disks result in lumbar pain with neurologic involvement. Medical treatment and rehabilitation provide improvement for this type of lumbar pain at the early stages. When conservative treatment fails, the surgical option offers the possibility of improving patients' health status. Moojen considers that the application of interspinous spacers provides good results. The purpose of this research is to assess the clinical and imaging results in patients with contained lumbar herniated disk treated with the DYNAMIC INTERSPACER interspinous spacer, a Mexican product. MATERIAL AND METHODS: The efficacy of the interspinous device was assessed by means of a near-investigational and longitudinal study conducted at "General Ignacio Zaragoza" ISSSTE Regional Hospital in patients with a diagnosis of lumbar pain. RESULTS: The mean age of the sample is 46.1 years, with an age range of 26-55 years. The treated levels were 6 L5-S1 and 5 L4-L5; two levels were treated in two patients. The mean preoperative VAS score was 8.1. The mean VAS score at postoperative year three was 1.6. CONCLUSION: Multiple types and brands of foreign interspinous devices are applied in Mexico which results in patients' clinical improvement. We proved that the use of the Mexican interspinous device can clinically improve patients with lumbar pain due to herniated disk. A decrease in the compression of the sac or the nerve roots by the hernia was observed in the comparative preoperative and postoperative MRI images.

Induction of Fc receptors on murine macrophages and leukemic cells by interleukin-1 beta.

Recombinant human interleukin-1 beta (rhIL-1 beta) is shown to be a strong inducer of Fc receptors (FcR) on murine macrophages and not on granulocytes. Data is provided indicating that rhIL-1 beta does induce specific but not nonspecific phagocytosis. Macrophages are shown to autoinduce their FcR expression as a function of time in culture. This induction is increased by the use of exogenous rhIL-1 beta and inhibited by anti-rhIL-1 beta antibody, pointing to an autocrine regulation of FcR expression on macrophages. On the other hand the myelomonocytic cell line WEH13BD- and the macrophage like cell line WR19M.1 are also shown to be inducible for the expression of FcR by this molecule. Data is also provided showing that recombinant murine Interferon gamma (rmIFN gamma) induces FcR on both macrophages and granulocytes. Whereas polyclonal antibodies inhibit FcR induction by IL-1 on macrophages, it does not inhibit FcR induction by IFN gamma on these cells. This points to a different mechanism of induction of FcR by IFN and IL-1. Finally, the possible application of rhIL-1 beta in vivo to help the organism fight infections is discussed.

[Induction of Fc receptors and proliferative effect of recombinant human interleukins 1 and 2 (rhIL-1 and rhIL-2) on the leukemic lines WR19M.1 and WEHI3BD-]. / Inducción de receptores Fc y efecto proliferador de las interleucinas 1 y 2 recombinantes humanas (rhIL-1 y rhIL-2) sobre las líneas leucémicas WR19M.1 y WEHI3BD-.

Recombinant human interleukins 1 and 2 (rhIL-1 and rhIL-2) have recently been shown to interact with cells not only of the lymphoid lineage but also of myeloid origin. In fact, rhIL-1 indirectly stimulates normal haemopoietic cell proliferation without any influence on the differentiation, and can also induce lysozyme secretion by leukaemic cells. On the other hand, rhIL-2 is capable of indirectly stimulating the proliferation of monocytic precursors. Nevertheless, the effect of both factors on the expression of Fc receptors or on the proliferation of cells of myeloid origin has not been evaluated thus far. In order to assess whether these interleukins take part in the induction to proliferation of Fc receptor expression by homogeneous populations of myeloid cells, two leukaemic cell lines were used in this work, namely, WR19M.1, macrophagic, and WEHI3BD-, myelomonocytic. The results achieved show that: 1) rhIL-1 strongly stimulated the expression of Fc receptors in both leukaemic cell lines; 2) rhIL-1 does not stimulate the proliferation of these lineages; 3) on the contrary, rhIL-2 stimulated cell proliferation in both leukaemic cell lines, and 4) rhIL-2 had no effect on the induction of Fc receptors or on the stimulation of lysozyme secretion. The role played by the proliferative effect of rhIL-2, as well as the rhIL-1-mediated appearance of Fc receptors, in myeloid proliferation and differentiation are discussed.

Evidence that G-CSF is a fibroblast growth factor that induces granulocytes to increase phagocytosis and to present a mature morphology, and that macrophages secrete 45-kd molecules with these activities as well as with G-CSF-like activity.

Evidence is provided that conditioned medium from a macrophage-like cell line contains molecules of approximately 45 kd molecular weight with granulocyte colony-stimulating factor (G-CSF)-like activity as well as with the property of inducing granulocytes to phagocytose latex particles and to mature morphologically. This type of differentiation was found to be induced on either bone marrow or induced granulocytes, but not on resident or induced macrophages. On the other hand, resident but not induced macrophages are shown to induce these types of activities when challenged by bacterial lipopolysaccharides. Evidence that macrophages produce a factor that is mitogenic for fibroblasts is also provided. This activity was measured by the induction of increased proliferation by either low-density or saturated cultures of fibroblasts. Human recombinant G-CSF was employed and found also to possess these dual capabilities of inducing both the proliferation and differentiation of granulocytes as well as the proliferation of fibroblasts. Finally, a mechanism for the regulation of myeloid cell production and differentiation is described in which G-CSF produced by macrophages not only induces granulocytes to differentiate but induces fibroblasts to proliferate and secrete macrophage colony-stimulating factor (M-CSF), which in turn makes myeloid monocyte precursors proliferate and secrete more G-CSF.

Evidence that the macrophage-granulocyte inducer (MGI) is produced during cell proliferation, stored in G0, released in G1, cell specific, and induces the secretion of other colony-stimulating activities (CSA).

The secretion of the macrophage and granulocyte inducer (MGI), also known as colony-stimulating factor (CSF), by epithelial cells from lungs and kidneys, and by fibroblasts from lungs, was determined as a function of time in culture; it was found to be secreted during the initial exponential proliferation period, and not when the cells approached saturation density. When the cells were again induced to proliferate, large amounts of CSF were released after 3 h, thus hinting at the existence of a reserve pool. A CSF activity of 70,000 daltons was found in cultures of fibroblasts from lungs, kidneys, and the peritoneal cavity, a 45,000-dalton CSF was obtained from mouse peritoneal macrophages, and from bone marrow cells when activated for macrophage proliferation, and a 22,000-dalton CSF was found from epithelial cells, thus suggesting that the different CSFs are cell specific. When fibroblast CSF was used to induce bone marrow cells, three new molecules with colony-stimulating activity were produced, of 45,000, 30,000, and 17,000 daltons. The fraction with the 17,000-dalton activity also contained interleukin 1 activity, hinting at an indirect induction of colony formation by this factor. Finally the possible existence of a cascade reaction in which one CSF induces the appearance of other CSFs during the normal regulation of myeloid cell differentiation is discussed.

Evidences that fibroblasts and epithelial cells produce a specific type of macrophage and granulocyte inducer, also known as colony-stimulating factor, and that monocyte-macrophages can produce another factor with proliferative inducing activity on myeloid cells and differentiative activity on macrophages.

Molecules with the property to induce proliferation of bone marrow cells in liquid cultures, and with colony-stimulating activity, were found on media conditioned (MC) by lung fibroblasts and kidney epithelial cells. These factors presented an apparent mol wt of 70,000 and 22,000 d respectively. Also when MC by epithelial cells from lungs was tested for the induction of proliferation of bone marrow cells a molecule with 22,000 d was detected. These molecules are thought to be CSF because they induce colony formation, and they are also similar in mol wt to two of the already known CSF. In fact the GM-CSF obtained from endotoxic lungs with a large epithelial cell content has a mot wt of 22,000 d, and the CSF-1 produced by a fibroblast cell line had 70,000. When the MC by fibroblast was used to induce bone marrow cells to proliferate, three new molecules with colony-stimulating activity were secreted. These molecules with apparent mol wts of 45,000, 30,000 and 17,000 d were also found in the MC by bone marrow cells when induced to proliferate with MC by epithelial cells. When the 45,000-d molecules was used in induced bone marrow cells to proliferate, once again the 30,000- and the 17,000-d molecules were secreted. Evidence is also provided that the 45,000-d molecule is produced by the monocyte-macrophage cells, and that it can induce Fc receptors or resident and elicited peritoneal macrophages. The possibility that the production of CSF is cell specific is discussed together with two models to explain the way in which these molecules can participate as proliferative (MGI-1) and differentiative (MGI-2) function in normal myeloid cell differentiation. Finally, a new terminology is proposed to classify this family of molecules.