bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Potential Inductive Effects of Aprepitant on Cytochrome P450 3A4 and 2C9 Activity
Authors: Shadle Craig R. , Lee Yih , Majumdar Anup K. , Petty Kevin J. , Gargano Cynthia , Bradstreet Thomas E. , Evans Judith K. , Blum Robert A.
Published: February 2004

The NK1 receptor antagonist aprepitant (EMEND®), developed for use in combination with a 5HT3 receptor antagonist and a corticosteroid to prevent highly emetogenic chemotherapy‐induced nausea and vomiting (CINV), has been shown to have a moderate inhibitory effect as well as a possible inductive effect on cytochrome P450 (CYP) 3A4. Aprepitant has been noted to produce modest decreases in plasma S(−)‐warfarin concentrations, suggesting potential induction of CYP2C9. Because metabolism of some chemotherapeutic agents may involve CYP3A4, the potential inductive effect of the CINV dosing regimen of aprepitant on this metabolic pathway was evaluated using intravenous midazolam, a sensitive probe substrate of CYP3A4. The time course of induction of CYP2C9 by aprepitant was also evaluated using oral tolbutamide, a probe substrate of CYP2C9. In this double‐blind, randomized, placebo‐controlled, single‐center study, 24 healthy subjects were randomized (12 subjects per group) to receive either an aprepitant 3‐day regimen (aprepitant 125 mg p.o. on day 1 and aprepitant 80 mg p.o. on days 2 and 3) or matching placebo. All subjects also received probe drugs (midazolam 2 mg i.v. and tolbutamide 500 mg p.o.) once prior to aprepitant dosing (baseline) and again on days 4, 8, and 15. The ratio (aprepitant/placebo) of the geometric mean area under the plasma concentration curve (AUC) fold‐change from baseline for midazolam was 1.25 on day 4 (p < 0.01), 0.81 on day 8 (p < 0.01), and 0.96 on day 15 (p = 0.646). The ratio (aprepitant/placebo) of the geometric mean AUC fold‐change from baseline for tolbutamide was 0.77 on day 4 (p < 0.01), 0.72 on day 8 (p < 0.001), and 0.85 on day 15 (p = 0.05). Assessed using intravenous midazolam as a probe, aprepitant 125/80 mg p.o. administered over days 1 to 3 produced clinically insignificant weak inhibition (day 4) and induction (day 8) of CYP3A4 activity and no effect on CYP3A4 activity on day 15. Assessed using oral tolbutamide as a probe, the aprepitant regimen also produced modest induction of CYP2C9 activity on days 4 and 8, which resolved nearly to baseline by day 15. Thus, the aprepitant regimen for CINV results in modest, transient induction of CYPs 3A4 and 2C9 in the 2 weeks following administration.
Rheumatoid Arthritis Does Not Reduce the Pharmacodynamic Response to Valsartan
Authors: Daneshtalab Noriko , Lewanczuk Richard Z. , Russell Anthony , Jamali Fakhreddin
Published: February 2004

Inflammatory conditions decrease the cardiovascular response to calcium channel and β‐adrenergics blockers due, likely, to down‐regulation of the receptors mediated by pro‐inflammatory mediators such as C‐reactive protein (CRP), nitric oxide (NO), and tumor necrosis factor. The purpose of this investigation was to determine whether down‐regulation is also evident in angiotensin II type 1 receptors (AT1R) during varying inflammatory states. Normotensive subjects were divided into three groups according to the severity of disease: 14 with active rheumatoid arthritis, 12 with controlled rheumatoid arthritis, and 12 healthy control subjects. The AT1R antagonist valsartan (160 mg) was given to all the subjects, and blood samples were taken for pharmacokinetic analysis. The systolic, diastolic, and mean arterial pressures were determined at all blood collection times. The degree of inflammation was measured using joint swelling, NO, and CRP. Plasma valsartan concentration was measured using high‐performance liquid chromatography (HPLC). Patients with active disease had significantly higher joint swelling, NO, and CRP than other groups. Plasma valsartan concentration‐time curves were remarkably similar in all groups. No reduced response was noticed. Our preliminary observation suggests a need for further studies to examine the possibility of AT1R antagonists as alternatives to other cardiovascular drugs so that their potency may be reduced by inflammation.
Pharmacokinetics and Safety of the Ketolide Telithromycin in Patients with Renal Impairment
Authors: Shi Jun , Montay Guy , Chapel Sunny , Hardy Pierre , Barrett Jeffrey S. , Sack Marshall , Marbury Thomas , Swan Suzanne K. , Vargas Ramon , Leclerc Violette , Leroy Bruno , Bhargava Vijay O.
Published: February 2004

The pharmacokinetics and safety of the ketolide telithromycin were evaluated in two separate studies after single and repeat oral dosing in patients with varying degrees of renal impairment and in subjects with normal renal function. The single‐dose study was an open‐label, nonrandomized, parallel‐group design in which all 40 patients received a single oral dose of telithromycin 800 mg. The repeat‐dose study was an open‐label study with a randomized, balanced, incomplete three‐block treatment crossover design. In this study, each of the 36 patients received two of three telithromycin regimens (400, 600, or 800 mg once daily for 5 days), with a washout period of ≥ 7 days between treatments. Telithromycin was well tolerated. Adverse events were generally mild in severity, and no serious drug‐related adverse events were reported. Plasma exposure to telithromycin (Cmax, AUC) showed a tendency to increase with increasing severity of renal impairment in both studies. In patients with severe renal impairment (CLCR < 30 mL/min) receiving telithromycin 800 mg in the repeat‐dose study, Cmax,ss and AUC(0–24 h)ss increased 1.5‐fold (p < 0.05) to 2.0‐fold (p = 0.0005), respectively, compared with healthy subjects. The percentage of dose excreted in urine and renal clearance (CLR) of telithromycin was found to decrease significantly with increasing severity of renal impairment in both studies, and CLR was found to be independent of telithromycin dose in the repeat‐dose study. In conclusion, telithromycin dosage adjustment is not necessary in patients with mild to moderate renal impairment (CLCR ≥ 30 mL/min). In patients with severe renal impairment (CLCR < 30 mL/min), dosage adjustment could be considered.
The Effects of Once‐Daily Saquinavir/Minidose Ritonavir on the Pharmacokinetics of Methadone
Authors: Shelton Mark J. , Cloen Denise , DiFrancesco Robin , Berenson Charles S. , Esch Andrew , de Caprariis Pascal J. , Palic Branka , Schur Jane L. , Buggé Christopher J. L. , Ljungqvist Anders , Espinosa Orlando , Hewitt Ross G.
Published: February 2004

Twelve methadone‐maintained HIV‐negative subjects were given saquinavir/ritonavir (SQV/rtv) 1600 mg/100 mg once daily for 14 days. Pharmacokinetic evaluations of total and unbound methadone enantiomers (R and S) were conducted before and after SQV/rtv. SQV/rtv was well tolerated, with no ACTG Grade 3–4 adverse events, no evidence of sedation, and no changes in methadone dose. For R‐methadone (active isomer), Cmax, AUC0–24 h, and Cmin were unchanged, but percent unbound 4 hours after dosing was reduced by 12%. For S‐methadone, no differences in pharmacokinetic parameters of total drug were seen, but unbound concentrations were reduced by 15% and 21% at 4 and 24 hours after dosing, respectively. SQV trough concentrations exceeded the anticipated EC50 (50 ng/mL) in 10/12 subjects, persisting for at least 6 hours after the final dose in 4/6 subjects. Once‐daily SQV/rtv in methadone‐maintained subjects is safe and not associated with any clinically significant interaction with methadone during 14 days of concomitant administration.
Pharmacokinetics and Safety of Viramidine, a Prodrug of Ribavirin, in Healthy Volunteers
Authors: Lin Chin‐Chung , Philips Lee , Xu Christine , Yeh Li‐Tain
Published: February 2004

Ribavirin, part of the current first‐line combination therapy for the treatment of chronic hepatitis C, has side effects—in particular, hemolytic anemia—that is frequently dose limiting. Based on animal studies, viramidine, a prodrug of ribavirin, is converted to ribavirin in the liver. Viramidine dosing yielded 50% higher ribavirin levels in the monkey liver but only half in plasma and red blood cells compared to ribavirin dosing. At the same dose, it also had a safer profile than ribavirin in a 28‐day toxicity study in monkeys. The current study was carried out to evaluate the safety, tolerability, and pharmacokinetics of viramidine in healthy male volunteers (n = 8–18 on viramidine vs. 2 on placebo at each dose level) after oral dosing of viramidine at 200, 600, and 1200 mg. There were no serious adverse events, and most adverse events were mild. The percentages of treatment‐emergent events judged to be possibly related to the study drug were 50% in the 1200‐mg group, 26% in the 600‐mg group, and none in the 200‐mg group. Viramidine was orally absorbed and rapidly converted to ribavirin with a tmax of 1.5 to 3.0 hours for both viramidine and ribavirin in plasma. There was dose proportionality in plasma AUC0–168 h and Cmax for viramidine and in plasma AUC0–168 h for ribavirin. Plasma AUC0–168 h for ribavirin was two to four times higher than plasma AUC0–168 h for viramidine, indicating that viramidine is extensively metabolized to ribavirin and is a prodrug of ribavirin in man. Amounts of viramidine and ribavirin excreted in the urine were small (2%‐5% of dose), indicating that the main route of elimination for both viramidine and ribavirin is metabolism. Both viramidine and ribavirin were excreted into urine through the mechanism of glomerular filtration. In addition, an evaluation of the effect of a high‐fat meal on the pharmacokinetics of viramidine and ribavirin after oral dosing of viramidine at 600 mg was conducted in healthy male volunteers (n = 33–34) in a crossover study design. A high‐fat meal increased viramidine plasma AUC0–168 h by 44% and Cmax by 20%. It also increased ribavirin plasma AUC0–168 h by 19% and Cmax by 43%. The clinical relevance of these increases is unknown.
Strain Behavior of the Distal Achilles Tendon
Authors: Lyman Jeffrey , Weinhold Paul S. , Almekinders Louis C.
Published: February 2004

Background

The changes associated with Achilles insertional tendinopathy (AIT) are seen in the anterior portion of the Achilles tendon near its calcaneal insertion. Strain behavior of this portion of the tendon was evaluated.

Hypothesis

The highest strains are in the anterior portion of the tendon.

Study Design

Controlled laboratory study.

Methods

Six cadaveric legs were tested. While moving through a functional range of ankle motion, strains in five different regions of the tendon insertion were tested. First, the load on the tendon was increased from 30 to 170 N in the starting, plantar flexed position. Then, the ankle was moved from a plantar flexed position into dorsiflexion.

Results

Strains in the posterior sites increased significantly (P < 0.001) as the movement into dorsiflexion occurred. This was significantly (P < 0.01) different than the anterior sites, which showed a trend toward decreasing strain.

Conclusions

Although the anterior portion of the Achilles tendon is generally affected in AIT, relative strain shielding is seen in this portion of the tendon. These findings suggest that the role of repetitive tensile loads in the causation of AIT is more complex than often described.

Clinical Relevance

These findings may explain the variable therapeutic response following measures aimed at decreasing tensile loads on the tendon.
Cartilage Lesions of the Patella in Recurrent Patellar Dislocation
Authors: Nomura Eiki , Inoue M.
Published: February 2004

Background

The etiology of patellar cartilage lesions in recurrent patellar dislocation has been poorly understood.

Hypothesis

The pathology of cartilage lesions of the patella accompanied by recurrent patellar dislocation can be analyzed.

Study Design

Series of case reports.

Methods

In 70 knees from 57 patients with recurrent patellar dislocation, the cartilage lesions of the patella were examined using arthroscopy and/or macroscopic observation. The average age of the patients was 22 years (range, 13 to 40 years). Lesions that involved only softening were not included.

Results

Sixty-seven knees (96%) had articular cartilage lesions of the patella, and only 3 knees had no change. Fissuring was observed in 53 knees (76%). The most common site of fissuring was on the central dome. There were basically two types of fissuring: multiple longitudinal fissuring and marginal/radial fissuring. Fibrillation and/or erosion were observed in 54 knees (77%). Of these, 40 knees had fissuring and 14 did not have fissuring. The main site of fibrillation and/or erosion was the medial facet.

Conclusions

Cartilage lesions of the patella in recurrent patellar dislocation cases were very common. Fissuring was observed mainly on the central dome, and fibrillation and/or erosion were observed mainly on the medial facet.
Inflammatory Response of Human Tendon Fibroblasts to Cyclic Mechanical Stretching
Authors: Li Zhaozhu , Yang Guoguang , Khan Mustafa , Stone David , Woo Savio L-Y. , Wang James H-C.
Published: February 2004

Background

The cellular and molecular mechanisms for the development of tendinopathy are not clear, but inflammatory mediators produced by tendon fibroblasts in response to repetitive mechanical loading may be an important factor.

Hypotheses

(1) Cyclic stretching of tendon fibroblasts affects the production of leukotriene B4 and the expression of 5-lipoxygenase; and (2) the production level of leukotriene B4 is inversely related to that of prostaglandin E2.

Study Design

Controlled laboratory study.

Methods

Human patellar tendon fibroblasts were uniaxially stretched in the presence of indomethacin (25 μM) or MK-886 (10 μM). After stretching for 4 hours, followed by 4 hours rest, levels of prostaglandin E2, leukotriene B4, and expression of 5-lipoxygenase were measured.

Results

Stretched tendon fibroblasts increased the levels of leukotriene B4 but did not appreciably change the expression of 5-lipoxygenase. Indomethacin decreased the cellular production of prostaglandin E2 but caused increased leukotriene B4 levels. MK-886 caused decreased production of leukotriene B4 but increased production of prostaglandin E2.

Conclusions

Cyclic stretching of human tendon fibroblasts increases the production of prostaglandin E2 and leukotriene B4. Blocking prostaglandin E2 production leads to increased leukotriene B4 levels and vice versa.

Clinical Relevance

The use of nonsteroidal anti-inflammatory drugs for the treatment of tendon inflammation might increase the levels of leukotriene B4 within the tendon, potentially contributing to the development of tendinopathy.
An Evaluation of the Apprehension, Relocation, and Surprise Tests for Anterior Shoulder Instability
Authors: Lo Ian K. Y. , Nonweiler Blake , Woolfrey Michael , Litchfield Robert , Kirkley Alexandra
Published: February 2004

Background

Although there are many studies describing tests for shoulder instability, there are few assessing the validity of these tests in diagnosing anterior shoulder instability.

Purpose

To assess the validity of the apprehension, relocation, and surprise tests as predictors of anterior shoulder instability.

Study Design

Retrospective review of prospectively collected data.

Methods

Forty-six patients with a clear diagnosis of one of the following shoulder disorders were evaluated by four independent, blinded examiners: traumatic anterior instability (18), rotator cuff tendinosis (17), posterior instability (2), glenohumeral osteoarthritis (4), or multidirectional instability (5). Interobserver reliability was also determined.

Results

In subjects who had a feeling of apprehension on all three tests, the mean positive and negative predictive values were 93.6% and 71.9%, respectively. The surprise test was the single most accurate test (sensitivity = 63.89%; specificity = 98.91%). An improvement in the feeling of apprehension or painwith the relocation test added little to the value of the tests. Interobserver reliability was determined to be 0.83.

Conclusions and Clinical Relevance

The results of this study suggest that a positive instability exam on all three tests is highly specific and predictive of traumatic anterior glenohumeral instability.
The Accessory Anteroinferior Tibiofibular Ligament as a Cause of Talar Impingement
Authors: Nikolopoulos Constantinos E. , Tsirikos Athanasios I. , Sourmelis Savas , Papachristou Georgios
Published: February 2004

Background

A distal fascicle of the anteroinferior tibiofibular ligament has been reported as a possible cause of anterolateral ankle impingement.

Hypothesis

This fascicle represents an independent accessory ligament in the anterior aspect of the inferior tibiofibular syndesmosis.

Study Design

Descriptive anatomical study.

Methods

The inferior tibiofibular syndesmosis was exposed in 24 fresh-frozen cadaveric ankles. Morphological characteristics of the inferior tibiofibular ligaments and interactions between the anterior ligaments and the talus were investigated in different degrees of ankle motion.

Results

A separate accessory anterior ligament was identified in 22 specimens. Its orientation was parallel and distal to the anterior tibiofibular ligament, from which it was separated by a fibrofatty septum. Its length ranged from 17 to 22 mm, its thickness from 1 to 2 mm, and its width from 3 to 5 mm. Impingement of this ligament against the talar dome was documented in all specimens in neutral ankle position, with bending of the ligamentous bands in dorsiflexion. Distraction maneuvers reproducing traction during arthroscopic approaches relieved contact.

Conclusions

An accessory anteroinferior tibiofibular ligament with distinct anatomical features was recognized.

Clinical Relevance

Based on its increased incidence in the cadaver ankles, the accessory ligament reflects a normal anatomical finding. Nevertheless, it could lead to anterolateral impingement in cases with coexistent ankle instability.
Triceps Tendon Ruptures in Professional Football Players
Authors: Mair Scott D. , Isbell William M. , Gill Thomas J. , Schlegel Theodore F. , Hawkins Richard J.
Published: February 2004

Background

Distal rupture of the triceps tendon is a rare injury, and treatment guidelines are not well established.

Hypothesis

Football players with triceps tendon ruptures will be able to return to their sport with minimal functional deficits.

Study Design

Uncontrolled retrospective review.

Methods

Twenty-one partial and complete ruptures of the triceps tendon were identified in 19 National Football League players over a period of 6 years. Team physicians retrospectively reviewed training room, clinical, and operative notes for each of these players.

Results

Most of the injured players were linemen. The most common mechanism of injury was an eccentric load to a contracting triceps. Seven players had prodromal symptoms prior to injury, and 5 had received a cortisone injection. Eleven elbows with complete tears underwent surgical repair. Of 10 players with partial tears, 6 healed without surgery. One player suffered a subsequent complete tear requiring surgery, and 3 with residual pain and weakness underwent surgical repair following the season. Two surgical complications occurred, both requiring a second operation. All of the players but 1 returned to play at least one season of professional football after their injury.

Conclusions

Partial triceps tendon ruptures can heal without functional deficit. Surgical repair for complete ruptures generally produces good functional results and allows return to play.
Effects of Increasing Tibial Slope on the Biomechanics of the Knee
Authors: Giffin J. Robert , Vogrin Tracy M. , Zantop Thore , Woo Savio L-Y. , Harner Christopher D.
Published: February 2004

Purpose

To determine the effects of increasing anterior-posterior (A-P) tibial slope on knee kinematics and in situ forces in the cruciate ligaments.

Methods

Ten cadaveric knees were studied using a robotic testing system using three loading conditions: (1) 200 N axial compression; (2) 134 N A-P tibial load; and (3) combined 200 N axial and 134 N A-P loads. Resulting knee kinematics were determined before and after a 5-mm anterior opening wedge osteotomy. Resulting in situ forces in each cruciate ligament were determined.

Results

Tibial slope was increased from 8.8 ± 1.8 ° to 13.2 ± 2.1 °, causing an anterior shift in the resting position of the tibia relative to the femur up to 3.6 ± 1.4 mm. Under axial compression, the osteotomy caused a significant anterior tibial translation up to 1.9 ± 2.5 mm (90 °). Under A-P and combined loads, no differences were detected in A-P translation or in situ forces in the cruciates (intact versus osteotomy).

Conclusions

Results suggest that small increases in tibial slope do not affect A-P translations or in situ forces in the cruciate ligaments. However, increasing slope causes an anterior shift in tibial resting position that is accentuated under axial loads. This suggests that increasing tibial slope may be beneficial in reducing tibial sag in a PCL-deficient knee, whereas decreasing slope may be protective in an ACL-deficient knee.
Relative Balance of Serratus Anterior and Upper Trapezius Muscle Activity during Push-Up Exercises
Authors: Ludewig Paula M. , Hoff Molly S. , Osowski Erin E. , Meschke Shane A. , Rundquist Peter J.
Published: February 2004

Background

Serratus anterior strengthening is used in prevention and treatment programs for poor scapular control. In certain clinical cases, exercises substantially activating the serratus with minimal upper trapezius activation are preferred.

Hypothesis

The standard push-up plus would show both the highest serratus anterior activation and lowest upper trapezius/ serratus ratios for both groups and all phases.

Study Design

Controlled laboratory study.

Methods

Thirty subjects, grouped as healthy or with mild shoulder dysfunction, were evaluated performing standard push-up plus exercises and modifications on elbows, knees, and against a wall. Surface electromyography of the serratus anterior and upper trapezius was compared between exercises.

Results

Both groups responded similarly across exercises. The standard push-up plus demonstrated the highest activation of the serratus (to 123%) and lowest trapezius/serratus ratios (< 0.2) during plus phases. The wall push-up plus and phases of other exercises demonstrated higher upper trapezius/serratus ratios (to 2.0).

Conclusions

In clinical cases where excess upper trapezius activation or imbalance of serratus and trapezius activation occurs, the push-up plus is an optimal exercise. Other cases may benefit from a progression of modified push-up exercises.

Clinical Relevance

Clinical selection of exercises for improving scapular control should consider both maximum serratus activation and upper trapezius/serratus anterior ratios.
Biomechanical and Histological Evaluation of Osteochondral Transplantation in a Rabbit Model
Authors: Nam Ellis K. , Makhsous Mohsen , Koh Jason , Bowen Mark , Nuber Gordon , Zhang Li-Qun
Published: February 2004

Background

Biomechanical and histological properties of osteochondral transplantation have not been extensively examined.

Hypothesis

Osteochondral grafts have properties similar to native articular cartilage.

Study Design

Controlled laboratory study.

Methods

A 2.7 mm (diameter) × 4.0 mm (depth) osteochondral defect was created in 17 New Zealand white rabbit knees. An osteochondral graft, harvested from the contralateral knee, was transplanted into the defect. Eight rabbits were sacrificed each at 6 and 8 weeks.

Results

The 12-week grafts (1213.6 ± 309.0 N/mm) had significantly higher stiffness than the 6-week grafts (483.1 ± 229.1 N/mm; P< .001) and of normal cartilage (774.8 ± 117.1 N/mm; P< .003). Stiffness of the 6-week grafts was significantly lower than normal cartilage (P< .036). At all time points, full-thickness defects had significantly lower stiffness than normal cartilage (P< .001). Histologically, transplanted grafts scored significantly higher than the full-thickness defects (P< .001). The defects showed inconsistent, fibrocartilage healing. The grafts demonstrated cartilage viability, yet with a persistent cleft between the graft and host.

Conclusions

Osteochondral transplants undergo increased stiffness in the short term, with evidence of structurally intact grafts.

Clinical Relevance

Osteochondral transplantation may be a viable treatment option; however, long-term investigation on graft function is necessary.
Interference Screw Fixation of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction: Part 1
Authors: Nurmi Janne T. , Kannus Pekka , Sievänen Harri , Järvelä Timo , Järvinen Markku , Järvinen Teppo L. N.
Published: February 2004

Background

Compaction of the bone-tunnel walls by serial dilation is believed to enhance the interference screw fixation strength of the soft tissue grafts in anterior cruciate ligament (ACL) reconstruction.

Hypothesis

Serial dilation enhances the fixation strength of soft tissue grafts in ACL reconstruction over extraction drilling.

Study Design

Randomized experimental study.

Methods

Initial fixation strength of the doubled anterior tibialis tendon grafts (fixed with a bioabsorbable interference screw) was assessed in 21 pairs of human cadaver tibiae with either serially dilated or extraction-drilled bone tunnels. The specimens were subjected to a cyclic-loading test, and those surviving were then tested using the single-cycle load-to-failure test.

Results

During the cyclic-loading test, there were 3 fixation failures in the serially dilated and 6 failures in the extraction-drilled specimens but no significant stiffness or displacement differences between the groups. In the subsequent load-to-failure test, the average yield loads were 473 ± 110 N and 480 ± 115 N for the 2 groups respectively (P= .97) and no difference with regard to stiffness or mode of failure.

Conclusions

Serial dilation does not increase the strength of interference fixation of soft tissue grafts in ACL reconstruction over extraction drilling.

Clinical Relevance

The results of this experiment do not support the use of serial dilators in ACL reconstruction.
Arthroscopic Posterior Cruciate Ligament Reconstruction with Quadriceps Tendon Autograft
Authors: Chen Chih-Hwa , Chen Wen-Jer , Shih Chun-Hsiung , Chou Shih-Wei
Published: February 2004

Background

Various autografts or allografts have been used for posterior cruciate ligament (PCL) reconstruction. Quadriceps tendon-patellar bone autograft is considered a good graft choice.

Hypothesis

Quadriceps tendon-patellar bone graft for PCL reconstruction can achieve a satisfactory clinical outcome after 3 years postoperatively.

Study Design

Retrospective review of prospectively collected data.

Methods

From 1996, the graft has been used in 32 patients. Twenty-nine patients with a minimum of 3 years of follow-up were analyzed.

Results

Twenty-four (83%) patients achieved good or excellent results by Lysholm knee rating. Sixteen (55%) patients could return to moderate or strenuous activity. Twenty-five (86%) patients had ligament laxity of less than 5 mm. Twenty-four (83%) patients were rated as normal or nearly normal by International Knee Documentation Committee (IKDC) guidelines. Twenty-four (83%) and 26 (90%) patients could achieve recovery of extensor and flexor muscle strength to 80% or more of normal knee, respectively. A statistically significant difference exists in thigh girth difference, extensor strength, and flexor strength before and after reconstruction.

Conclusion

Our study revealed satisfactory clinical subjective and objective results at a minimum 3 years follow-up. Quadriceps tendon autograft has the advantage of being self-available, a relatively easier arthroscopic technique, and having a suitable size, making it an acceptable graft choice for PCL reconstruction.
Fractures in the Collegiate Athlete
Authors: Hame Sharon L. , LaFemina Jennifer M. , McAllister David R. , Schaadt Geoffrey W. , Dorey Frederick J.
Published: February 2004

Purpose

To determine the demographics and incidence of fractures in collegiate athletes.

Study Design

Retrospective review of prospectively collected data.

Methods

Division I collegiate athletes who sustained a fracture while enrolled at the university from 1986 to 2000 were identified through training room records. Type and location of fracture, sport, gender, age, position, height, and weight were recorded and analyzed. Team information was obtained from athletic department records and was used to calculate incidence.

Results

Between 1986 and 2000, 5900 Division I athletes at our institution sustained 349 primary fractures (5.9%). By gender, the incidence did not differ significantly between males and females (P = .236), except in water polo where the men sustained significantly more fractures. By type, females sustained significantly more stress fractures (P = .001) than males. Overall, by location, the hand contributed the greatest number of total fractures. By sport, the incidence rate was highest in basketball (0.081) for male athletes and in gymnastics (0.069) for female athletes. The incidence of a second fracture during the study period was twice the rate of the first fracture.

Conclusions

As expected, athletes participating in contact sports contributed the greatest number of fractures. Participation in basketball for men and in gymnastics for women posed the greatest risk. Female athletes sustained significantly more stress fractures.
The Surgical Treatment of External Coxa Saltans (the Snapping Hip) by Z-Plasty of the Iliotibial Band
Authors: Provencher Matthew T. , Hofmeister Eric P. , Muldoon Michael P.
Published: February 2004

Purpose

A snapping hip (coxa saltans) secondary to a tight iliotibial band rarely needs surgical intervention. The purpose of this study is to present the surgical results of refractory external-type snapping hip by Z-plasty of the iliotibial band.

Materials and Methods

Nine symptomatic snapping hips in 8 consecutive patients (1 bilateral) from August 1997 through March 2002 who underwent an iliotibial band Z-plasty were reviewed.

Results

Eight of the 9 hips were in active-duty military and 1 was a civilian, with an average age of 25.6 years (range, 21 to 38 years). Mean duration of symptoms prior to surgical intervention was 25.2 months (range, 16 to 39 months) with an average follow-up of 22.9 months (range, 7 to 38 months). All patients had complete resolution of the snapping hip, and all but 1 returned to full unrestricted activities. The 1 failure had persistent groin pain but no residual snapping.

Conclusions

Patients with snapping hip of the iliotibial band refractory to conservative treatment are rare. The surgical results of Z-plasty are excellent and predictable. Careful screening is necessary to preclude other confounding diagnoses. Z-plasty is recommended as an effective surgical treatment of the refractory snapping hip secondary to iliotibial band tightness.
A Prospective Cohort Study of Injury Incidence and Risk Factors in North Carolina High School Competitive Cheerleaders
Authors: Schulz Mark R. , Marshall Stephen W. , Yang Jingzhen , Mueller Frederick O. , Weaver Nancy L. , Bowling J. Michael
Published: February 2004

Background

Cheerleaders suffer nearly half of catastrophic injuries observed in female scholastic athletes in the United States. However, incidence of noncatastrophic injury in this population has not been described.

Hypothesis

Coach, athlete, and injury circumstance variables may predict the injury rate among cheerleaders.

Study Design

Prospective cohort.

Methods

The authors investigated injury incidence in a sample of North Carolina female cheerleaders who competed interscholastically from 1996 to 1999. Injury, exposure, and demographic data were collected from squads that participated in the North Carolina High School Athletic Injury Study.

Results

Cheerleaders suffered 133 injuries during 1701 athlete seasons. More than 21% of the injuries were ankle sprains. The injury rate was 8.7; the 95% confidence interval (CI) was 6.5 to 11.7 per 10,000 athlete exposures. In a multivariate Poisson regression model, cheerleaders supervised by coaches with the most education, qualifications, and training (coach EQT) had a nearly 50% reduction in injury risk (rate ratio [RR], 0.5; 95% CI, 0.3-0.9), and cheerleaders supervised by coaches with medium coach EQT had a nearly 40% reduction in injury risk (RR = 0.6; 95% CI, 0.3-1.2) compared to cheerleaders supervised by coaches with low coach EQT.
The Effect of Graft Height Mismatch on Contact Pressure following Osteochondral Grafting
Authors: Koh Jason Lee , Wirsing Kim , Lautenschlager Eugene , Zhang Li-Oun
Published: February 2004

Hypothesis

Incongruity of the articular cartilage following osteochondral transplantation affects surface contact pressure.

Study Design

An 80 N load was applied for 120 seconds to the femoral condyles of 10 swine knees. Contact pressures were measured using Fuji prescale film. Seven conditions were tested: (1) intact articular surface; (2) 4.5-mm diameter defect; (3) grafted with 4.5-mm diameter plug elevated 1 mm above adjacent cartilage; (4) plug elevated 0.5 mm; (5) plug flush; (6) plug sunk 0.5 mm below surface; and (7) sunk 1.0 mm.

Conclusions

Peak contact pressures were significantly (P< .001) elevated by ~20% after defect creation and were reduced to normal when plugs were flush. There were large and significant (P< .001) increases in pressure with plugs elevated 1 and 0.5 mm. Contact pressures with plugs sunk 0.5 and 1 mm were significantly (P< .01) higher than intact cartilage but were significantly (P < .01) lower than an empty defect.

Clinical Relevance

Normal contact pressures and patterns can be duplicated with flush articular surface grafts. However, small incongruities, particularly when the plug is elevated, can lead to significantly increased pressure. This reinforces the importance of articular surface congruity in the initial biomechanical state following osteochondral implantation.
The Effect of Creatine Supplementation on Strength Recovery after Anterior Cruciate Ligament (ACL) Reconstruction
Authors: Tyler Timothy F. , Nicholas Stephen J. , Hershman Elliott B. , Glace Beth W. , Mullaney Michael J. , McHugh Malachy P.
Published: February 2004

Background

Creatine supplementation has been shown to augment training-induced strength gains. The purpose of this study was to examine the effect of creatine supplementation on recovery of muscle strength after anterior cruciate ligament (ACL) reconstruction.

Hypothesis

Creatine supplementation will facilitate strength gains after ACL reconstruction.

Study Design

Double-blind, prospective, and randomized clinical trial.

Methods

Sixty patients were randomized into creatine or placebo groups. Quadriceps and hamstring strength and power were measured isokinetically. Hip flexor, abductor, and adductor strengths were measured with a handheld dynamometer prior to surgery and at 6 weeks, 12 weeks, or 6 months after surgery.

Results

From 6 weeks to 12 weeks after surgery, there were significant increases in strength on the involved side for knee extension (47%), knee flexion (27%), hip flexion (20%), hip abduction (9%), and hip adduction (17%). These strength improvements were unaffected by creatine supplementation with similar effects in the creatine and placebo groups. From 6 weeks to 12 weeks after surgery, there were significant increases in power on the involved side for knee extension (46%) and knee flexion (26%), but these effects were not affected by creatine supplementation. At 6 months, creatine supplementation did not affect outcome as measured by the single leg hop test for distance or the knee outcome score.

Conclusions

The results demonstrate that patients do not benefit from creatine supplementation during the first 12 weeks of rehabilitation after ACL reconstruction.
Shoulder Injuries to Quarterbacks in the National Football League
Authors: Kelly Bryan T. , Barnes Ronnie P. , Powell John W. , Warren Russell F.
Published: February 2004

Background

Quarterbacks are at risk for shoulder injury secondary to both the throwing motion as well as from contact injury.

Objective

To delineate the incidence and etiology of shoulder injuries to quarterbacks in the National Football League (NFL).

Methods

Using the NFL Injury Surveillance System (NFLISS), all reported injuries to quarterbacks between 1980 and 2001 were identified.

Results

A total of 1534 quarterback injuries were identified with a mean of 18.8 and a median of 6.0 days of playing time lost. The majority of these injuries occurred during a game (83.8%). Passing plays were responsible for 77.4% of all quarterbackrelated injuries. Shoulder injuries were the second most common injury reported (233 or 15.2%), following closely behind head injuries (15.4%). Direct trauma was responsible for 82.3% of the injuries, with acromioclavicular joint sprains being the most common injury overall (40%). Overuse injuries were responsible for 14% of the injuries, the most common being rotator cuff tendinitis (6.1%) followed by biceps tendinitis (3.5%).

Conclusion

In this review, the vast majority of shoulder injuries in quarterbacks occurred as a result of direct trauma (82.3%), and less than 15% were overuse injuries resulting from the actual throwing motion.
Current Concepts in Anabolic-Androgenic Steroids
Authors: Evans Nick A.
Published: February 2004

Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone. According to surveys and media reports, the legal and illegal use of these drugs is gaining popularity. Testosterone restores sex drive and boosts muscle mass, making it central to 2 of society's rising preoccupations: perfecting the male body and sustaining the male libido. The anabolic effects of AAS have been questioned for decades, but recent scientific investigation of supraphysiologic doses supports the efficacy of these regimens. Testosterone has potent anabolic effects on the musculoskeletal system, including an increase in lean body mass, a dose-related hypertrophy of muscle fibers, and an increase in muscle strength. For athletes requiring speed and strength and men desiring a cosmetic muscle makeover, illegal steroids are a powerful lure, despite the risk of subjective side effects. Recent clinical studies have discovered novel therapeutic uses for physiologic doses of AAS, without any significant adverse effects in the short term. In the wake of important scientific advances during the past decade, the positive and negative effects of AAS warrant reevaluation. Guidelines for the clinical evaluation of AAS users will be presented for sports medicine practitioners.
Tunnel Enlargement after Anterior Cruciate Ligament Surgery
Authors: Wilson Timothy C. , Kantaras Anthony , Atay Ahmet , Johnson Darren L.
Published: February 2004

Bone tunnel enlargement has been reported after anterior cruciate ligament (ACL) reconstruction surgery. Although the long-term outcome of this phenomenon is not yet known, tunnel lysis or expansion may be clinically significant in revision surgery because the enlarged tunnels may complicate graft placement and fixation. There any many proposed theories for tunnel lysis. The most accurate statement is that this condition has a multifactorial etiology. Mechanical and biological causes have been reported, and both contribute to enlarged graft tunnels. This article describes the multiple causes of bone tunnel enlargement after ACL surgery. Future techniques and advances in primary ACL surgery must seek to eliminate this phenomenon.
Economic evaluation of the use of PCR assay in diagnosing pulmonary TB in a low-incidence area
Authors: Rajalahti I. , Ruokonen E‐L. , Kotomäki T. , Sintonen H. , Nieminen M.M.
Published: February 2004

To determine whether polymerase chain reaction (PCR) testing in the initial diagnosis of pulmonary tuberculosis (TB) is cost-effective in a low-prevalence population, an economic evaluation was carried out between the smear and culture (NOPCR) and smear, culture and PCR (+PCR) strategies.

A decision tree model based on retrospective laboratory data was developed to assess the strategies of testing patients with suspicion of TB. Direct healthcare costs prior to confirmation of TB or nontuberculous mycobacteria by PCR or culture were included. Effectiveness was measured by the probability of correct treatment and isolation decisions.

In the baseline situation NOPCR costs 29.50 less than the +PCR strategy per patient tested. According to sensitivity analyses, reducing PCR test price, shortening test performance time or increasing the proportion of smear-positive patients in the tested population would contribute to cost savings with the +PCR strategy.

Routine polymerase chain reaction testing of all specimens from suspected tuberculosis patients in a low-prevalence population was not cost-saving. When the polymerase chain reaction assay was applied only to smear-positive sputum specimens, the smear and culture strategy was clearly dominated by it,i.e.the polymerase chain reaction smear-positive sputum strategy was less costly and more effective in producing correct treatment decisions and isolations.
The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation
Authors: Willemse B.W.M. , Postma D.S. , Timens W. , ten Hacken N.H.T.
Published: February 2004

Smoking is the main risk factor in the development of chronic obstructive pulmonary disease (COPD), and smoking cessation is the only effective treatment for avoiding or reducing the progression of this disease.

Despite the fact that smoking cessation is a very important health issue, information about the underlying mechanisms of the effects of smoking cessation on the lungs is surprisingly scarce. It is likely that the reversibility of smoke-induced changes differs between smokers without chronic symptoms, smokers with nonobstructive chronic bronchitis and smokers with COPD. This review describes how these three groups differ regarding the effects of smoking cessation on respiratory symptoms, lung function (forced expiratory volume in one second), airway hyperresponsiveness, and pathological and inflammatory changes in the lung.

Smoking cessation clearly improves respiratory symptoms and bronchial hyperresponsiveness, and prevents excessive decline in lung function in all three groups.

Data from well-designed studies are lacking regarding the effects on inflammation and remodelling, and the few available studies show contradictory results. In chronic obstructive pulmonary disease, a few histopathological studies suggest that airway inflammation persists in exsmokers. Nevertheless, many studies have shown that smoking cessation improves the accelerated decline in forced expiratory volume in one second, which strongly indicates that important inflammatory and/or remodelling processes are positively affected.
Omalizumab inhibits allergen challenge-induced nasal response
Authors: Hanf G. , Noga O. , O'Connor A. , Kunkel G.
Published: February 2004

Elevated serum levels of antigen-specific immunoglobulin (Ig)E are often associated with allergic respiratory diseases. This parallel-group, randomised, double-blind, placebo-controlled trial was designed to study the influence of omalizumab on the early nasal response to allergen challenge reflected by symptom score and inflammatory marker levels in nasal lavage fluid (NAL).

A total of 23 patients with allergic rhinitis took part in the study, 11 were given placebo and omalizumab was administered subcutaneously in 12. Omalizumab or placebo were given at 2‐ or 4‐week intervals based on a patient's body weight and IgE levels to a total dose of 0.016 mg·kg−1·IgE−1(IU·mL−1) every 4 weeks.

Compared to placebo, 16 weeks of treatment with omalizumab significantly inhibited allergen challenge-induced nasal symptoms (median symptom score 7.0–0.5versus7.0–7.0) and inhibited the increase of human serum albumin (median 15.3–0.12 mg·mL−1versus8.2–19.7 mg·mL−1) in the NAL after allergen challenge. Treatment with omalizumab induced a significant decrease in tumour necrosis factor‐α levels in basal NAL, but no change was seen for histamine.

These results indicate that subcutaneously administered monoclonal anti-immunoglobulin‐E antibody, omalizumab, inhibits the nasal responses to allergen challenge of patients with allergic rhinitis. Omalizumab may provide a new strategy for the treatment of allergic rhinitis.
Iron lungversusconventional mechanical ventilation in acute exacerbation of COPD
Authors: Corrado A. , Ginanni R. , Villella G. , Gorini M. , Augustynen A. , Tozzi D. , Peris A. , Grifoni S. , Messori A. , Nozzoli C. , Berni G.
Published: February 2004

The aim of this randomised study was to compare the effects of iron lung ventilation (ILV) with invasive mechanical ventilation (IMV) in patients with acute respiratory failure (ARF) due to exacerbation of chronic obstructive pulmonary disease.

Forty-four patients with ARF were assigned either to ILV (22 patients) or IMV (22 patients). Primary end-points were the improvement in gas exchange and complications related to mechanical ventilation.

On admission ILV and IMV groups did not differ in age, simplified acute physiology score II, arterial oxygen tension (Pa,O2)/inspiratory oxygen fraction (FI,O2), arterial carbon dioxide tension (Pa,CO2) and pH. Compared with baseline, ILV and IMV induced a similar and significant improvement inPa,O2/FI,O2,Pa,CO2and pH after 1 h of treatment and at discontinuation of mechanical ventilation. Major complications tended to be more frequent in patients treated with IMV than in those treated with ILV (27.3%versus4.5%), whereas mortality rate was similar (27.3%versus18.2%). The ventilator-free days and the length of hospital stay were significantly lower in the ILV than in the IMV group.

This study suggests that iron lung ventilation is as effective as invasive mechanical ventilation in improving gas exchange in chronic obstructive pulmonary disease patients with acute respiratory failure, and is associated with a tendency towards a lower rate of major complications.
Increased mortality in COPD among construction workers exposed to inorganic dust
Authors: Bergdahl I.A. , Torén K. , Eriksson K. , Hedlund U. , Nilsson T. , Flodin R. , Järvholm B.
Published: February 2004

The aim of this study was to find out if occupational exposure to dust, fumes or gases, especially among never-smokers, increased the mortality from chronic obstructive pulmonary disease (COPD).

A cohort of 317,629 Swedish male construction workers was followed from 1971 to 1999. Exposure to inorganic dust (asbestos, man-made mineral fibres, dust from cement, concrete and quartz), gases and irritants (epoxy resins, isocyanates and organic solvents), fumes (asphalt fumes, diesel exhaust and metal fumes), and wood dust was based on a job-exposure matrix. An internal control group with “unexposed” construction workers was used, and the analyses were adjusted for age and smoking.

When all subjects were analysed, there was an increased mortality from COPD among those with any airborne exposure (relative risk 1.12 (95% confidence interval (CI) 1.03–1.22)). In a Poisson regression model, including smoking, age and the major exposure groups, exposure to inorganic dust was associated with an increased risk (hazard ratio (HR) 1.10 (95% CI 1.06–1.14)), especially among never-smokers (HR 2.30 (95% CI 1.07–4.96)). The fraction of COPD among the exposed attributable to any airborne exposure was estimated as 10.7% overall and 52.6% among never-smokers.

In conclusion, occupational exposure among construction workers increases mortality due to chronic obstructive pulmonary disease, even among never-smokers.