Anterior cruciate ligament reconstruction with special reference to magnetic resonance imaging of the postoperative outcome

Anterior cruciate ligament (ACL) tear is a common sports injury of the knee. Arthroscopic reconstruction using autogenous graft material is widely used for patients with ACL instability. The grafts most commonly used are the patellar and the hamstring tendons, by various fixation techniques. Although clinical evaluation and conventional radiography are routinely used in follow-up after ACL surgery, magnetic resonance imaging (MRI) plays an important role in the diagnosis of complications after ACL surgery. The aim of this thesis was to study the clinical outcome of patellar and hamstring tendon ACL reconstruction techniques. In addition, the postoperative appearance of the ACL graft was evaluated using several MRI sequences. Of the 175 patients who underwent an arthroscopically assisted ACL reconstruction, 99 patients were randomized into patellar tendon (n=51) or hamstring tendon (n=48) groups. In addition, 62 patients with hamstring graft ACL reconstruction were randomized into either cross-pin (n=31) or interference screw (n=31) fixation groups. Follow-up evaluation determined knee laxity, isokinetic muscle performance and several knee scores. Lateral and anteroposterior view radiographs were obtained. Several MRI sequences were obtained with a 1.5-T imager. The appearance and enhancement pattern of the graft and periligamentous tissue, and the location of bone tunnels were evaluated. After MRI, arthroscopy was performed on 14 symptomatic knees. The results revealed no significant differences in the 2-year outcome between the groups. In the hamstring tendon group, the average femoral and tibial bone tunnel diameter increased during 2 years follow-up by 33% and 23%, respectively. In the asymptomatic knees, the graft showed homogeneous and low signal intensity with periligamentous streaks of intermediate signal intensity on T2-weighted MR images. In the symptomatic knees, arthroscopy revealed 12 abnormal grafts and two meniscal tears, each with an intact graft. Among 3 lax grafts visible on arthroscopy, MRI showed an intact graft and improper bone tunnel placement. For diagnosing graft failure, all MRI findings combined gave a specificity of 90% and a sensitivity of 81%. In conclusion, all techniques appeared to improve patients' performance, and were therefore considered as good choices for ACL reconstruction. In follow-up, MRI permits direct evaluation of the ACL graft, the bone tunnels, and additional disorders of the knee. Bone tunnel enlargement and periligamentous tissue showing contrast enhancement were non-specific MRI findings that did not signify ACL deficiency. With an intact graft and optimal femoral bone tunnel placement, graft deficiency is unlikely, and the MRI examination should be carefully scrutinized for possible other causes for the patients symptoms.

Distal anterior cerebral artery aneurysms

Objective: Distal anterior cerebral artery (DACA) aneurysms represent about 6% of all intracranial aneurysms. So far, only small series on treatment of these aneurysms have been published. Our aim is to evaluate the anatomic features, microneurosurgical techniques, treatment results, and long-term outcome in patients treated for DACA aneurysms. Patients and methods: We analyzed the clinical and radiological data on 517 consecutive patients diagnosed with DACA aneurysm at two neurosurgical centers serving solely the Southern (Helsinki) and Eastern (Kuopio) Finland in 1936–2007, and used a defined subgroup of the whole study population in each part of the study. Detailed anatomic analysis was performed in 101 consecutive patients from 1998 to 2007. Treatment results were analyzed in 427 patients treated between 1980 to 2005, the era of CT imaging and microneurosurgery. Long-term treatment outcome of ruptured DACA aneurysm(s) was evaluated in 280 patients with a median follow-up of 10 years; no patients were lost to follow-up. Results: DACA aneurysms, found most often (83%) at the A3 segment of the anterior cerebral artery (ACA), were smaller (median 6 mm vs. 8 mm), more frequently associated with multiple aneurysms (35% vs. 18%), and presented more often with intracerebral hematomas (ICHs) (53% vs. 26%) than ruptured aneurysms in general. They were associated with anomalies of the ACA in 23% of the patients. Microsurgical treatment showed similar complication rates (treatment morbidity 15%, treatment mortality 0.4%) as for other ruptured aneurysms. At one year after subarachnoid hemorrhage (SAH), DACA aneurysms had equally favorable outcome (GOS≥4) as other ruptured aneurysms (74% vs. 69%) but their mortality was lower (13% vs. 24%). Factors predicting unfavorable outcome for ruptured DACA aneurysms were advanced age, Hunt&Hess≥3, rebleeding before treatment, ICH, intraventricular hemorrhage, and severe preoperative hydrocephalus. The cumulative relative survival ratio showed 16% excess mortality in patients with ruptured DACA aneurysm during the first three years after SAH compared to the matched general population. From the fourth year onwards, there was no excess mortality during the follow-up. There were four episodes of recurrent SAH, only one due to treated DACA aneurysm, with a 10-year cumulative risk of 1.4%. Conclusions: The special neurovascular features and frequent association with anterior cerebral artery anomalies must be taken into account when planning occlusive treatment of DACA aneurysms. Clipping of DACA aneurysms provides a long-lasting result, with very small rates of rebleeding. After surviving three years from rupture of DACA aneurysm, the long-term survival of these patients becomes similar to that of the matched general population.

Epoxy resin chamber for high voltage breakdown studies in high vacuum

As the study of electrical breakdown phenomena in vacuum systems, gains more importance, a thorough understanding of the breakdown mechanism at high voltages necessitates a chamber for experimental studies. An epoxy-resin chamber has been constructed by casting ring sections which were joined together. The advantages of such a chamber over the conventional metal or glass chamber are given especially as regards the electric field configuration, high voltage lead-in, and the ease of construction. Special facilities can be incorporated while constructing the chamber which makes it more versatile; for example, in pre-breakdown current measurements, electron beam focusing studies, etc.

Effect of wall thickness on the end corrections of the extended inlet and outlet of a double-tuned expansion chamber

Simple expansion chambers, the simplest of the muffler configurations, have very limited practical application due to the presence of periodic troughs in the transmission loss spectrum which drastically lower the overall transmission loss of the muffler. Tuned extended inlet and outlet can be designed to nullify three-fourths of these troughs, making use of the plane wave theory. These cancellations would not occur unless one altered the geometric lengths for the extended tube in order to incorporate the effect of evanescent higher-order modes (multidimensional effect) through end corrections or lumped inertance approximation at the area discontinuities or junctions. End corrections of the extended inlet and outlet have been studied by several researchers. However the effect of wall thickness of the inlet/outlet duct on end correction has not been studied explicitly. This has significant effect on the tuning of an extended inlet/outlet expansion chamber. It is investigated here experimentally as well as numerically (through use of 3-D FEM software) for stationary medium. Crown Copyright (C) 2010 Published by Elsevier Ltd. All rights reserved.

FGF signaling in neurogenesis and patterning of the developing midbrain and anterior hindbrain

Embryonic midbrain and hindbrain are structures which will give rise to brain stem and cerebellum in the adult vertebrates. Brain stem contains several nuclei which are essential for the regulation of movements and behavior. They include serotonin-producing neurons, which develop in the hindbrain, and dopamine-producing neurons in the ventral midbrain. Degeneration and malfunction of these neurons leads to various neurological disorders, including schizophrenia, depression, Alzheimer s, and Parkinson s disease. Thus, understanding their development is of high interest. During embryogenesis, a local signaling center called isthmic organizer regulates the development of midbrain and anterior hindbrain. It secretes peptides belonging to fibroblast growth factor (FGF) and Wingless/Int (Wnt) families. These factors bind to their receptors in the surrounding tissues, and activate various downstream signaling pathways which lead to alterations in gene expression. This in turn affects the various developmental processes in this region, such as proliferation, survival, patterning, and neuronal differentiation. In this study we have analyzed the role of FGFs in the development of midbrain and anterior hindbrain, by using mouse as a model organism. We show that FGF receptors cooperate to receive isthmic signals, and cell-autonomously promote cell survival, proliferation, and maintenance of neuronal progenitors. FGF signaling is required for the maintenance of Sox3 and Hes1 expression in progenitors, and Hes1 in turn suppresses the activity of proneural genes. Loss of Hes1 is correlated with increased cell cycle exit and premature neuronal differentiation. We further demonstrate that FGF8 protein forms an antero-posterior gradient in the basal lamina, and might enter the neuronal progenitors via their basal processes. We also analyze the impact of FGF signaling on the various neuronal nuclei in midbrain and hindbrain. Rostral serotonergic neurons appear to require high levels of FGF signaling in order to develop. In the absence of FGF signaling, these neurons are absent. We also show that embryonic meso-diencephalic dopaminergic domain consists of two populations in the anterior-posterior direction, and that these populations display different molecular profiles. The anterior diencephalic domain appears less dependent on isthmic FGFs, and lack several genes typical of midbrain dopaminergic neurons, such as Pitx3 and DAT. In Fgfr compound mutants, midbrain dopaminergic neurons begin to develop but soon adopt characteristics which highly resemble those of diencephalic dopaminergic precursors. Our results indicate that FGF signaling regulates patterning of these two domains cell-autonomously.

Transverse plane wave analysis of short elliptical chamber mufflers: An analytical approach

Short elliptical chamber mufflers are used often in the modern day automotive exhaust systems. The acoustic analysis of such short chamber mufflers is facilitated by considering a transverse plane wave propagation model along the major axis up to the low frequency limit. The one dimensional differential equation governing the transverse plane wave propagation in such short chambers is solved using the segmentation approaches which are inherently numerical schemes, wherein the transfer matrix relating the upstream state variables to the downstream variables is obtained. Analytical solution of the transverse plane wave model used to analyze such short chambers has not been reported in the literature so far. This present work is thus an attempt to fill up this lacuna, whereby Frobenius solution of the differential equation governing the transverse plane wave propagation is obtained. By taking a sufficient number of terms of the infinite series, an approximate analytical solution so obtained shows good convergence up to about 1300 Hz and also covers most of the range of muffler dimensions used in practice. The transmission loss (TL) performance of the muffler configurations computed by this analytical approach agrees excellently with that computed by the Matrizant approach used earlier by the authors, thereby offering a faster and more elegant alternate method to analyze short elliptical muffler configurations. (C) 2010 Elsevier Ltd. All rights reserved.

A simple numerical method for three-dimensional analysis of simple expansion chamber mufflers of rectangular as well as circular cross-section with a stationary medium

Three-dimensional effects are a primary source of discrepancy between the measured values of automotive muffler performance and those predicted by the plane wave theory at higher frequencies. The basically exact method of (truncated) eigenfunction expansions for simple expansion chambers involves very complicated algebra, and the numerical finite element method requires large computation time and core storage. A simple numerical method is presented in this paper. It makes use of compatibility conditions for acoustic pressure and particle velocity at a number of equally spaced points in the planes of the junctions (or area discontinuities) to generate the required number of algebraic equations for evaluation of the relative amplitudes of the various modes (eigenfunctions), the total number of which is proportional to the area ratio. The method is demonstrated for evaluation of the four-pole parameters of rigid-walled, simple expansion chambers of rectangular as well as circular cross-section for the case of a stationary medium. Computed values of transmission loss are compared with those computed by means of the plane wave theory, in order to highlight the onset (cutting-on) of various higher order modes and the effect thereof on transmission loss of the muffler. These are also compared with predictions of the finite element methods (FEM) and the exact methods involving eigenfunction expansions, in order to demonstrate the accuracy of the simple method presented here.

3D Acoustic Analysis Of Spherical Chamber Having Single Inlet And Multiple Outlet: An Impedance Matrix Approach

The transmission loss (TL) performance of spherical chambers having single inlet and multiple outlet is obtained analytically through modal expansion of acoustic field inside the spherical cavity in terms of the spherical Bessel functions and Legendre polynomials. The uniform piston driven model based upon the impedance [Z] matrix is used to characterize the multi-port spherical chamber. It is shown analytically that the [Z] parameters are independent of the azimuthal angle (phi) due to the axisymmetric shape of the sphere; rather, they depend only upon the polar angle (theta) and radius of the chamber R(0). Thus, the effects of relative polar angular location of the ports and number of outlet ports are investigated. The analytical results are shown to be in good agreement with the 3D FEA results, thereby validating the procedure suggested in this work.

3-D acoustic analysis of elliptical chamber mufflers having an end-inlet and a side-outlet: An impedance matrix approach

The acoustical behavior of an elliptical chamber muffler having an end-inlet and side-outlet port is analyzed semi-analytically. A uniform piston source is assumed to model the 3-D acoustic field in the elliptical chamber cavity. Towards this end, we consider the modal expansion of acoustic pressure field in the elliptical cavity in terms of angular and radial Mathieu functions, subjected to rigid wall condition, whereupon under the assumption of a point source, Green's function is obtained. On integrating this function over piston area of the side or end port and dividing it by piston area, one obtains the acoustic field, whence one can find the impedance matrix parameters characterizing the 2-port system. The acoustic performance of these configurations is evaluated in terms of transmission loss (TL). The analytical results thus obtained are compared with 3-D HA carried on a commercial software for certain muffler configurations. These show excellent agreement, thereby validating the 3-D semi-analytical piston driven model. The influence of the chamber length as well as the angular and axial location of the end and side ports on TL performance is also discussed, thus providing useful guidelines to the muffler designer. (c) 2011 Elsevier B.V. All rights reserved.

On the Role of Higher-Order Evanescent Modes in End-Offset Inlet and End-Centered Outlet Elliptical Flow-Reversal Chamber Mufflers

This paper deals with the role of the higher-order evanescent modes generated at the area discontinuities in the acoustic attenuation characteristics of an elliptical end-chamber muffler with an end-offset inlet and end-centered outlet. It has been observed that with an increase in length, the muffler undergoes a transition from being acoustically short to acoustically long. Short end chambers and long end chambers are characterized by transverse plane waves and axial plane waves, respectively, in the low-frequency range. The nondimensional frequency limit k(0)(D-1/2) or k(0)R(0) as well as the chamber length to inlet/outlet pipe diameter ratio, i.e., L/d(0), up to which the muffler behaves like a short chamber and the corresponding limit beyond which the muffler is acoustically long are determined. The limits between which neither the transverse plane-wave model nor the conventional axial plane-wave model gives a satisfactory prediction have also been determined, the region being called the intermediate range. The end-correction expression for this muffler configuration in the acoustically long limit has been obtained using 3-D FEA carried on commercial software, covering most of the dimension range used in the design exercise. Development of a method of combining the transverse plane wave model with the axial plane wave model using the impedance Z] matrix is another noteworthy contribution of this work.

Acoustical behavior of single inlet and multiple outlet elliptical cylindrical chamber muffler

Transmission loss (TL) of an elliptical cylindrical chamber muffler having a single side/end inlet and multiple side/end outlet is analyzed by means of the 3-D semi-analytical formulation based upon the modal expansion (in terms of the angular and radial Mathieu functions) and the Green's function. The acoustic pressure response obtained in terms of Green's function is integrated over surface area of the side/end ports (modeled as rigid pistons) and upon subsequent division by the port area, yields the acoustic pressure response or impedance Z] matrix parameters due to the uniform piston-driven model. The 3-D semi-analytical results are found to be in excellent agreement with the results obtained by means of 3-D FEA (SYSNOISE) simulations, thereby validating the semi-analytical procedure suggested in this work. Parametric studies such as the effect of chamber length (L), angular and axial locations of the ports, interchanging the locations of inlet and outlet ports as well as the addition of an outlet port for double outlet mufflers on the TL performance are reported, thereby leading to the formulation of design guidelines for obtaining muffler configurations exhibiting a broad-band TL spectrum. One such configuration is an axially long chamber having side-inlet and side-outlet ports such that one of the side ports is located at half the axial length on themajor/minor axis and the other side port is located at three-quarters (or one-quarter) of the axial length on the minor/major axis. (C) 2012 Institute of Noise Control Engineering.