RESUMEN
Uterine fibroid is an estrogen-dependent mass growing during pregnancy. Caesarean myomectomy (CM) is a controversial procedure. A 35-year-old obese (106 Kg) patient gravida 2 para1 (caesarean section), undergoing caesarean section, had two myomas occupying the whole uterine fundus (104.2 mm and 50 mm respectively). Intracesarean myomectomy was carried out after extraction foetus (Apgar score: 9/10). Postoperative course was uneventful and patient was discharged after four days.
Asunto(s)
Cesárea , Leiomioma/cirugía , Miomectomía Uterina , Neoplasias Uterinas/cirugía , Adulto , Femenino , Humanos , Periodo Intraoperatorio , Leiomioma/patología , Embarazo , Neoplasias Uterinas/patología , Útero/patologíaRESUMEN
Phycobiliproteins extraction (primary refining) from Gracilaria gracilis seaweed, harvested in Lesina Lagoon (Italy) and further valorization of the residual algal via pyrolysis (secondary refining), were investigated with a cascade biorefinery approach. R-phycoerythrin (7 mg/g d.w.), allophycocyanin (3.5 mg/g d.w.) and phycocyanin (2 mg/g d.w.) were the main phycobiliproteins extracted. Pyrolysis of G.gracilis residue followed, aiming to investigate the production of bio-oil and biochar within a pyrolysis temperature range of 400-600 °C. Results showed that the bio-oil yield is high (â¼65 wt%) at pyrolysis temperature â¼500 °C, but its high content in nitrogenous compounds prevents its use as a biofuel, unless some further de-nitrogenation takes place. Biochar yield ranged between 33 wt% (400 °C) and 26.5 wt% (600 °C). Interestingly, inorganic nutrients including P, K, Ca, Fe and Mg were detected in biochar, suggesting its potential use as recovering system of natural mineral resources from the oceanic reservoir.
Asunto(s)
Biotecnología/métodos , Gracilaria/metabolismo , Ficobiliproteínas/aislamiento & purificación , Algas Marinas/metabolismo , Temperatura , Biomasa , Carbón Orgánico/metabolismo , Cromatografía de Gases y Espectrometría de Masas , Aceites/metabolismo , Termogravimetría , VolatilizaciónRESUMEN
Em 2009 o município de São Paulo desencadeou ações inter setoriais com sociedade civil e comunidade para reduzir a vulnerabilidade social, denominada Virada Social. A Secretaria Municipal de Saúde (SMS) e a Coordenadoria Regional de Saúde Sul (CRS Sul) participaram da Jornada da Saúde propiciando o acesso aos serviços de promoção e prevenção da saúde: elaboração do cartão SUS, alimentação saudável, medidas de pressão arterial, glicemia, vacinas, prevenção de gravidez precoce e doenças sexualmente transmissíveis (DST) para adolescentes, prevenção de câncer do colo de útero, dengue, saúde bucal e outras.
Asunto(s)
Humanos , Salud de la Familia , Servicios de Salud , Salud Mental , Salud Pública , Organización y AdministraciónRESUMEN
Em 2009 o município de São Paulo desencadeou ações inter setoriais com sociedade civil e comunidade para reduzir a vulnerabilidade social, denominada Virada Social. A Secretaria Municipal de Saúde (SMS) e a Coordenadoria Regional de Saúde Sul (CRS Sul) participaram da Jornada da Saúde propiciando o acesso aos serviços de promoção e prevenção da saúde: elaboração do cartão SUS, alimentação saudável, medidas de pressão arterial, glicemia, vacinas, prevenção de gravidez precoce e doenças sexualmente transmissíveis (DST) para adolescentes, prevenção de câncer do colo de útero, dengue, saúde bucal e outras
Asunto(s)
Humanos , Salud de la Familia , Servicios de Salud , Salud Mental , Salud Pública , Organización y AdministraciónRESUMEN
Em 2009 o município de São Paulo desencadeou ações inter setoriais com sociedade civil e comunidade para reduzir a vulnerabilidade social, denominada Virada Social. A Secretaria Municipal de Saúde (SMS) e a Coordenadoria Regional de Saúde Sul (CRS Sul) participaram da Jornada da Saúde propiciando o acesso aos serviços de promoção e prevenção da saúde: elaboração do cartão SUS, alimentação saudável, medidas de pressão arterial, glicemia, vacinas, prevenção de gravidez precoce e doenças sexualmente transmissíveis (DST) para adolescentes, prevenção de câncer do colo de útero, dengue, saúde bucal e outras(AU)
Asunto(s)
Humanos , Salud Pública , Servicios de Salud , Salud de la Familia , Salud Mental , Organización y AdministraciónRESUMEN
OBJECTIVE: To determine possible relations between Apgar score, umbilical artery haemogasanalysis and delivery mode. METHODS: 948 babies were considered; preterm infants and charts with incomplete data were excluded. 762 newborns and their respective umbilical artery blood gas parameters at delivery were evaluated. The collected Data were related to mode of delivery: vaginal with and without analgesia, elective caesarean section (CS), CS after labour, emergency CS for non reassuring trace. RESULTS: Mean pH (+/- DS) was 7.26 (+/- 0.08). The comparison vaginal delivery vs. CS was statistically significant (p < 0.0001). Analyzing the CS only, the babies born by emergency CS for non reassuring trace had pH statistically lower (ANOVA p < 0.004) and, in the latter group, there was a statistically difference between Italian newborns and those from other ethnicities (p < 0.02). No difference were found on Apgar score, excluding babies by vaginal delivery with analgesia that showed lower scores both at 1 (p < 0.02) and 5 (p < 0.002) minutes versus newborns without analgesia. CONCLUSIONS: Normal labour causes frequently a mild degree of acidosis, but it is not always related to neonatal asphyxia. The differences found between different delivery modes are, probably, the expression of causes related to the obstetric choice. That is also remarked by the statistically difference found in emergency CS for non reassuring trace in Italian population and in other ethnicities, showing a probably different cultural level, mainly about the "obstetric emergency" poorly understood by the pregnant. In vaginal deliveries the analgesia does not modify the neonatal metabolism, but can be a reason of delayed adaptation of extrauterine life.
Asunto(s)
Equilibrio Ácido-Base , Parto Obstétrico , Sangre Fetal/química , Humanos , Recién NacidoRESUMEN
Five UK sludge treatment plants have been monitored for Escherichia coli (E.coli) variation after mechanical belt press and centrifuge dewatering processes. A complementary laboratory trial was also completed to examine the effects of varying centrifugal force on raw sludge E.coli content. An E.coli balance between the numbers contained in the flows entering and exiting four full scale centrifuge dewatering systems indicated a minimum 63 % increase in E.coli numbers between the input feed and sludge cake for a digested sludge input to the centrifuge. For two of the centrifuge sites this increase was statistically significant and corresponded to an increase in E.coli concentration ranging up to 1.4 Log after centrifugation. However, E.coli variation was found to be dependent on the type of sludge, as centrifuge dewatering of raw sludge at full scale resulted in a 40 % decrease in E.coli numbers. The complementary laboratory centrifuge work confirmed that E.coli numbers decreased in raw sludge after centrifugation. E.coli numbers were not observed to increase in digested sludge which had been dewatered using a belt press. A decrease of 44 % was observed.
Asunto(s)
Escherichia coli/aislamiento & purificación , Aguas del Alcantarillado/microbiología , Purificación del Agua/métodos , Centrifugación , Dinámica Poblacional , Movimientos del AguaRESUMEN
Of 54 patients, we reviewed 26 with 28 operations for hallux valgus according to the Viladot-Regnauld technique. Follow-up was 18.7 (12-26) years. In 26 operations, the score according to Kitaoka and modified by Calder was excellent or good, and in two, fair. There were no complications. Average valgus angle correction was 15 degrees (8 degrees-29 degrees) and average intermetatarsal angle correction was 7 degrees (4 degrees-12 degrees). Sesamoids were medialised, on average, by at least 25% compared to the pre-operative situation. The results confirm the validity of this surgical procedure.
Asunto(s)
Hallux Valgus/diagnóstico por imagen , Hallux Valgus/cirugía , Osteotomía/métodos , Adulto , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Deformidades Adquiridas del Pie/diagnóstico por imagen , Deformidades Adquiridas del Pie/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteotomía/rehabilitación , Radiografía , Rango del Movimiento Articular/fisiología , Recuperación de la Función , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Regional migratory osteoporosis (RMO) is a migrating arthralgia of the weight-bearing joints of the lower limb which mainly affects middle-aged males. Its aetiology is unknown. The association of RMO with generalised osteoporosis has recently been reported. A concurrent systemic osteoporosis was also reported in some cases of transient osteoporosis of the hip (TOH), a disorder closely related to RMO. In its turn, TOH is considered a reversible stage of avascular necrosis of the hip (AVN), and the aetiopathogenesis of both of them remains strongly debated. We report three cases of RMO associated with generalised severe idiopathic osteoporosis. Three men, in the fourth and fifth decades of life, complained of at least four episodes of arthralgia in the lower limbs, with a migratory pattern, radiographic focal osteoporosis and final clinical resolution. The most striking common feature of these patients was the presence of a severe systemic osteoporosis with a prevailing trabecular involvement. We suggest that a prolonged or exaggerated activation of regional acceleratory phenomena (RAP) is the cause of transient osteoporosis. Bone tissue microdamage due to osteoporosis may be the most frequent noxious stimulus that turns RAP on, and, bone tissue microfracture is the most prevalent consequence. When this pathogenetic pathway is activated, the progression from focal osteoporosis and bone marrow oedema to avascular necrosis is associated with the amount of structural damage.
Asunto(s)
Artralgia/diagnóstico , Artralgia/fisiopatología , Densidad Ósea/fisiología , Osteoporosis/diagnóstico por imagen , Osteoporosis/fisiopatología , Adulto , Artralgia/terapia , Densitometría , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteoporosis/terapia , Dimensión del Dolor , Radiografía , Cintigrafía , Recurrencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Soporte de PesoRESUMEN
Total hip arthroplasty (THA) in congenital high grade hip dislocation often represents a problematic issue. Reviewing their selected cases and literature data, authors focus on some key points for this demanding surgery. Most important steps are acetabular positioning and surgical approach (exposure and release). We used two different cups, the Zweymuller and the Wagner cup, with good primary stability. A Conus stem (Wagner) or an Alloclassic stem (in less displastic femoral shape) were used. We always performed this surgery as a one step procedure. In the same cases a shortening femoral osteotomy was performed to allow refractory reduction. Possible complications are discussed. (Hip International 2002; 2: 139-41).
RESUMEN
Osteochondromas represent the largest group of benign tumors of bone. Multiple osteochondromatosis or hereditary multiple exostoses (EXT) is an autosomal dominant inherited disorder characterized by the presence of multiple benign cartilage-capped exostoses. EXT is genetically heterogeneous with at least 3 chromosomal loci: EXT1 (8q24.1), EXT2 (11p11-p13), and EXT3 (19p). In <5% of EXT patients, the inactivation of both copies of EXT alleles (LOH) is associated with malignant transformation. We have analyzed the EXT1 and EXT2 genes in 9 unrelated EXT families and in a patient with a sporadic osteochondroma, all originating from Italy. Four families show an EXT1 mutation, consisting of a small deletion in 3 of them and a small insertion in the 4th. All these mutations lead to premature termination of translation and thus a truncated EXT1 protein. Three families presented EXT2 mutations consisting of nucleotide substitutions leading to alterations of the third intron splice-site, to an amino acid substitution and to a nonsense mutation. All these mutations cosegregate with the disease phenotype. The sporadic osteochondroma patient carried a novel missense mutation in exon 11 of EXT2 gene, leading to an amino acid substitution. Seven of these mutations have never been described before. EXT2 missense mutations were also confirmed by amino acids conservation between human and mouse and by analysis of a healthy control population. In conclusion, our study provide further evidence that loss of function of the EXT1 or EXT2 gene is the main cause of EXT supporting the putative tumor-suppressor function of these genes.
Asunto(s)
Neoplasias Óseas/diagnóstico , Neoplasias Óseas/genética , N-Acetilglucosaminiltransferasas/genética , Osteocondroma/diagnóstico , Osteocondroma/genética , Proteínas/genética , Adolescente , Adulto , Edad de Inicio , Anciano , Alelos , Secuencia de Bases , Neoplasias Óseas/metabolismo , Niño , Preescolar , Análisis Mutacional de ADN , Salud de la Familia , Femenino , Genes Dominantes , Humanos , Lactante , Italia , Pérdida de Heterocigocidad , Masculino , Persona de Mediana Edad , Mutación , Mutación Missense , Osteocondroma/metabolismo , Linaje , Polimorfismo Conformacional Retorcido-SimpleRESUMEN
PURPOSE: It is known that participating in sports can have a beneficial effect on bone mass. However, it is not well established which sport is more beneficial for increased bone mineral density (BMD) and appendicular muscle mass (AMM). This study investigated the effects of different high-intensity activities on BMD and AMM in highly trained athletes. MATERIALS AND METHODS: Sixty-two male subjects aged 18--25 yr participated in the study. The sample included judo (J; N = 21), karate (K; N = 14), and water polo (W; N = 24) athletes who all competed at national and international level. Twelve age-matched nonathletic individuals served as the control group (C). All athletes exercised regularly for at least 3 h x d(-1), 6 d x wk(-1). Segmental, total BMD, and AMM were measured with a dual-energy x-ray (DXA) absorptiometry (Lunar Corp., Madison, WI). DXA analysis also includes bone mineral content (BMC) and fat and lean masses. RESULTS: Total BMD(C) was significantly lower (mean +/- SD: 1.27 +/- 0.06 g x cm(-2), P < 0.05) than either judo or karate athletes (total BMD(J) (1.4 +/- 0.06 g x cm(-2)) and total BMD(K) (1.36 +/- 0.08 g x cm(-2))) but not different from the W athletes (total BMD(W) (1.31 +/- 0.09 g x cm(-2))). AMM was significantly lower in the C group compared with the three athletic groups (P < 0.05). Fat mass was higher in the W versus J and K athletes but not different from the C group (P < 0.05). CONCLUSIONS: This cross-sectional study has shown that athletes, especially those engaged in high-impact sports, have significantly higher total BMD and AMM than controls. These results suggest that the type of sport activity may be an important factor in achieving a high peak bone mass and reducing osteoporosis risk.
Asunto(s)
Densidad Ósea/fisiología , Músculo Esquelético/fisiología , Deportes/fisiología , Absorciometría de Fotón , Adulto , Análisis de Varianza , Composición Corporal , Estudios Transversales , Humanos , Masculino , Aptitud Física/fisiologíaRESUMEN
Ifosfamide is a leading drug in soft tissue sarcoma therapy. Recently high dose therapy (>9 g/m2) has been introduced in different schemes to obtain a higher response rate. All these higher doses can be administered following two different schedules: continuous infusion 24 hours a day for 4-5 days or bolus administration for 5 consecutive days. In this study we compare the differences in the pharmacokinetic profile between the two schedules. In both schemes we saw a very important autoinduction phenomenon, with a corresponding half-life decrease and total body clearance increase during the days of therapy. The clearances were not directly correlated with the administered dose. We can conclude that ifosfamide continuous infusion therapy is equivalent to fractionated administration, at least from a pharmacokinetic point of view. Short-term infusion is subjectively better tolerated and is therefore preferred.
Asunto(s)
Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Alquilantes/farmacocinética , Neoplasias Óseas/metabolismo , Ifosfamida/administración & dosificación , Ifosfamida/farmacocinética , Sarcoma/metabolismo , Neoplasias de los Tejidos Blandos/metabolismo , Adulto , Anciano , Antineoplásicos Alquilantes/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Biotransformación , Neoplasias Óseas/tratamiento farmacológico , Doxorrubicina/administración & dosificación , Esquema de Medicación , Interacciones Farmacológicas , Femenino , Humanos , Ifosfamida/efectos adversos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Sarcoma/tratamiento farmacológico , Neoplasias de los Tejidos Blandos/tratamiento farmacológicoRESUMEN
The results of a study conducted on 50 knees endoscopically reconstructed for an anterior cruciate ligament (ACL) lesion with a free bone-patellar tendon-bone graft and 9 cadaver knees are reported. The mean lengths of the patellar tendon (45.48 +/- 4.71 mm) and intra-articular ACL graft (20.44 +/- 1.98 mm) were measured in the operated knees. The mean length of the tibial bone tunnel (51.62 +/- 2.60 mm) was also measured with a tibial guide at 55 degrees. No statistically significant correlation was found between these three measurements. The length of the patellar tendon was weakly correlated with body height. Measurement of the tibial tunnel on the cadaver knees with increasing degrees of inclination revealed a mean length increase of 0.68 mm per degree (confidence limits: 0.49-0.86). Comparison between the tunnel lengths obtained with the guide and those measured with a Kirschner wire showed a mean difference of 2.3 mm. It is thus desirable to make the tunnel about 53 mm long to ensure excellent fixation of a 28 mm bone block with a 25 mm interference screw. Correct measurement of the anatomical structures involved is in any event an essential requirement for proper execution of the surgical technique.
Asunto(s)
Ligamento Cruzado Anterior/cirugía , Endoscopía/métodos , Procedimientos de Cirugía Plástica/métodos , Tendones/anatomía & histología , Adolescente , Adulto , Trasplante Óseo , Cadáver , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Tendones/trasplante , Tibia/cirugía , Trasplante AutólogoRESUMEN
The aim of this study was to evaluate the efficacy and safety of enzyme-potentiated desensitization (EPD) in children with asthma. Twenty asthmatic children (14 males and 6 females; median age: 8.5 years) were included in the study. They had positive skin tests to Dermatophagoides pteronyssinus (Dpt), no history of other allergy and had suffered from asthma for at least two years. The children were examined before starting the trial, at the first EPD dose, after 8 weeks, at the second EPD dose and 3 months after the second EPD dose. Blood samples for PRIST and RAST were drawn before the first and at the second EPD dose, and at the last follow-up. Conjunctival provocation tests (CPT) and skin test endpoint determinations were performed with dilutions of a freeze-dried Dpt extract (10-100,000 SQ-U/ml) at the start of the trial and at the last follow-up. Parents kept a diary record of the days with asthma and daily drug usage. The children were randomized to receive either two intradermal placebo injections or the active material with an 8-week interval (November 1991 and January 1992). Ten children received EPD and 10 children placebo. The intradermal injection of EPD (0.05 ml) contained 0.01 ml of beta-glucuronidase (40 Fishman units) and 0.04 ml of a mixture of inhalant allergens (1 Noon unit). The placebo injection consisted of buffer solution only. The EPD-treated children had significantly fewer days with asthma (p = 0.00000). In addition, the EPD-treated children used significantly less medication for the management of asthma attacks (p = 0.00000). At the start of the trial, three out of 10 children in the EPD group and two out of 10 in the placebo group reacted only to the highest dose of allergen used in the CPT (100,000 SQ/ml) (NS). At the last follow-up, the threshold dose in the CPT was 100,000 SQ/ml or more in nine out of 10 children in the EPD group and in four out of 10 children of the placebo group (p = 0.0349). At the last follow-up, one child in the EPD group had a negative CPT with all doses tested. Global clinical evaluation by the investigators showed that eight out of 10 EPD-treated children improved, in comparison with three out of 10 children in the placebo group (p = 0.0349). Assessment by the parents was six out of 10 and four out of 10 improved, respectively (NS). Specific IgE to Dpt, total IgE and skin prick test endpoints before and after EPD showed no significant changes. One child in the placebo group experienced mild urticaria several hours following the second injection. No other local or systemic side effects were reported. The results of the present study provide further data on the effectiveness and safety of EPD in patients with asthma.
Asunto(s)
Asma/enzimología , Asma/terapia , Desensibilización Inmunológica , Hipersensibilidad/enzimología , Hipersensibilidad/terapia , Ácaros/inmunología , Adyuvantes Inmunológicos/uso terapéutico , Adolescente , Alérgenos/inmunología , Animales , Antígenos Dermatofagoides , Asma/inmunología , Niño , Preescolar , Método Doble Ciego , Femenino , Glucuronidasa/uso terapéutico , Glicoproteínas/inmunología , Humanos , Hipersensibilidad/inmunología , Inmunoglobulina E/sangre , Pruebas Intradérmicas , MasculinoRESUMEN
This paper discusses the long-term results of the anterior cruciate ligament (ACL) reconstruction with the Leeds-Keio (LK) prosthetic ligament. For this type of reconstruction we used arthrotomy and an arthroscopy-assisted technique. The fixation was obtained with two bone plugs, and the distal portion was also attached with a staple. A postoperative protocol was used with a progressive range of motion and weight bearing after 50 days. We performed 50 LK operations in professional and amateur athletes aged 17-39 years with an isolated anterior instability. We reviewed at follow-up (5-7 years) 37 patients; 8 were lost, and 5 had a subsequent failure. At the Lysholm score the patients were classified: 19 excellent, 13 good, 3 fair, and 2 poor. At the IKDC grading the patients were classified as follows: 2 class A, 22 B, 8 C, and 5 D. The Lachmann test was 1+ in 15 patients, 2+ in 7, 3+ in 2, and negative in 13; pivot shift was 1+ in 9, 2+ in 7, 3+ in 2, and negative in 25. Results of the KT 1000 test at 30 lb side to side was < 3 mm in 23 patients, 3-5 mm in 6, 6-10 mm in 6, and > 10 mm in 2. In view of the results observed and the progressive deterioration over the years, this procedure should no longer be performed as an ACL substitute.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Traumatismos de la Rodilla/cirugía , Prótesis e Implantes , Adolescente , Adulto , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
A double-blind prospective study was done with 15 patients with anterior shoulder instability to determine the diagnostic efficacy of magnetic resonance (MR) imaging versus arthroscopy in the evaluation of chondral or osteochondral lesions of the humeral head. MR produced 6 true positives, 5 true negatives and 4 false negatives, and its accuracy and sensitivity were 60% and 87%, respectively, whereas arthroscopy gave 8 true positives, 5 true negatives and 2 false negatives, with a sensitivity of 80% and an accuracy of 87%. All lesions diagnosed with either method were regarded as positive by definition, with the result that the specificity was always 100%. The differences in diagnosis sprang from the false negatives. The 40% discrepancy between the two methods was probably due to our distinction in MR between intra- and extra-articular osteochondral lesions. In the first group (the 4 MR false negatives), there were three instances of first-degree intra-articular lesion and one diagnostic error (third-degree lesion). In the second (the 2 arthroscopy false negatives), the lesions were of the extra-articular type. It is thus advisable to employ both of these methods to ensure the correct diagnosis of a Hill-Sachs lesion, and hence the correct choice of treatment.
Asunto(s)
Artroscopía , Cartílago Articular/lesiones , Húmero/lesiones , Inestabilidad de la Articulación/etiología , Imagen por Resonancia Magnética , Luxación del Hombro/diagnóstico , Adolescente , Adulto , Artroscopía/métodos , Cartílago Articular/patología , Método Doble Ciego , Femenino , Humanos , Húmero/patología , Inestabilidad de la Articulación/patología , Imagen por Resonancia Magnética/métodos , Masculino , Estudios Prospectivos , Sensibilidad y Especificidad , Luxación del Hombro/etiología , Luxación del Hombro/patologíaRESUMEN
The fate of mechanoreceptors was studied in torn and reconstructed anterior cruciate ligaments in animals and in humans. In untreated anterior cruciate ligament lesions in humans, morphologically normal mechanoreceptors remained in the ligament for 3 months after the injury. After that time, their number gradually decreased. By the 9th postinjury month, only a few free nerve endings were present. Even free nerve endings were totally absent in the biopsy specimens from 1-year-old lesions. In experimental animals, anterior cruciate ligament reconstruction with autologous patellar tendon resulted in the presence of mechanoreceptors in the reconstructed anterior cruciate ligament. When an artificial ligament was used, no mechanoreceptors were found. Morphologically normal mechanoreceptors were present in 2 patients with a lax biologic anterior cruciate ligament reconstruction 9 and 10 years after the operation.