Molecular mechanisms of ATP and insulin synergistic stimulation of coronary artery smooth muscle growth.

Coronary artery disease (CAD) is the major cause of death in diabetics. Abnormal proliferation of coronary artery smooth muscle cells (CASMC) leads to intimal thickening in CAD. We examined signaling mechanisms involved in the mitogenic effect of ATP and insulin on CASMC.

Anterior cruciate ligament reconstruction using part of the patellar tendon as a free graft.

We have reviewed 40 patients after replacement of a ruptured anterior cruciate ligament with a free graft of the medial third of the patellar tendon, combining this in 17 of the cases with a MacIntosh extra-articular tenodesis. The average age of the patients at operation was 25.4 years; instability of the knee had been present for 1.

The treatment of delayed union and non-union of the carpal scaphoid by screw fixation.

A simple technique for screw fixation of the carpal scaphoid in cases of delayed union and non-union is described. The results obtained in 32 patients treated by this method are reported. The average follow-up was three years ranging from 10 months to 12 years.

Meniscectomy for tears of the meniscus combined with rupture of the anterior cruciate ligament.

A group of 40 patients with unstable knees due to a combination of a meniscal tear with a rupture of the anterior cruciate ligament was studied to assess the effects of treatment by meniscectomy alone. The results were assessed both subjectively and objectively, but emphasis was placed on the symptoms rather than the physical signs of instability. Meniscectomy alone cured the symptoms of instability in 22 of the patients and a further eight required no further surgical treatment; bucket-handle tears were associated with a good result and posterior-horn tears with a poor result.

Macintosh tenodesis for anterolateral instability of the knee.

Fifty patients who underwent a MacIntosh repair for anterolateral instability of the knee have been reviewed after a mean follow-up of two and a quarter years. The repair abolished a positive anterolateral jerk test in 42 out of 50 knees and at the time of review 37 patients (74 per cent) were involved in some form of active sport, having regained functional and clinical stability. The MacIntosh repair is described in detail and the importance of excluding meniscal lesions as the main cause of instability is emphasised.