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Sample records for betametasona intra-articular sobre

  1. Análise fotocolorimétrica computadorizada dos efeitos da betametasona intra-articular sobre a concentração de proteoglicanos da matriz cartilaginosa de joelhos leporinos: influência do número de injeções intra-articulares

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    Mauro Batista Albano

    Full Text Available OBJETIVO: Analisar os efeitos da injeção repetida de betametasona na concentração de proteoglicanos da cartilagem articular do joelhos normais de coelhos californianos de ambos os sexos. MÉTODOS: Os animais foram randomizados em oito grupos de dez animais cada. Três grupos controle (injeção ou não de solução salina isotônica e cinco grupos de estudo - doses terapêuticas, repetidas ou não, de betametasona injetadas no joelho direito de cada coelho, com intervalos semanais. Após oito dias da última injeção prevista, cortes histológicos da cartilagem das áreas de apoio dos platôs tibiais foram corados com hematoxilina e eosina para análise por microscopia óptica, e com safranina O para a pesquisa da quantidade de proteoglicanos. A intensidade da coloração da safranina O foi quantificada em aparelho de histomorfometria, composto por microscópio Olympus BX 50 e microcomputador com software Image Pro-plus 4.5Ò. RESULTADOS: Não houve diferenças nos animais que tiveram seus joelhos injetados com betametasona uma, duas e quatro vezes quando comparados com os grupos controle. Nos animais que receberam seis e oito aplicações a intensidade da coloração com safranina O reduziu-se significativamente (p < 0,05 quando comparada tanto com grupos controle quanto com os outros de estudo. CONCLUSÃO: Foi possível demonstrar redução da concentração de proteoglicanos na matriz cartilaginosa articular dependente do efeito deletério cumulativo das repetidas injeções intra-articulares de betametasona.

  2. Análise fotocolorimétrica computadorizada dos efeitos da betametasona intra-articular sobre a concentração de proteoglicanos da matriz cartilaginosa de joelhos leporinos: influência do número de injeções intra-articulares

    OpenAIRE

    Mauro Batista Albano; Gabriel Paulo Skroch; Sérgio Ossamu Ioshii; Xavier Soler Grahels; Paulo Gilberto Cimbalista Alencar; Jorge Eduardo Fouto Matias

    2009-01-01

    OBJETIVO: Analisar os efeitos da injeção repetida de betametasona na concentração de proteoglicanos da cartilagem articular do joelhos normais de coelhos californianos de ambos os sexos. MÉTODOS: Os animais foram randomizados em oito grupos de dez animais cada. Três grupos controle (injeção ou não de solução salina isotônica) e cinco grupos de estudo - doses terapêuticas, repetidas ou não, de betametasona injetadas no joelho direito de cada coelho, com intervalos semanais. Após oito dias da ú...

  3. [Intra-articular injections].

    Science.gov (United States)

    Chapelle, Ch

    2015-09-01

    It is not unusual for a specialist or general practitioner to be presented with a pathology which necessitates the use of an intra-articular injection of corticosteroids, hyaluronic acid or a local anaesthetic. It would seem to be interesting to update and to precise the techniques and methods of intraarticular injections which have appeared in recent international publications, when we know that 30 % of the injections given into the knee and so called "dry" are incorrect and, therefore, inefficient. The indication of an articular injection depends, firstly, on the diagnosis which should be done with great care; after which should be an objective analysis complete with secondary effects linked to both the injection and the product used. The conditions of asepsis, the choice of needles and quantities of the injection and even the ways of the injections should be reviewed in detail. The last studies clearly question the secondary effects of the cartilage degradations of the cortisone given as an intra-articular injection and shows its efficiency on the pain and inflammatory phenomonen in osteoarthritis. Studies on hyaluronic acid are often contradictory going from a modest result to an important pain relief but it is necessary to be aware that the objective criteria are difficult to interpret. The use of local anaesthetics in intra-articular is limited by the few indications in view of the major risk of aggravating the pre-existing lesions by the disappearing signs of pain.

  4. Efeitos da betametasona sobre os fetos e placentas da rata albina

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    Souza Eduardo de

    2001-01-01

    Full Text Available Objetivos: analisar os efeitos da betametasona sobre o binômio materno-fetal da rata albina. Métodos: utilizamos 60 ratas albinas prenhes divididas ao acaso em três grupos numericamente iguais. As ratas do grupo I foram tratadas com betametasona na dose de 1 mg/kg de peso em 0,5 ml de água destilada, por via intramuscular no 11º, 12º, 18º e 19º dia de prenhez; as do grupo II receberam 0,5 ml de água destilada, por via intramuscular no 11º, 12º, 18º e 19º dia de prenhez, e as do grupo III não receberam qualquer fármaco ou veículo. O ganho de peso das matrizes foi avaliado nos dias 0, 7, 14 e 20 de prenhez, sendo que no 20º dia todos os animais foram sacrificados por decapitação. Foram quantificados o número de implantações, de reabsorções, de fetos, de placentas, de malformações maiores, de mortalidade materna e fetal, assim como o peso dos fetos e das placentas. Resultados: nossos resultados revelaram que as matrizes tratadas com betametasona apresentaram menor ganho de peso. Quanto aos fetos e as placentas do grupo tratado, observamos que os pesos foram inferiores aos dos outros grupos. A média de peso dos fetos foi de 3,20 g contra 3,75 g no grupo controle. A média de peso das placentas foi de 0,36 g no grupo tratado com betametasona contra 0,48 g no grupo controle. Todas estas diferenças foram estatisticamente significantes. Conclusões: a betametasona apresenta efeito negativo sobre o ganho de peso das matrizes, fetos e placentas, quando administrada de forma repetitiva a partir da segunda metade da prenhez.

  5. Influencia da betametasona, empregada na forma de preparações farmaceuticas distintas, sobre alguns valores de auto-hemostasia, em ratos

    OpenAIRE

    Solange Maria Dieterich Rabelo Junqueira

    1992-01-01

    Resumo: Este trabalho teve por objetivo avaliar os efeitos da betametasona, empregada na forma de duas preparações farmacêuticas distintas, sobre alguns valores de auto-hemostasia. Para tanto,foram utilizados 30 ratos Wistar,machos,divididos em 3 grupos experimentais,tratados (via 1M) com solução de NaCI a 0,9% (Grupo Controle), fosfato dissódico de betametasona ou com a associação deste mesmo sal ao acetato de betametasona, que possibilita uma ação farmacológica de maior duração do glucocor...

  6. [Intra-articular injection of cortisone].

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    Hammer, M; Schwarz, T; Ganser, G

    2015-11-01

    Intra-articular injections with glucocorticoids are standard procedures according to therapy guidelines in many rheumatic conditions. There is increasing evidence from clinical trials on the treatment of rheumatoid arthritis that more patients will attain the target of remission using a combination of systemic medication and intra-articular injections with glucocorticoids compared to systemic medication alone. Intra-articular injections with glucocorticoids play an important role in the therapeutic management of pediatric rheumatic diseases. In many countries competency in performing intra-articular injections is among the important skills necessary for certification as a specialist in rheumatology.

  7. Imaging of intra-articular osteoid osteoma

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    Allen, S.D.; Saifuddin, A. E-mail: asaifuddin@aol.com

    2003-11-01

    Intra-articular osteoid osteoma accounts for approximately 13% of all osteoid osteomas and presents as a monoarthropathy. Radiographs commonly do not identify the nidus, and in this event, MRI is likely to be the next imaging investigation. MRI may show a variety of appearances depending upon the age of the lesion. This article illustrates the imaging features of intra-articular osteoid osteoma, with emphasis on MRI. CT remains the investigation of choice for identifying the nidus.

  8. Intra-articular angiolipoma of the knee: a case report

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    Nishimori Makoto

    2010-04-01

    Full Text Available Abstract We report a case of intra-articular angiolipoma of the knee. This case report describes our experience in excising an intra-articular angiolipoma of the knee joint. Complete resection under arthroscopy was performed in a 30-year-old man. Two years after the surgery, no evidence of recurrence was seen. Intra-articular angiolipomas should be considered in the differential diagnosis of intra-articular masses in adolescents with recurrent hemarthrosis without trauma.

  9. Intra-articular chondroma of the knee

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    Talwalkar, S.C.; Kambhampati, S.B.S.; Lang Stevenson, A.I. [Oldchurch Hospital, Romford, Essex (United Kingdom); Whitehouse, R. [Manchester University, Department of Radiology, Manchester (United Kingdom); Freemont, A. [University of Manchester, Department of Osteoarticular Pathology, Manchester (United Kingdom)

    2005-06-01

    Chondromas are tumours that develop in relation to the periosteum and, although they are common around the knee, most reports deal with soft tissue chondromas in para-articular locations or intracortical tumours in extra-articular regions. We report a rare case of an intra-articular chondroma in a 16-year-old boy of Asian origin developing in the region of the medial femoral condyle of the femur and extending into the femoral sulcus and the patellofemoral joint. (orig.)

  10. Intra-Articular Osteoid Osteoma Mimicking Juvenile Arthritis

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    Sidi Yaya Traore

    2014-01-01

    Full Text Available In case of intra-articular osteoid osteoma, misdiagnosis as juvenile arthritis may occur, delaying adequate treatment. We report cases of intra-articular osteoid osteomas in children that were misdiagnosed and initially inappropriately treated with intra-articular corticoid injection. Diagnosis of osteoid osteoma was finally given by CT-scan and appropriate treatment by radiofrequency ablation or surgical ablation was performed. Clinicians and radiologists should be aware of the potentially confusing clinical and imaging findings associated with intra-articular osteoid osteoma.

  11. Clinical benefits of intra-articular anakinra for arthrofibrosis.

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    Brown, Christopher A; Toth, Alison P; Magnussen, Bob

    2010-12-01

    Postoperative inflammation and stiffness, as well as the struggle to achieve full range of motion (ROM), following knee surgery is a significant clinical challenge. Interleukin-1 is a crucial mediator of the inflammatory response and development of pathological conditions leading to chronic inflammation. We hypothesized that intra-articular injection of intra-articular anakinra, an IL-1 antagonist, would result in sustained improvements of chronic refractory arthrofibrosis and limited arthrofibrosis of the knee joint. We retrospectively reviewed 8 patients who underwent injection of intra-articular anakinra, 200 mg. Four patients (3 women, 1 man) had intra-articular anakinra for treatment of chronic refractory arthrofibrosis, and 4 patients (4 women) had intra-articular anakinra for limited arthrofibrosis. All 4 of the refractory arthrofibrosis patients had failed conservative treatment with intensive physical therapy, corticosteroid injections, and anti-inflammatory medication. Three of the 4 patients had failed a prior manipulation under anesthesia with lysis of adhesions. All 4 reported improvement in ROM (10°-45°) and swelling, with 75% reporting improvement in pain. Seventy-five percent of these patients returned to prior activity level. All 4 of the limited arthrofibrosis also failed similar attempts at conservative treatment, and 2 of the 4 had failed a prior manipulation under anesthesia with lysis of adhesions. After intra-articular anakinra, all 4 reported improvement in ROM (20°-45°) and swelling, with 80% reporting improvement in pain. Seventy-five percent of these patients were able to return to prior activity level. We found intra-articular anakinra to be effective in this small cohort of patients with refractory arthrofibrosis and limited arthrofibrosis. Copyright 2010, SLACK Incorporated.

  12. Intra-articular capacity of the elbow joint.

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    Van Den Broek, Mathias; Van Riet, Roger

    2017-09-01

    The intra-articular capacity of the elbow joint is reported to be 23 ± 4 ml on cadaveric elbows. During years, this value was the standard. The aim of this observational study was to reanalyze the volume of the elbow joint on live patients. Measurement of the intra-articular capacity and pressure of the elbow joint was performed on 30 patients (mean age: 43.8 years) undergoing elbow arthroscopy. Intra-articular capacity was recorded when the elbow moved to the maximum lose packed position and/or when there was a sudden drop in pressure, indicating a capsular rupture (maximum capacity). Indications for arthroscopy were loose bodies, osteoarthritis, synovitis, radial head resection, and lateral collateral ligament repair. Mean intra-articular capacity and pressure were 35.8 ml and 557.5 mm Hg, respectively. Mean maximal capacity was 40.5 ml. We conclude that the intra-articular capacity of the elbow joint is substantially greater than reported in previous studies. Clin. Anat. 30:795-798, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  13. Intra-Articular Osteotomy for Distal Humerus Malunion

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    René K. Marti

    2009-01-01

    Full Text Available Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular necrosis of capitellum or trochlea is a major pitfall of the this technically challenging procedure. Two cases are presented which illustrate the potential problems of intra-articular osteotomy for malunion of the distal humerus.

  14. Clinical Outcome Scoring of Intra-articular Calcaneal Fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); M.J. Heetveld (Martin); P.G.H. Mulder (Paul); P. Patka (Peter)

    2008-01-01

    textabstractOutcome reporting of intra-articular calcaneal fractures is inconsistent. This study aimed to identify the most cited outcome scores in the literature and to analyze their reliability and validity. A systematic literature search identified 34 different outcome scores. The most cited outc

  15. Percutaneous treatment of displaced intra-articular calcaneal fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); I.B. Schipper (Inger); L.M.M. Vogels (Lucas); A.Z. Ginai (Abida); P.G.H. Mulder (Paul); M.J. Heetveld (Martin); P. Patka (Peter)

    2007-01-01

    textabstractBackground. The outcome after displaced intra-articular calcaneal fractures is influenced by the condition of the surrounding soft tissues. To avoid secondary soft tissue complications after surgical treatment, several less-invasive procedures for reduction and fixation have been

  16. Clinical Outcome Scoring of Intra-articular Calcaneal Fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); M.J. Heetveld (Martin); P.G.H. Mulder (Paul); P. Patka (Peter)

    2008-01-01

    textabstractOutcome reporting of intra-articular calcaneal fractures is inconsistent. This study aimed to identify the most cited outcome scores in the literature and to analyze their reliability and validity. A systematic literature search identified 34 different outcome scores. The most cited

  17. Subtalar versus triple arthrodesis after intra-articular calcaneal fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); B.C.T. Kieboom (Brenda); J.H.J.M. Bessems (Gert); L.M.M. Vogels (Lucas); E.M.M. van Lieshout (Esther); P. Patka (Peter)

    2010-01-01

    textabstractDepending upon initial treatment, between 2 and 30% of patients with a displaced intra-articular calcaneal fracture require a secondary arthrodesis. The aim of this study was to investigate the effect of subtalar versus triple arthrodesis on functional outcome. A total of 33 patients

  18. Luxación intra-articular de rótula Intra-articular dislocation of patella

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    S. García-Mata

    2006-08-01

    Full Text Available Presentamos el caso de una paciente de 73 años de edad que, tras una caída accidental en las escaleras, sufrió una luxación intra-articular aguda de rótula de la rodilla izquierda. Esta luxación excepcional presentaba incarceración del polo proximal rotuliano en el surco intercondíleo femoral. Se realizó reducción bajo anestesia general debido al dolor y contractura muscular en los intentos de reducción sin anestesia. Realizamos revision quirúrgica que descartó lesiones asociadas del aparato extensor, partes blandas, estructuras articulares y osteofitos. Presentaba artrosis avanzada, sobre todo fémoro-patelar. Tras dos semanas de inmovilización reinició movilidad. No ha presentado recidiva u otro tipo de complicaciones.The case of a patient aged 73 years who, following an accidental fall on a staircase, suffered an acute intraarticular dislocation in the left knee-cap is presented. This exceptional dislocation presented incarceration of the proximal kneecap pole in the femoral intercondylar groove. A reduction was carried out under general anaesthetic due to pain and muscular contraction in the attempts at reduction without anaesthetic. We made a surgical check that ruled out associated lesions to the extensor apparatus, soft parts, joint structures and osteophytes. The patient presented advanced arthrosis, above all femoral-patellar. Following two weeks of immobilisation, the patient restarted mobility. There has been no relapse or other type of complication.

  19. Intra-articular osteoid osteoma at the femoral trochlea treated with osteochondral autograft transplantation

    Science.gov (United States)

    Leeman, Joshua J; Motamedi, Daria; Wildman-Tobriner, Ben; O’Donnell, Richard J; Link, Thomas M

    2016-01-01

    We present the case of an intra-articular osteoid osteoma at the femoral trochlea. Intra-articular osteoid osteoma can present a diagnostic challenge both clinically and with imaging because it presents differently from the classic cortical osteoid osteoma. Given the lesion’s proximity to overlying cartilage, the patient underwent resection of the lesion with osteochondral autograft transplantation at the surgical defect. A comprehensive literature review and discussion of intra-articular osteoma will be provided. PMID:27761182

  20. Luxación intra-articular de rótula Intra-articular dislocation of patella

    OpenAIRE

    2006-01-01

    Presentamos el caso de una paciente de 73 años de edad que, tras una caída accidental en las escaleras, sufrió una luxación intra-articular aguda de rótula de la rodilla izquierda. Esta luxación excepcional presentaba incarceración del polo proximal rotuliano en el surco intercondíleo femoral. Se realizó reducción bajo anestesia general debido al dolor y contractura muscular en los intentos de reducción sin anestesia. Realizamos revision quirúrgica que descartó lesiones asociadas del aparato ...

  1. Intra-articular Implantation of Mesenchymal Stem Cells, Part 2

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    Kraeutler, Matthew J.; Mitchell, Justin J.; Chahla, Jorge; McCarty, Eric C.; Pascual-Garrido, Cecilia

    2017-01-01

    Knee osteoarthritis (OA) after partial or total meniscectomy is a prevalent issue that patients must face. Various methods of replacing meniscal tissue have been studied to avoid this progression, including meniscal allograft transplantation, meniscal scaffolds, and synthetic meniscus replacement. Studies have shown that meniscal scaffolds may improve symptoms but have not been shown to prevent progression of OA. Recently, mesenchymal stem cells (MSCs) have been proposed as a possible biological therapy for meniscal regeneration. Several animal studies and 1 human study have evaluated the effect of transplanting MSCs into the knee joint after partial meniscectomy. The purpose of this review was to assess the outcomes of intra-articular transplantation of MSCs on meniscal regeneration in animals and humans after partial meniscectomy. Limited results from animal studies suggest that there is some potential for intra-articular injection of MSCs for the regeneration of meniscal tissue. However, further studies are necessary to determine the quality of regenerated meniscal tissue through histological and biomechanical testing. PMID:28203596

  2. Subtalar versus triple arthrodesis after intra-articular calcaneal fractures.

    Science.gov (United States)

    Schepers, Tim; Kieboom, Brenda C T; Bessems, Gert H J M; Vogels, Lucas M M; van Lieshout, Esther M M; Patka, Peter

    2010-08-01

    Depending upon initial treatment, between 2 and 30% of patients with a displaced intra-articular calcaneal fracture require a secondary arthrodesis. The aim of this study was to investigate the effect of subtalar versus triple arthrodesis on functional outcome. A total of 33 patients with 37 secondary arthrodeses (17 subtalar and 20 triple) with a median follow-up of 116 months were asked to complete questionnaires regarding disease-specific functional outcome (Maryland Foot Score, MFS), quality of life (SF-36) and overall satisfaction with the treatment (Visual Analogue Scale, VAS). Patient groups were comparable considering median age at fracture, initial treatment (conservative or operative), time to arthrodesis, median follow-up, and post-arthrodesis radiographic angles. The MFS score was similar after subtalar versus triple arthrodesis (59 vs. 56 points; P = 0.79). No statistically significant difference was found for the SF-36 (84 vs. 83 points; P = 0.67) and the VAS (5 vs. 6; P = 0.21). Smoking was statistically significantly associated with a non-union (χ(2) = 6.60, P = 0.017). The current study suggests that there is no significant difference in functional outcome between an in situ subtalar or triple arthrodesis as a salvage technique for symptomatic arthrosis after an intra-articular calcaneal fracture. Smoking is a risk factor for non-union.

  3. Pseudomonas aeruginosa septic arthritis of knee after intra-articular ozone injection.

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    Seyman, Derya; Ozen, Nevgun Sepin; Inan, Dilara; Ongut, Gozde; Ogunc, Dilara

    2012-07-01

    We describe a case of septic arthritis caused by Pseudomonas aeruginosa in an immunocompetent patient following intra-articular ozone injection into the knee. To the best of our knowledge, and after considering the current literature,we believe this case is unique as no other reports of septic arthritis caused by P. aeruginosa following intra-articular ozone injection has been made.

  4. [Gait analysis after intra-articular calcaneus fractures].

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    Siegmeth, A; Petje, G; Mittlmeier, T; Vécsei, V

    1996-01-01

    We retrospectively compared 20 patients with displaced intra-articular calcaneal fractures by clinical assessment and dynamic pedography. Eleven were treated operatively, 9 conservatively. The purpose was to identify differences in post-traumatic gait performance and to correlate the pedographic data to a clinical score to show its reliability. Twenty individuals without a history of foot injuries were used as a control group. Both groups had restricted motion in the subtalar joint, increased hindfoot and midfoot loading and decreased forefoot loading. Furthermore, they showed prolonged contact phases and an impaired ability to speed up gait during the toe-off phase. Load transfer from the hindfoot to the forefoot showed typical distribution patterns. The operatively treated group showed better functional results with fewer subjective complaints.

  5. Intra-articular analgesia and steroid reduce pain sensitivity in knee OA patients

    DEFF Research Database (Denmark)

    Jørgensen, Tanja Schjødt; Graven-Nielsen, Thomas; Ellegaard, Karen

    2014-01-01

    Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and surrounding tissues in knee OA patients. Methods. Twenty-five knee OA patients with symptomatic knee OA were included in this interventional cohort study. Pressure pain thresholds (PPT) were recorded...... before, immediately after, and two weeks after ultrasound guided intra-articular injection of lidocaine combined with glucocorticosteroid. Computer-controlled and manual pressure algometers were used to assess PPT on the knee, vastus lateralis, tibialis anterior, and the extensor carpi radialis longus...... muscles (control site). Results. Significantly increased PPTs were found following intra-articular injection, at both the knee (P 

  6. Early Intra-Articular Complement Activation in Ankle Fractures

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    Hagen Schmal

    2014-01-01

    Full Text Available Cytokine regulation possibly influences long term outcome following ankle fractures, but little is known about synovial fracture biochemistry. Eight patients with an ankle dislocation fracture were included in a prospective case series and matched with patients suffering from grade 2 osteochondritis dissecans (OCD of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1β, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture and collection of effusion were only significantly associated with synovial aggrecan and C5b-9 levels (P<0.001. Furthermore, synovial expressions of both proteins correlated with each other (P<0.001. Although IL-1β expression was relatively low, intra-articular levels correlated with C5a (P<0.01 and serological C-reactive protein concentrations 2 days after surgery (P<0.05. Joint effusions were initially dominated by neutrophils, but the portion of monocytes constantly increased reaching 50% at day 6 after fracture (P<0.02. Whereas aggrecan and IL-1β concentrations were not different in fracture and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P<0.01. Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures.

  7. Bilateral Intra-Articular Radiofrequency Ablation for Cervicogenic Headache

    Science.gov (United States)

    Tang, Teresa; Taftian, David; Chhatre, Akhil

    2017-01-01

    Introduction. Cervicogenic headache is characterized by unilateral neck or face pain referred from various structures such as the cervical joints and intervertebral disks. A recent study of patients with cervical pain showed significant pain relief after cervical medial branch neurotomy but excluded patients with C1-2 joint pain. It remains unclear whether targeting this joint has potential for symptomatic relief. To address this issue, we present a case report of C1-2 joint ablation with positive outcomes. Case Presentation. A 27-year-old female presented with worsening cervicogenic headache. Her pain was 9/10 by visual analog scale (VAS) and described as cramping and aching. Pain was localized suboccipitally with radiation to her jaw and posterior neck, worse on the right. Associated symptoms included clicking of her temporomandibular joint, neck stiffness, bilateral headaches with periorbital pain, numbness, and tingling. History, physical exam, and diagnostic studies indicated localization to the C1-2 joint with 80% decrease in pain after C1-2 diagnostic blocks. She underwent bilateral intra-articular radiofrequency ablation of the C1-C2 joint. Follow-up at 2, 4, 8, and 12 weeks showed improved function and pain relief with peak results at 12 weeks. Conclusion. Clinicians may consider C1-C2 joint ablation as a viable long-term treatment option for cervicogenic headaches. PMID:28149652

  8. Intracortical chondroblastoma mimicking intra-articular osteoid osteoma

    Energy Technology Data Exchange (ETDEWEB)

    Ishida, Tsuyoshi; Mukai, Kiyoshi [First Department of Pathology, Tokyo Medical University, Shinjuku 6-1-1, Shinjuku-ku, Tokyo 160-8402 (Japan); Goto, Takahiro [Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo (Japan); Motoi, Noriko [Department of Pathology, Toranomon Hospital, Tokyo (Japan)

    2002-10-01

    We report a case of intra-articular intracortical chondroblastoma of the femoral condyle which radiologically appeared to be osteoid osteoma. A 19-year-old woman presented with a 3-year history of gradually increasing pain in the right knee and had been on nonsteroidal anti-inflammatory drugs for pain relief. Laboratory data were within normal limits. Radiographs showed a well-demarcated lucent lesion in the medial condyle of the right femur. A nidus-like lesion with calcifications and a sclerotic rim located in the cortex was imaged by computed tomography scan. Magnetic resonance imaging revealed bone marrow edema and soft tissue swelling around the lesion, with low signal intensity of the nidus-like lesion on both T1- and T2-weighted images. The lesion was excised en bloc and the histological diagnosis of chondroblastoma was made. A mild inflammatory reaction was observed in the bone marrow and synovium around the tumor. The chondroblastoma cells were shown to express cyclooxygenase-2 with immunohistochemistry. (orig.)

  9. Diagnosis and management of an intra-articular foreign body in the foot.

    LENUS (Irish Health Repository)

    Mulhall, K J

    2002-10-01

    We describe a case of a small intra-articular foreign body in the foot presenting 48 hours following injury, which at operation showed early evidence of septic arthritis. It is essential to accurately localise periarticular foreign bodies in the foot and proceed to arthrotomy and debridement in all cases where there is radiological or clinical evidence to suggest intra-articular retention of a foreign body.

  10. Intra-Articular Sufentanil Compared to Morphine for Pain Relief After Arthroscopic Knee Surgery

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    A P Kazemi

    2004-08-01

    Full Text Available Background: Prevention of postoperative pain by injecting opioid into the knee joint is believed to support the hypothesis of peripheral opioid receptor activation in inflammation. Main outcomes were reduction of pain intensity and need for supplementary analgesics. The aim of the present study was to evaluate the analgesic effects of intra-articular sufentanil in comparison with morphine, after arthreoscopic procedures of knee joint. Methods: In this prospective, double-blind study, 45 patients were randomized in three equal number groups to receive either sufentanil 5 µg (group s, morphine 3 mg (group M or normal saline 20 cc as placebo (group p, intra-articularly at the end of arthroscopic knee surgery, under general anesthesia, which was same in all three groups. Pain levels at rest were measured by Visual Analog Scale (VAS at intervals of 1,2,4,8,12,14 hours and during movement of knee at discharge time . Results: Significant difference between the groups (p<0.001 were found. Pain scores were statistically lower in the S and M groups in comparison with the P group, but intra-articular sufentanil was more effective than morphine. Conclusion: Intra-articular injection of morphine and sufentanil both reduce the post arthroscopic knee procedure’s pain and need for supplementary analgesics, but sufentanil, 5 µg is more effective than morphine (3 mg. Keywords: Postoperative analgesia, intra-articular opioids, sufentanil, Morphine, Knee arthroscopy.

  11. Comparison of analgesic effects of intra-articular tenoxicam and morphine in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Guler, Gulen; Karaoglu, Sinan; Velibasoglu, Hediye; Ramazanogullari, Nesrin; Boyaci, Adem

    2002-07-01

    This study compared the analgesic effect of intra-articular injection of tenoxicam with that of morphine on postoperative pain after anterior cruciate ligament (ACL) reconstruction. Forty-two patients undergoing arthroscopically ACL reconstructions using hamstring tendons underwent the same anesthetic protocol. The patients were randomized to receive 25 ml normal saline, 20 mg tenoxicam in 25 ml normal saline, or 2 mg morphine in 25 ml normal saline. Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements. We found both that both intra-articular tenoxicam and intra-articular morphine provided better analgesia than that in the control group. Although pain scores were similar between tenoxicam and morphine groups 30 min postoperative, the analgesic requirements in with tenoxicam were significantly lower than those with morphine group 3-6 h postoperatively.

  12. Intra-articular Nodular Fasciitis: An Unexpected Diagnosis for a Joint Lesion: A Case Report

    Directory of Open Access Journals (Sweden)

    MF Michelle Chan

    2014-07-01

    Full Text Available Pathological lesions in and around a joint can arise from underlying dermis, subcutis, deep muscle, bone or synovium. Clinical presentation can include joint pain, joint swelling, palpable masses and mechanical restriction. Whilst giant cell tumour of tendon sheath, pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, juxta articular myxomas and inflammatory arthritis are the better-known conditions of the joint. Intra-articular nodular fasciitis, on the other hand, is less well recognized both clinically and radiologically. It is rarely seen in routine practice and is only described in case reports in the literature. Due to the non-specific clinical and radiological findings as well as the unfamiliarity with the entity, the diagnosis of intra-articular nodular fasciitis is usually clinched only after histological examination. We present a case of intra-articular nodular fasciitis arising in the knee joint which was not suspected clinically or radiologically.

  13. Combined intra-articular glucocorticoid, bupivacaine and morphine reduces pain and convalescence after diagnostic knee arthroscopy

    DEFF Research Database (Denmark)

    Rasmussen, Sten; Lorentzen, Jan S; Larsen, Allan S

    2002-01-01

    We studied the effect of intra-articullar saline vs. bupivacaine + morphine or bupivacaine morphine + methylprednisolone after diagnostic knee arthroscopy. In a double-blind randomized study, 60 patients undergoing diagnostic knee arthroscopy without a therapeutic procedure were allocated to groups...... receiving intra-articular saline, intra-articular bupivacaine 150 mg + morphine 4 mg or the same dose of bupivacaine + morphine + intra-articular methylprednisolone 40 mg at the end of arthroscopy during general anesthesia. All patients were instructed to resume normal activities immediately after...... the procedure. Pain during movement and walking, leg muscle force and joint effusion, use of crutches and duration of sick leave were assessed. A combination of bupivacaine and morphine reduced pain, duration of immobilization and of convalescence. The addition of methylprednisolone further reduced pain, use...

  14. Necrotizing Faciitis after shoulder mobilization and intra-articular infiltration with betametasone.

    Science.gov (United States)

    Bento-Rodrigues, Joana; Judas, Fernando; Pedrosa Rodrigues, Jorge; Oliveira, João; Simões, Pedro; Lucas, Francisco; Pais Lopes, António

    2013-01-01

    Necrotizing Fasciitis is a rapidly progressive, potentially fatal infection of superficial fasciae and subcutaneous tissue, usually resulting from an inciting trauma to the skin. Medical literature refers few cases of necrotizing fasciitis related to intra-articular infiltrations, that often lead to patients death. This report describes the clinical events on a 55 year-old diabetic patient who developed upper extremity Necrotizing Fasciitis, 18 days after shoulder mobilization and intra-articular infiltration, due to Staphylococcus epidermidis. An early surgical debridement was performed and antibiotherapy was established, resulting in a successful outcome, despite the functional disability. We point out, through this case, the possibility of intra-articular injections of drugs causing Necrotizing Fasciitis, especially in risk patients.

  15. Usefulness of fluoroscopy-guided intra-articular injection of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Myung, Jae Sung; Lee, Joon Woo [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Lee, Ji Yeon [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)] (and others)

    2007-06-15

    To determine the accuracy of the intra-articular location of hyaluronic acid injection using a blind approach and to establish the usefulness of fluoroscopy-guided intra-articular injection. A fluoroscopy unit was used for 368 intra-articular injections of hyaluronic acid to 93 knees in 65 patients. Initially, blind needle positioning was conducted on the fluoroscopy table. The failure rate of the blind approach among the 368 injections was evaluated, and a relationship between the Kellgren-Lawrence grade (K-L grade) and the incidence of repeated failures using the blind approach was determined for injections to 52 knees in 37 patients who received a complete cycle of injections (five consecutive injections with a one-week interval between injections). Using a blind approach, 298 of 368 trials (81.2%) resulted in a needle tip being placed in an intra-articular location, while 70 of 368 trials resulted in an extra-articular placement of the needle tip. Among 52 knees to which a complete cycle of injection (five consecutive injections with a one-week interval between injections) was administered, repeated failure of intra-articular placement using the blind approach was seen for 18 knees (34.6%); a more severe K-L grade assigned was associated with a higher rate of repeated failure. However, the trend was not statistically significant based on the Chi-squared test ({rho} value = 0.14). Fluoroscopy-guided needle placement may be helpful to ensure therapeutic intra-articular injection of the knee.

  16. [Arthrocentesis of the temporomandibular joint and intra-articular injections : An update].

    Science.gov (United States)

    Marty, P; Louvrier, A; Weber, E; Dubreuil, P-A; Chatelain, B; Meyer, C

    2016-09-01

    Arthocentesis of the temporomandibular joint combined with intra-articular washout and, more recently, intra-articular injection of pharmacological agents has been developed from the 1990s and is nowadays extensively in use for the treatment of temporomandibular dysfunctions (TMDs). The goal of our work was to answer 3 questions: 1. Is intra-articular washout effective for the treatment of TMDs ? 2. What kind of pharmacological agents may nowadays be injected in addition to washout and are these injections useful ? 3. What is the place of these treatments in the treatment strategies of TMDs ? A bibliographic research has been carried out in the PubMed database using following keywords arthrocentesis, temporomandibular joint. The 27 articles published between 1991 and 2016, indicating patient's inclusion criterions and objectively evaluating the clinical results (mouth opening, intra-articular noises, pain) were selected. Pharmacological agents were noticed when used. 1. All authors concluded to the efficacy of intra-articular washout. No prognostic factor for arthrocentesis efficacy could be identified. 2. Main pharmacological agents used were steroids, hyaluronic acid, morphine-based drugs and platelet rich plasma. Superiority of ith-injection protocols failed to win unanimous support. All authors who compared with- and without-injection protocols concluded to the superiority of with-injection protocols, whatever the agent. Numerous studies have proven the efficacy of intra-articular washout for the treatment of TMDs resistant to noninvasive treatments. The advantage of any kind of pharmacological agent is not clear. Mechanisms of action are not all elucidated. No pharmacological agent showed any superiority over another. Study methodologies are often defective: imprecise inclusion criterions, short follow-up, confounding variables not taken into account, few comparison between pharmacological agents. Copyright © 2016 Elsevier Masson SAS. All rights

  17. Clinical Analysis of Internal Fixation Treatment of Intra-articular Calcaneal Fractures with Titanium Plate.

    Science.gov (United States)

    Chen, Xiao-Dong; Zhang, Chang-Chun; Li, Zhao-Cheng; Zhang, Heng; Zhou, Xin-She; Deng, Min

    2015-05-01

    To explore the clinical effect of internal fixation treatment of intra-articular calcaneal fractures with titanium plate, we used open reduction and internal fixation with titanium plate to 48 treated feet from 42 patients with intra-articular calcaneal fractures. The efficacy of surgical treatment was evaluated based on assessment of pain, function, and line of force aspects according to the American Orthopedic Foot and Ankle Society scoring system. Our data show that internal fixation with titanium plate is an effective treatment for calcaneal fractures. It provides satisfactory reduction, reliable fixation, and early rehabilitation.

  18. A Case of Recurrent Acute Pancreatitis Due to Intra-Articular Corticosteroid Injection

    Directory of Open Access Journals (Sweden)

    Patompong Ungprasert

    2014-03-01

    Full Text Available Context Corticosteroid is a well-established cause of drug-induced pancreatitis. However, acute pancreatitis from intraarticularinjection of corticosteroid has never been described. Case report A 69-year-old male presented with acuteabdominal pain and was diagnosed with acute pancreatitis. The patient had one episode of acute pancreatitis two yearearlier. Both episodes occurred after intra-articular cortisone injection. Investigations for other causes of pancreatitis werenegative. Conclusion We report the first case of acute pancreatitis from intra-articular corticosteroid injection. Physiciansshould be aware of this adverse reaction of corticosteroid that can even occur with local administration.

  19. The influence of surface porosity on gap-healing around intra-articular implants in the presence of migrating particles

    DEFF Research Database (Denmark)

    Rahbek, Ole; Kold, Soren; Zippor, Berit;

    2005-01-01

    -pore coating (Fi) were inserted intra-articular in exact fit or with a 0.75 mm peri-implant gap. A weight-loaded implant device in the distal femur was used. We used a randomized paired design in eight dogs. PE particles were injected repeatedly intra-articular in the knee until the dogs were killed after 8...

  20. Plantar pressure analysis after percutaneous repair of displaced intra-articular calcaneal fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); A. van der Stoep (Arjan); H. van der Avert (Hans); E.M.M. van Lieshout (Esther); P. Patka (Peter)

    2008-01-01

    textabstractBackground: Clinical results for the treatment of displaced intra-articular calcaneal fractures are mainly expressed using disease-specific outcome scores, physical examination and radiographs. We hypothesized that plantar pressure and foot position analysis is a valuable tool in

  1. Intra-articular injection of tenoxicam in osteoarthritic knee joints with effusion.

    Science.gov (United States)

    Oztuna, Volkan; Eskandari, Metin; Bugdayci, Resul; Kuyurtar, Fehmi

    2007-12-01

    Thirty patients who had grade II to III osteoarthritis according to Kellgren-Lawrence system and presenting with acute effusion of the knee joint were randomly assigned to 2 groups. All patients were treated with aspiration of the synovial fluid, cold application, and rest. Fifteen patients received an intra-articular injection of tenoxicam 20 mg following aspiration. The other group was administered oral tenoxicam 20 mg a day for 10 days. Patients were examined at 2, 4, and 8 weeks and then in 3-month intervals. At followup visits, pain was assessed using visual analog scale: range of motion, and effusion of the knee joint were recorded. A repeated measure test was used to determine the significance of changes in pain and mobility between the groups. Student's Neyman Keuls test was used to determine the significance of differences within the groups. Chi-square test was used for the number of episodes. The intra-articular injection group had more rapid pain relief than the oral treatment group (P < .01). At the end of 1 year, the number of effusions was significantly lower in the intra-articular treatment group (P < .01). These results indicate that intra-articular injection of tenoxicam provides rapid pain relief in the patients with acute flare-up of knee osteoarthritis and helps to prevent effusion.

  2. Displaced Intra-articular Fractures of the Calcaneus: with an emphasis on minimally invasive surgery

    NARCIS (Netherlands)

    T. Schepers (Tim)

    2009-01-01

    textabstractDisplaced intra-articular calcaneal fractures are complex injuries. Classically these fractures are treated with open reduction and internal fixation (ORIF) or conservatively. When comparing these two treatment modalities, ORIF has a significantly higher rate of wound complications and c

  3. Polyethylene-glycol-modified single-walled carbon nanotubes for intra-articular delivery to chondrocytes.

    Science.gov (United States)

    Sacchetti, Cristiano; Liu-Bryan, Ru; Magrini, Andrea; Rosato, Nicola; Bottini, Nunzio; Bottini, Massimo

    2014-12-23

    Osteoarthritis (OA) is a common and debilitating degenerative disease of articular joints for which no disease-modifying medical therapy is currently available. Inefficient delivery of pharmacologic agents into cartilage-resident chondrocytes after systemic administration has been a limitation to the development of anti-OA medications. Direct intra-articular injection enables delivery of high concentrations of agents in close proximity to chondrocytes; however, the efficacy of this approach is limited by the fast clearance of small molecules and biomacromolecules after injection into the synovial cavity. Coupling of pharmacologic agents with drug delivery systems able to enhance their residence time and cartilage penetration can enhance the effectiveness of intra-articularly injected anti-OA medications. Herein we describe an efficient intra-articular delivery nanosystem based on single-walled carbon nanotubes (SWCNTs) modified with polyethylene glycol (PEG) chains (PEG-SWCNTs). We show that PEG-SWCNTs are capable to persist in the joint cavity for a prolonged time, enter the cartilage matrix, and deliver gene inhibitors into chondrocytes of both healthy and OA mice. PEG-SWCNT nanoparticles did not elicit systemic or local side effects. Our data suggest that PEG-SWCNTs represent a biocompatible and effective nanocarrier for intra-articular delivery of agents to chondrocytes.

  4. Intra-Articular Synovial Sarcomas: Incidence and Differentiating Features from Localized Pigmented Villonodular Synovitis.

    Science.gov (United States)

    Nordemar, D; Öberg, J; Brosjö, O; Skorpil, M

    2015-01-01

    Purpose. To determine the incidence of intra-articular synovial sarcomas and investigate if any radiological variables can differentiate them from localized (unifocal) pigmented villonodular synovitis (PVNS) and if multivariate data analysis could be used as a complementary clinical tool. Methods. Magnetic resonance images and radiographs of 7 cases of intra-articular synovial sarcomas and 14 cases of localized PVNS were blindedly reviewed. Variables analyzed were size, extra-articular growth, tumor border, blooming, calcification, contrast media enhancement, effusion, bowl of grapes sign, triple signal intensity sign, synovial low signal intensity, synovitis, age, and gender. Univariate and multivariate data analysis, the method of partial least squares-discriminant analysis (PLS-DA), were used. Register data on all synovial sarcomas were extracted for comparison. Results. The incidence of intra-articular synovial sarcomas was 3%. PLS-DA showed that age, effusion, size, and gender were the most important factors for discrimination between sarcomas and localized PVNS. No sarcomas were misclassified as PVNS with PLS-DA, while some PVNS were misclassified as sarcomas. Conclusions. The most important variables in differentiating intra-articular sarcomas from localized PVNS were age, effusion, size, and gender. Multivariate data analysis can be helpful as additive information to avoid a biopsy, if the tumor is classified as most likely being PVNS.

  5. Intra-Articular Synovial Sarcomas: Incidence and Differentiating Features from Localized Pigmented Villonodular Synovitis

    Directory of Open Access Journals (Sweden)

    D. Nordemar

    2015-01-01

    Full Text Available Purpose. To determine the incidence of intra-articular synovial sarcomas and investigate if any radiological variables can differentiate them from localized (unifocal pigmented villonodular synovitis (PVNS and if multivariate data analysis could be used as a complementary clinical tool. Methods. Magnetic resonance images and radiographs of 7 cases of intra-articular synovial sarcomas and 14 cases of localized PVNS were blindedly reviewed. Variables analyzed were size, extra-articular growth, tumor border, blooming, calcification, contrast media enhancement, effusion, bowl of grapes sign, triple signal intensity sign, synovial low signal intensity, synovitis, age, and gender. Univariate and multivariate data analysis, the method of partial least squares-discriminant analysis (PLS-DA, were used. Register data on all synovial sarcomas were extracted for comparison. Results. The incidence of intra-articular synovial sarcomas was 3%. PLS-DA showed that age, effusion, size, and gender were the most important factors for discrimination between sarcomas and localized PVNS. No sarcomas were misclassified as PVNS with PLS-DA, while some PVNS were misclassified as sarcomas. Conclusions. The most important variables in differentiating intra-articular sarcomas from localized PVNS were age, effusion, size, and gender. Multivariate data analysis can be helpful as additive information to avoid a biopsy, if the tumor is classified as most likely being PVNS.

  6. Displaced Intra-articular Fractures of the Calcaneus: with an emphasis on minimally invasive surgery

    NARCIS (Netherlands)

    T. Schepers (Tim)

    2009-01-01

    textabstractDisplaced intra-articular calcaneal fractures are complex injuries. Classically these fractures are treated with open reduction and internal fixation (ORIF) or conservatively. When comparing these two treatment modalities, ORIF has a significantly higher rate of wound complications and

  7. Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation

    NARCIS (Netherlands)

    Tomesen, T.; Biert, J.; Frolke, J.P.M.

    2011-01-01

    BACKGROUND: Surgical treatment of displaced intra-articular fractures of the calcaneus is a standard procedure in many institutions. To avoid soft-tissue complications, several minimally invasive procedures have recently been introduced. The aim of this study was to assess the percutaneous treatment

  8. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review

    NARCIS (Netherlands)

    T. Schepers (Tim)

    2011-01-01

    textabstractPurpose: Although open reduction and internal fixation is currently considered the gold standard in surgical treatment of displaced intra-articular calcaneal fractures, various different approaches exist including the limited lateral approach. The aim of this systematic review was to

  9. Does joint architecture influence the nature of intra-articular fractures?

    Science.gov (United States)

    Steer, R A; Smith, S D; Lang, A; Hohmann, E; Tetsworth, K D

    2015-07-01

    The architecture of joints has potentially the greatest influence on the nature of intra-articular fractures. We analysed a large number of intra-articular fractures with two aims: (1) to determine if the pattern of injuries observed supports our conjecture that the local skeletal architecture is an important factor and (2) to investigate whether associated dislocations further affect the fracture pattern. A retrospective study of intra-articular fractures over a 3.5-year period; 1003 joints met inclusion criteria and were analysed. Three independent investigators determined if fractures affected the convex dome, the concave socket, or if both joint surfaces were involved. Further review determined if a joint dislocation occurred with the initial injury. Statistical analysis was performed using a one-way frequency table, and the χ(2) test was used to compare the frequencies of concave and convex surface fractures. The odds ratios (ORs) were calculated to establish the association between the frequencies of concave and convex surface fractures, as well as between dislocation and either fracture surface involvement. Of the 1003 fractures analysed, 956 (95.3%) involved only the concavity of the joint; in 21 fractures (2.1%) both joint surfaces were involved; and in 26 fractures (2.6%) only the convexity was involved (χ(2)=1654.9, df=2, parchitecture of joints clearly plays a highly significant role in determining the nature of intra-articular fractures. Intra-articular fractures involving the convexity are much more likely to be associated with a concurrent joint dislocation. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  10. Analgesic effects of intra-articular botulinum toxin Type B in a murine model of chronic degenerative knee arthritis pain

    Directory of Open Access Journals (Sweden)

    Stephanie Anderson

    2010-09-01

    Full Text Available Stephanie Anderson1,2, Hollis Krug1,2, Christopher Dorman1, Pari McGarraugh1, Sandra Frizelle1, Maren Mahowald1,21Rheumatology Section, Veteran’s Affairs Medical Center, Minneapolis, Minnesota; 2Division of Rheumatology and Autoimmune Diseases, University of Minnesota Medical School, Minneapolis, Minnesota, USAObjective: To evaluate the analgesic effectiveness of intra-articular botulinum toxin Type B (BoNT/B in a murine model of chronic degenerative arthritis pain.Methods and materials: Chronic arthritis was produced in adult C57Bl6 mice by intra-articular injection of Type IV collagenase into the left knee. Following induction of arthritis, the treatment group received intra-articular BoNT/B. Arthritic control groups were treated with intra-articular normal saline or sham injections. Pain behavior testing was performed prior to arthritis, after induction of arthritis, and following treatments. Pain behavior measures included analysis of gait impairment (spontaneous pain behavior and joint tenderness evaluation (evoked pain response. Strength was measured as ability to grasp and cling.Results: Visual gait analysis showed significant impairment of gait in arthritic mice that improved 43% after intra-articular BoNT/B, demonstrating a substantial articular analgesic effect. Joint tenderness, measured with evoked pain response scores, increased with arthritis induction and decreased 49.5% after intra-articular BoNT/B treatment. No improvement in visual gait scores or decrease in evoked pain response scores were found in the control groups receiving intra-articular normal saline or sham injections. Intra-articular BoNT/B was safe, and no systemic effects or limb weakness was noted.Conclusions: This study is the first report of intra-articular BoNT/B for analgesia in a murine model of arthritis pain. The results of this study validate prior work using intra-articular neurotoxins in murine models. Our findings show chronic degenerative arthritis

  11. En bloc joystick reduction of a comminuted intra-articular distal radius fracture: a technical trick.

    Science.gov (United States)

    Siegall, Evan; Ziran, Bruce

    2014-08-01

    A patient with a 1-month-old intra-articular distal radius fracture (treated closed in a splint) presented with an unacceptable degree of pain and stiffness caused by shortening and dorsal angulation of the distal radius. The fracture was comminuted with 4 or 5 distinct fragments, several involving the articular surface. Surgical correction was attempted. During the procedure, it was noted that, though the distal radius was shortened and angulated, there was actually acceptable congruity of the articular surface itself, despite the intra-articular nature of the fracture. Bone quality was poor and healing incomplete. Thus, we were concerned the currently congruous articular surface would fall apart with manipulation. Given this situation, we used a unique scaffolding technique with Kirschner wires placed in perpendicular fashion to both hold the articular surface intact and manipulate it en bloc. This technique is a simple way to turn a complex fracture into an easily reduced 2-part fracture.

  12. Intra-Articular Corticosteroids in Addition to Exercise for Reducing Pain Sensitivity in Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Soriano-Maldonado, Alberto; Klokker, Louise; Bartholdy, Cecilie

    2016-01-01

    participants with clinical and radiographic knee OA that were randomized to one intra-articular injection on the knee with either 1 ml of 40 mg/ml methylprednisolone (corticosteroid) dissolved in 4 ml lidocaine (10 mg/ml) or 1 ml isotonic saline (placebo) mixed with 4 ml lidocaine (10 mg/ml). Two weeks after....... The mean group difference in changes from baseline at week 14 was 0.6 kPa (95% CI: -1.7 to 2.8; P = 0.626) for PPT and 384 mm×sec (95% CI: -2980 to 3750; P = 0.821) for TS. CONCLUSIONS: These results suggest that adding intra-articular corticosteroid injection 2 weeks prior to an exercise program does...

  13. Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

    Directory of Open Access Journals (Sweden)

    Jake Sloane

    2010-01-01

    Full Text Available A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL, extending into the Hoffa's infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient's symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.

  14. Intra-Articular Lubricin Gene Therapy for Post-Traumatic Arthritis

    Science.gov (United States)

    2016-09-01

    C (LubC) in adeno-associated virus (AAV) vectors and retroviral vectors and have begun to assess intra-articular PRG4 gene therapy as a means to...mitigate OA in ACL-deficient joints in the rabbit. 2. KEYWORDS: ACL replacement, post-traumatic OA, PRG4, lubricin, gene therapy, adeno-associated virus ...was completed. Histologic processing of tissues was completed. Results will be gathered and analyzed for statistical significance and write -ups begun

  15. Intra-Articular Lubricin Gene Therapy for Post-Traumatic Arthritis

    Science.gov (United States)

    2015-09-01

    regeneration factors, and lubricants for OA cure and treatment . Nowadays, physical therapy and joint splinting and joint replacement surgery are also...negotiated: Joint Distraction Treatments of Intra-articular Fracture Induced Post-traumatic Ostearthritis in a Large Animal Model W81XWH-15-1-0642... fracture (IAF). As part of that work, the model was used to demonstrate short term effects of a promising biological treatment , and it is currently being

  16. Intra-articular membranous interposition detected by MRI in developmental dysplasia of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, W.; Itoi, Eiji; Sato, Kozo [Akita Univ. (Japan). Dept. of Orthopedic Surgery

    2000-12-01

    Intra-articular membranous interposition was detected by MRI in the hip joint with residual subluxation of a girl aged 5 years 10 months. This structure, which had low signal intensity on both T1- and T2-weighted images, separated the femoral head from the acetabulum. Histological examination revealed chondrometaplasia, which suggested that this interposition might be transformed to a surface cartilaginous tissue of the secondary acetabulum often observed in residual subluxation of the hip. (orig.)

  17. Iatrogenic Cushing syndrome after intra-articular triamcinolone in a patient receiving ritonavir-boosted darunavir.

    Science.gov (United States)

    Hall, Jill J; Hughes, Christine A; Foisy, Michelle M; Houston, Stan; Shafran, Stephen

    2013-09-01

    Drug interactions involving human immunodeficiency virus protease inhibitors are common due to their inhibition of the cytochrome P450 3A4 isoenzyme. We describe the case of an HIV-infected patient treated with ritonavir-boosted darunavir who developed cushingoid features following an intra-articular injection of triamcinolone acetate. We review the probable mechanism for this interaction and describe similar cases of Cushing syndrome in patients receiving concomitant ritonavir and triamcinolone.

  18. Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, L Ø; Husted, H; Kristensen, B B

    2010-01-01

    -articular catheters with 20 ml ropivacaine 0.5% given at 6 h and again at 24 h, postoperatively. Analgesic efficacy was assessed for 3 h after each injection, using a visual analogue score, where 0 = no pain and 100 = worst pain. There was no statistically significant difference between groups. Maximum pain relief...... anaesthetic has similar analgesic efficacy to intra-articular after total knee arthroplasty....

  19. Safety of Intra-Articular Use of Atelocollagen for Enhanced Tissue Repair

    OpenAIRE

    Magarian, Elise M; Vavken, Patrick; Connolly, Susan A; Mastrangelo, Ashley N.; Murray, Martha M.

    2012-01-01

    Collagen is an important biomaterial in intra-articular tissue engineering, but there are unanswered questions about its safety. We hypothesize that the addition of type-I-collagen for primary repair of the Anterior Cruciate Ligament (ACL) might result in a local and systemic reaction in a porcine model after 15 weeks as demonstrated by joint effusion, synovial thickening, elevated intraarticular and systemic leukocyte counts. Further, this reaction might be aggravated by the addition of a pl...

  20. Conservative treatment of temporomandibular joint osteoarthrosis: intra-articular injection of sodium hyaluronate.

    Science.gov (United States)

    Guarda-Nardini, L; Masiero, S; Marioni, G

    2005-10-01

    Promising short-term results in the treatment of temporomandibular joint osteoarthrosis with intra-articular injections of sodium hyaluronate (SH) have been reported in preliminary studies. The present prospective study compared long-term outcomes of temporomandibular joint SH injections with those of a conventional non-surgical treatment (bite-plane). Data from three groups of 20 patients with degenerative temporomandibular joint disease were considered. Group A underwent one cycle of five injections of 1 mL SH. Group B underwent a bite-plane treatment for at least 6 months. We considered a control group of 20 patients who refused any treatments. The description of the outcomes was based on objective and subjective parameters after a 6-month follow-up. Sodium hyaluronate and bite-plane treatments significantly improved patients conditions in all considered parameters. No significant differences in outcomes were confirmed by the statistical analysis. The tolerability of SH treatment resulted to be significantly higher. The analysis of results of serial controls in the SH treated group disclosed a significant worsening in pain at rest by comparing 1 and 6 months follow-up. Sodium hyaluronate infiltration resulted a valid non-surgical treatment for temporomandibular joint degenerative disease. Five well-tolerated intra-articular SH injections achieved equivalent results to those of a 6 months bite-plane treatment. We did not diagnose any complications of SH intra-articular injections. Longer time follow-up is necessary to determine the stability of SH properties.

  1. Nitrous Oxide sedation for intra-articular injection in juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Harel Liora

    2008-01-01

    Full Text Available Abstract Background Intra-articular corticosteroid injection in juvenile idiopathic arthritis (JIA is often associated with anxiety and pain. Recent reports advocate the use of nitrous oxide (NO, a volatile gas with analgesic, anxiolytic and sedative properties. Objective To prospectively evaluate the effectiveness and safety of NO analgesia for intra-articular corticosteroid injection in JIA, and to assess patients and staff satisfaction with the treatment. Methods NO was administered to JIA patients scheduled for joint injection. The patient, parent, physician and nurse completed visual-analog scores (VAS (0–10 for pain, and a 5-point satisfaction scale. Change in heart rate (HR during the procedure was recorded in order to examine physiologic response to pain and stress. Patient's behavior and adverse reactions were recorded. Results 54 procedures (72 joints were performed, 41 females, 13 males; 39 Jewish, 13 Arab; mean age was 12.2 ± 4.7 year. The median VAS pain score for patients, parents, physicians and nurses was 3. The HR increased ≥ 15% in 10 patients. They had higher VAS scores as evaluated by the staff. The median satisfaction level of the parents and staff was 3.0 and 5.0 respectively. Adverse reactions were mild. Conclusion NO provides effective and safe sedation for JIA children undergoing intra-articular injections.

  2. Measurement of three-dimensional intra-articular kinematics: methodological and interpretation problems.

    Science.gov (United States)

    Baeyens, J-P; Cattrysse, E; Van Roy, P; Clarys, J-P

    Intra-articular kinematics evaluates joint motion in terms of the configuration of the joint. Therefore data are needed concerning joint kinematics as well as joint configuration. We have developed accurate measurement methods for both in vivo and in vitro evaluation. Interpretation of the processed data is more complex than simply setting up a coordinate system based on the joint configuration. Although the description of intra-articular motion in terms of Euler-Cardan or helical angles may be complete, the therapeutic interpretation may be doubtful. Using the the ulno-humeral joint during flexion-extension as an example, we found the combination of helical angles in the directions of extension/external rotation/varus. In the case of the Cardan angles, inconsistent patterns of rotation resulted from a different choice of sequence order and were different from the helical angles. The finite helical axis (FHA) provides a functional representation of the joint movement, i.e. pathways of motion, whereas the sequence dependency of Euler-Cardan angles produces problems in the therapeutic interpretation of the movement. Therefore we believe that an FHA approach should be used in intra-articular kinematics research.

  3. Extreme Postinjection Flare in Response to Intra-Articular Triamcinolone Acetonide (Kenalog).

    Science.gov (United States)

    Young, Porter; Homlar, Kelly C

    2016-01-01

    As intra-articular corticosteroid injections (CSIs) are a common treatment for osteoarthritis, physicians must well understand their potential side effects. Postinjection flares are an acute side effect of intra-articular CSIs, with symptoms ranging from mild joint effusion to disabling pain. The present case involved a severe postinjection flare that occurred after the patient, a 56-year-old woman with moderate osteoarthritis in the left knee, received 2 mL of 1% lidocaine and 2 mL (40 mg) of triamcinolone acetonide (Kenalog). Two hours after injection, she experienced swelling and intense pain in the knee and was unable to ambulate. The knee was aspirated with a return of 25 mL of "butterscotch"-colored fluid. This case is novel in that its acuity of onset, severity of symptoms, and synovial fluid analysis mimicked septic arthritis, which was ultimately ruled out with negative cultures and confirmation of triamcinolone acetonide crystals in the synovial aspirate, viewed by polarized light microscopy. Thus, the patient's reaction represents an acute crystal-induced inflammatory response. Although reactions to an intra-articular CSI of this severity are rare, it is important for treating physicians to inform patients of this potential side effect.

  4. Protective Effect of Surgery Against Early Subtalar Arthrodesis in Displaced Intra-articular Calcaneal Fractures

    Science.gov (United States)

    Liu, Yueju; Li, Zhi; Li, Heng; Zhang, Yingze; Wang, Pengcheng

    2015-01-01

    Abstract The aim of this study is to determine whether surgery offers protection against early subtalar arthrodesis in displaced intraarticular calcaneal fractures. Systematic review and meta-analysis: searches of electronic databases 1980 to August 2014, checking of reference lists, hand searching of journals, and contact with experts. Randomized controlled trials (RCTs) in which surgical treatment was compared with nonsurgical treatment of displaced intra-articular calcaneal fractures from 1980 to 2014. The modified Jadad scale was used for trial quality and effective data were pooled for meta-analysis. Study results related to early subtalar arthrodesis were extracted and risk assessment was combined with surgical treatment and nonsurgical treatment. The primary analysis included 4 studies and 966 participants. The estimated overall risk ratio was 4.40 (95% confidence interval 2.67–7.39), indicating the incidence of early subtalar arthrodesis in nonsurgical group is 4.4 times the surgical group. The results showed that surgical treatment was superior to nonsurgical treatment in protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures (Z = 5.600, P < 0.001). Surgery offers protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures. PMID:26559281

  5. An Innovative Intra-articular Osteotomy in the Treatment of Posterolateral Tibial Plateau Fracture Malunion.

    Science.gov (United States)

    Wang, Yukai; Luo, Congfeng; Hu, Chengfang; Sun, Hui; Zhan, Yu

    2016-07-13

    Posterolateral tibial plateau fractures are not uncommon and the diagnosis can be easily missed. The treatment is technically demanding, which can easily lead to malunion of the posterolateral tibial plateau fracture. Here, we describe an innovative intra-articular osteotomy for the treatment of posterolateral tibial plateau fracture malunion. From 2010 through 2012, 13 patients with a posterolateral tibial plateau fracture malunion were treated in our trauma center. The patients were referred because of instability or knee pain. The instability was confirmed by physical examinations preoperatively. The depression malunion and lower limb alignment were evaluated on X-rays and computed tomography scans. All posterolateral tibial plateau fracture malunions were treated with an innovative intra-articular osteotomy via an extended anterolateral approach. The mean follow-up was 19.6 months (range, 14-28 months). The posterolateral osteotomy healed at an average of 15.1 weeks. The depression malunion was corrected in all patients, which was from 15.4 mm preoperatively to 3.3 mm at 12 months postoperatively. The average Lysholm, Knee Society Score, and visual analog scale scores were 91.7, 92.5, and 0.5, respectively. No loss of reduction, nonunion, or wound infection was observed. An innovative intra-articular osteotomy via an extended anterolateral approach is an effective treatment for posterolateral tibial plateau fracture malunion. The treatment achieved satisfactory functional results and knee stability restoration.

  6. Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture.

    Science.gov (United States)

    Gabl, M; Arora, R; Klauser, A S; Schmidle, Gernot

    2016-08-01

    The purpose of this study was to assess characteristics of radiocarpal arthrofibrosis after intra-articular distal radius fractures (DRF). In this study 20 patients who underwent wrist arthroscopy at the time of implant removal after volar plating for intra-articular DRF were included retrospectively. The direction of fibrous tissue formation (FTF) and its rigidity were investigated. The findings were correlated to the course of intraarticular fracture lines seen in the preoperative CT, patient age and AO fracture types. In all patients FTF spanned the radiocarpal joint. Fibrous tissue formations extended from previous fracture gaps to the scapholunate interosseous ligament and/or capsule. Four basic types of FTF (Type 1-4) and two combination types (Type 1a, 2a) were found. Fibrotic fans with dorsal capsular attachment (Type 1, 30 %) and its combination with dorsal capsule obliteration (Type 1a, 40 %) were the most common findings. Mild rigidity was present in 3 (15 %), moderate in 7 (35 %), and severe rigidity in 10 cases (50 %). Fracture lines crossing the radius extensor compartments or interfacet ridge, cartilage defects and C3 fractures showed the highest risk to develop severely rigid fibrous tissue formations. In older patients and in more comminuted fractures the number of rigid fibrous tissue formations was higher. Fracture severity correlates with the development of rigid intra-articular FTF. In case of rigid FTF with restricted wrist motion arthroscopic debridement may be considered at the time of hardware removal.

  7. Intra-articular mepivacaine reduces interventional analgesia requirements during arthroscopic surgery in dogs.

    Science.gov (United States)

    Dutton, T A G; Gurney, M A; Bright, S R

    2014-08-01

    To document efficacy of intra-articular mepivacaine in dogs based on the hypothesis that this would blunt the haemodynamic response to a nociceptive stimulus (arthroscopic surgery), reducing interventional analgesia requirements. A dose of mepivacaine 2% 0 · 1 ml/kg (2 mg/kg) was injected intra-articularly into one randomly assigned elbow joint before surgery in eight dogs undergoing bilateral elbow arthroscopy. Baseline haemodynamic measurements were recorded immediately before the start of each arthroscopic procedure and repeated at arthrocentesis, saline distension of the joint, incision, arthroscopic cannula and obturator insertion and placement of the second portal and haemodynamic variability calculated. If baseline parameters increased by more than 20% suggesting nociception, 1 µg/kg fentanyl was administered intravenously. Significantly less fentanyl was required during arthroscopy on the mepivacaine treated elbows compared to the non-treated elbows (P = 0 · 003) and the time to first fentanyl administration was significantly longer (P = 0 · 0001) in the mepivacaine treated elbows (21 · 2 ± 4 · 9 minutes) compared to the non-treated elbows (6 · 1 ± 2 · 3 minutes). Haemodynamic variability was significantly reduced in the mepivacaine group (heart rate P = 0 · 04, mean arterial pressure P = 0 · 003). Intra-articular mepivacaine blunts the haemodynamic response to arthroscopic surgery in dogs and reduces interventional analgesia requirement. © 2014 British Small Animal Veterinary Association.

  8. Analgesic efficacy of intra-articular morphine after arthroscopic knee surgery in sport injury patients

    Directory of Open Access Journals (Sweden)

    Mitra Yari

    2013-07-01

    Full Text Available BACKGROUND: Anterior Cruciate Ligament (ACL tearing is a common injury among football players. The present study aims to determine the best single-dose of intra-articular morphine for pain relief after arthroscopic knee surgery that, in addition to adequate and long-term analgesia, leads to fewer systemic side effects. METHODS: This clinical trial was conducted on 40 ASA-I athletes. After surgery, all participants received an injection of 20cc of 0.5% intra-articular bupivacaine. In addition, the first control group received a saline injection and 5, 10 and 15 mg of morphine were respectively injected into the joints of the second, third and fourth groups by use of Arthroscopic equipment before the Arthroscopic removal. The amount of pain based on VAS at 1, 2, 4, 6 and 24 hours after surgery, duration of analgesia and the consumption of narcotic drugs were recorded. RESULTS: The VAS scores in the fourth, sixth and twenty-fourth hours after surgery showed a significant difference between the study groups. The average time to the first analgesic request from the bupivacaine plus 15 mg morphine group was significantly longer than other groups and total analgesic requests were significantly lower than other groups. No drowsiness complications were observed in any of the groups in the first 24 hours after injection. CONCLUSION: Application of 15 mg intra-articular morphine after Arthroscopic knee surgery increases the analgesia level as well as its duration (IRCT138902172946N3 .

  9. The effect of intra-articular hyaluronate and tramadol injection on patients with adhesive capsulitis of the shoulder.

    Science.gov (United States)

    Kim, Kyung-Hee; Suh, Jung-Woo; Oh, Ki Young

    2017-08-03

    Local administration of opioids causes effective analgesia without adverse effects related to the central nervous system. After the beneficial demonstration of peripheral opioid receptors in joint synovia, intra-articular opioid injections were used for pain treatment. Clinical studies have reported the safety and efficacy of hyaluronate injection in the shoulder joint of patients with osteoarthritis, periarthritis, rotator cuff tears, and adhesive capsulitis. To estimate the efficacy of intra-articular hyaluronate and tramadol injection for adhesive capsulitis of the shoulder compared with that of intra-articular hyaluronate injection alone. Thirty patients with adhesive capsulitis of the shoulder were randomized to the hyaluronate group (n= 16) or the tramadol group (n= 14). Hyaluronate group members were administered five weekly intra-articular hyaluronate injections; tramadol group members were administered three weekly intra-articular hyaluronate and tramadol injections and then two weekly intra-articular injections of hyaluronate. Visual Analog Scale (VAS), passive range of motion (PROM) of the shoulder joint, and Shoulder Pain and Disability Index (SPADI) scores were assessed at baseline and weeks 1, 2, 3, 4, and 6 after the initial injection. A significant improvement was observed in VAS, PROM, and SPADI scores between time points in both groups. In comparison in both groups at weeks 1 and 2 after the initial injection the VAS scores of the tramadol group were significantly lower than those of the hyaluronate group. Intra-articular hyaluronate with tramadol showed more rapid and strong analgesic effects than intra-articular hyaluronate alone and did not induce any adverse effects.

  10. Comparing the Efficacy of Intra-Articular Application of Morphine and Tramadol on Postoperative Pain After Arthroscopic Knee Surgery

    OpenAIRE

    Jazayeri, Seyed Mohammad; Mosaffa, Faramarz; Abbasian, Mohammadreza; Hosseinzadeh, Hamid Reza

    2012-01-01

    Background: Intra-articular analgesia is a pain reliever that is frequently administered following arthroscopic knee surgery. Objectives: The purpose of this study was to compare the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery. Patients and Methods: For this randomized double blinded clinical trial, 132 patients undergoing minor arthroscopic knee surgery were randomly assigned to receive either; 5 mg morphine or 50 mg ...

  11. Comparison of intra-articular drilling and diode laser treatment for arthrodesis of the distal tarsal joints in normal horses.

    Science.gov (United States)

    Scruton, C; Baxter, G M; Cross, M W; Frisbie, D D

    2005-01-01

    Anecdotal reports suggest that laser-facilitated arthrodesis of the distal tarsal joints improves the prognosis compared with intra-articular drilling but no objective comparisons have been performed. To evaluate intra-articular drilling and laser-facilitated arthrodesis using in situ and in vivo techniques. Fourteen cadaver limbs were evaluated in situ for chondrocyte viability after both surgical techniques. In vivo, one randomly selected limb was subjected to laser-facilitated arthrodesis and the other underwent intra-articular drilling in 6 normal horses. Clinical examinations were performed at 1, 3 and 5 months. Two horses were subjected to euthanasia at 1, 3 and 5 months. Significantly more chondrocyte death was observed with laser-facilitated arthrodesis compared to drilling, but the overall degree suggested only a focal effect. In vivo, both groups demonstrated minimal post operative morbidity. There was more evidence of arthrodesis seen at all time points with intra-articular drilling. This study demonstrated that changes associated with ultimate arthrodesis occur earlier after intra-articular drilling of the distal tarsal joints than laser-facilitated arthrodesis, although clinically affected horses may respond differently. Intra-articular drilling may provide earlier arthrodesis of the distal tarsal joints, but not necessarily a better long-term result.

  12. MRI features of three paediatric intra-articular synovial lesions: a comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Kan, J.H. [Monroe Carell Jr. Children' s Hospital at Vanderbilt, Nashville, TN (United States)], E-mail: herman.kan@vanderbilt.edu; Hernanz-Schulman, M. [Monroe Carell Jr. Children' s Hospital at Vanderbilt, Nashville, TN (United States); Damon, B.M.; Yu, Chang [Vanderbilt University, Nashville, TN (United States); Connolly, S.A. [Boston Children' s Hospital, Boston, IL (United States)

    2008-07-15

    Aim: To determine reliable magnetic resonance imaging (MRI) features differentiating three paediatric intra-articular congenital or neoplastic synovial lesions that contain blood products, from post-traumatic or haemorrhagic inflammatory processes. Materials and methods: This was a retrospective review of MRI findings of 22 paediatric intra-articular congenital or neoplastic synovial lesions, including venous malformation (VM) (n = 12), pigmented villonodular synovitis (PVNS; n = 8), and synovial sarcoma (SS; n = 2). These MRI features were compared with 22 paediatric post-traumatic or inflammatory intra-articular processes containing blood products and producing mass effect. The following imaging features were assessed: presence of a discrete mass, extension, extra-articular oedema, susceptibility, joint effusion, and size. Fisher's exact test was used and results were considered statistically significant when p < 0.05. Results: The three intra-articular synovial lesions, compared with controls, were more likely to directly invade osseous structures when a discrete mass was present (13/16, 81.3% versus 1/9, 11.1%; p < 0.002) and extend into extra-articular soft tissues (13/21, 61.9% versus 2/17, 11.8%; p < 0.003), but were less likely to show extra-articular oedema (3/22, 13.6% versus 13/22, 59.1%; p < 0.004), a joint effusion (10/22,45.5% versus 19/22, 86.4%, p < 0.01), susceptibility within a joint effusion (0/22, 0% versus 11/22, 40.9%; p = 0.00), osseous oedema (3/16, 18.8% versus 7/9, 77.8%; p < 0.009), and synovial enhancement (8/21, 38.1% versus 14/16, 87.5%; p < 0.003). VMs had characteristic tubular vessels with internal fluid-fluid levels (11/12) that extended into bone (10/12) and extracapsular soft tissues (11/12). Conclusion: Our study indicates that, despite the overlapping presence of haemorrhagic products, intra-articular VM, PVNS, and SS show MRI features that permit distinction from acquired post-traumatic and haemorrhagic inflammatory

  13. Intra-articular temperatures of the knee in sports – An in-vivo study of jogging and alpine skiing

    Directory of Open Access Journals (Sweden)

    Cerulli Guiliano

    2008-04-01

    Full Text Available Abstract Background Up to date, no information exists about the intra-articular temperature changes of the knee related to activity and ambient temperature. Methods In 6 healthy males, a probe for intra-articular measurement was inserted into the notch of the right knee. Each subject was jogging on a treadmill in a closed room at 19°C room temperature and skiing in a ski resort at -3°C outside temperature for 60 minutes. In both conditions, temperatures were measured every fifteen minutes intra-articulary and at the skin surface of the knee. A possible influence on joint function and laxity was evaluated before and after activity. Statistical analysis of intra-articular and skin temperatures was done using nonparametric Wilcoxon's sign rank sum test and Mann-Whitney's-U-Test. Results Median intra-articular temperatures increased from 31.4°C before activity by 2.1°C, 4°C, 5.8°C and 6.1°C after 15, 30, 45 and 60 min of jogging (all p ≤ 0.05. Median intra-articular temperatures dropped from 32.2°C before activity by 0.5°C, 1.9°C, 3.6°C and 1.1°C after 15, 30, 45 and 60 min of skiing (all n.s.. After 60 minutes of skiing (jogging, the median intra-articular temperature was 19.6% (8.7% higher than the skin surface temperature at the knee. Joint function and laxity appeared not to be different before and after activity within both groups. Conclusion This study demonstrates different changes of intra-articular and skin temperatures during sports in jogging and alpine skiing and suggests that changes are related to activity and ambient temperature.

  14. Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ringler, Michael D.; Collins, Mark S.; Howe, B.M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Shotts, Ezekiel E. [NEA Baptist Clinic, Jonesboro, AR (United States)

    2016-12-15

    Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee. (orig.)

  15. The Role of Computed Tomography in Evaluating Intra-Articular Distal Humerus Fractures.

    Science.gov (United States)

    Nolan, Betsy M; Sweet, Stephan J; Ferkel, Eric; Udofia, Aniebet-Abasi; Itamura, John

    2015-09-01

    Computed tomography (CT) is often used to evaluate intra-articular distal humerus fracture patterns, but it increases radiation exposure and cost. We conducted a study to determine the effect of adding CT evaluation to plain radiographic evaluation on the classification of, and treatment plans for, intra-articular distal humerus fractures. Nine blinded orthopedic surgeons evaluated 30 consecutive fractures for classification and surgical approach. Evaluations were performed first using plain radiographs and then again using the same radiographs plus CT images. Statistical analysis was performed using the κ correlation coefficient and Cramer V testing. We hypothesized that adding CT images to plain radiographs would change the classification and treatment of these fractures and would improve interobserver agreement on classification and treatment. Intraobserver reliability (Cramer V) was fair (.393) for classification and moderate (.426) for treatment. Interobserver reliability (Cohen κ) did not improve with CT: For classification, κ was .21 without CT and .20 with CT; for treatment, κ was .28 without CT and .27 with CT. When classifying the fractures, attending surgeons chose the multiplanar fracture pattern 25.6% of the time without CT, and remained consistent at 23.3% with CT. Trainees chose this fracture pattern much less often without CT than with CT. Use of CT changed the treatment for multiplanar fractures (73.7% lateral approach vs 51.9% posterior approach with olecranon osteotomy). When added to plain radiographic evaluation, CT evaluation changes classification and treatment plans. Interobserver reliability did not improve. Less experienced surgeons were more likely to identify multiplanar fracture patterns with use of CT. We recommend performing CT for all intra-articular distal humerus fractures.

  16. Open Reduction and Internal Fixation of Displaced Calcaneum, Intra-Articular Fractures by Locking Calcaneal Plate

    Science.gov (United States)

    Santosha; Singh, Arambam Mahendra; Waikhom, Sanjib; Pakhrin, Vishal; Mukherjee, Sagnik; Debbarma, Rajkumar; Prashant, Prabhu Shrinivas

    2016-01-01

    Introduction Calcaneal fractures constitute the most common fractures in hindfoot. Lots of controversies exist in the management of calcaneal fractures but now-a-days, it is preferable to perform open reduction and internal fixation and early mobilizatation. Aim To evaluate the functional outcome after open reduction and internal fixation of displaced intra-articular fractures of the calcaneum by locking calcaneal plate. Materials and Methods The study was conducted in the Department of Orthopaedic Surgery from September 2013 to April 2016. Thirty intra-articular fractures of the calcaneum were treated by locking calcaneal plate. Patients were followed up for a period of 24 months. Bohler’s angle was measured in preoperative, immediate Post-operative period and after 2 years, follow-up was compared. Results were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) Score. Results After 24 months of follow-up, all 24 patients were available for evaluation. Radiological union was achieved in a mean time of 12.5 weeks. Mean duration of hospital stay was 21 days. Bohler’s angle was significantly higher after 2 years of follow-up when compared with preoperative x-ray. According to the AOFAS, Ankle–Hind foot Scale outcome score results were excellent in 43.3% of the patients, good in 33.3%, fair in 10%, and poor in 13.3% of patients. The mean AOFAS score was 79.9 (Range 49-96). Conclusion Open reduction and internal fixation of intra-articular fractures of the calcaneum with locking calcaneal plate gives good results. Maintenance of calcaneal height and Bohler’s angle helps to decrease the incidence of subtalar arthritis. PMID:28208957

  17. Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis?

    Energy Technology Data Exchange (ETDEWEB)

    Deshmukh, Ajit J.; Rodriguez, Jose A. [North Shore LIJ Lenox Hill Hospital, Department of Orthopaedic Surgery, New York, NY (United States); Panagopoulos, Georgia [North Shore LIJ Lenox Hill Hospital, Department of Research, New York, NY (United States); Alizadeh, Ahmadreza; Klein, Devon A. [North Shore LIJ Lenox Hill Hospital, Department of Radiology, New York, NY (United States)

    2011-11-15

    Intra-articular injection is being used widely for both diagnostic and therapeutic purposes in the hip. However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was predictive of the response to intra-articular injection of local anesthetic with corticosteroid and to determine the relationship between immediate pain relief resulting from the anesthetic and delayed pain relief resulting from corticosteroid administration. This retrospective study included 217 patients (220 injections) with diagnosis of hip OA who underwent a fluoroscopically guided therapeutic hip injection of local anesthetic and corticosteroid. Hip radiographs were scored using the Kellgren-Lawrence scale. Immediate and delayed pain relief was documented using a visual analog scale. Logistic regression analysis was performed to investigate whether age, gender or radiographic severity of OA were independent predictors of pain relief. Degree of agreement between immediate and delayed response was assessed with the kappa coefficient. Immediate pain relief was reported in 68.2% of hips and delayed relief in 71.4% of hips. A high level of agreement was observed between immediate and delayed pain relief (kappa = 0.80, p < 0.001). 94% of patients reporting immediate relief also reported relief 2 weeks later. Univariate and multivariate analysis revealed that neither gender nor age was related to immediate or delayed pain relief. Only severity of OA (based on radiographic analysis) was observed to be predictive of pain relief. Pain relief following intra-articular hip injection correlated with radiographic severity of OA. This intervention may be of therapeutic and prognostic value in patients awaiting hip arthroplasty. (orig.)

  18. OPERATIVE MANAGEMENT OF INTRA-ARTICULAR DISTAL HUMERAL FRACTURES WITH LOCKING PLATES

    Directory of Open Access Journals (Sweden)

    Abhilekh

    2015-11-01

    Full Text Available BACKGROUND: Intra-articular distal humeral fractures are common, but complex elbow injuries. To obtain good results, anatomical reduction with rigid fixation and early range of mobilization is required. Treatment of these fractures with conventional plates is associated with many complications such as non-anatomic reduction of articular surfaces, malunion, non-union, loosening of implant, residual stiffness of the elbow and post-traumatic osteoarthrosis. In this situation the application of locking plates having a fixed angle plate screw construct can minimise most of the above complications. OBJECTIVE: To evaluate radiological and functional outcome of locking plate application for the management of intra-articular distal humeral fractures. MATERIAL AND METHODS: This prospective study was conducted from January 2013 to December 2014. We operated 20 patients of AO type-C intra-articular distal humeral fractures. Fracture was exposed using modified Campbell’s posterior approach in less comminuted fractures and a V-shaped Olecranon osteotomy was done to get better exposure of the articular surface in cases with severe articular comminution. The fracture was stabilized using an intercondylar screw, pre-contoured locking compression plates and/or locking reconstruction plates as per preoperative planning. Patients were reviewed at monthly interval for clinical-radiological evaluation. Final outcome measures included radiological assessment, range of motion and Mayo elbow performance score (MEPS. RESULTS: All the fractures were united at an average 12 weeks. Two patients developed numbness in the distribution of ulnar nerve and one patient developed superficial infection in immediate postoperative period. None of the patients had malunion and loosening of implant. The average arc of flexion-extension was 105`, although no patient had loss of supination/pronation. Mayo Elbow Performance Score was excellent in 15 (75%, good in 3 (15%, fair in 1 (5

  19. Effects of intra articular tramadol on articular cartilage and synovium of rats

    OpenAIRE

    Musa Kola; Sennur Uzun; Naciye Dilara Zeybek; Fatma Sarıcaoğlu; Seda Banu Akıncı; Ülkü Aypar; Esin Asan

    2015-01-01

    Objective: To investigate the effects of intra articular tramadol injection on articular cartilage and synovium in rat knee joint.Methods: After Animal Ethical Committee approval, a total of 20 Sprague-Dawley rats were used and divided into 4 groups. Each group was composed of 5 rats. 0.2 ml of tramadol HCl was injected into the right knee joints and left knee joints of all the rats were considered as control. Control side joints received saline injection. Rats were sacrificed with ketamin on...

  20. Hypersensitivity to mechanical and intra-articular electrical stimuli in persons with painful temporomandibular joints

    DEFF Research Database (Denmark)

    Ayesh, Emad; Jensen, Troels Staehelin; Svensson, P

    2007-01-01

    This study tested whether persons with TMJ arthralgia have a modality-specific and site-specific hypersensitivity to somatosensory stimuli assessed by quantitative sensory tests (QST). Forty-three healthy persons and 20 with TMJ arthralgia participated. The QST consisted of: sensory and pain...... detection thresholds and summation threshold to intra-articular electrical stimulation, tactile and pin-prick sensitivity in the TMJ area, pressure-pain threshold and tolerance on the lateral side of the TMJ and on the finger. Persons with TMJ arthralgia had lower pain detection and summation thresholds (P...

  1. Intra-articular nodular fasciitis of the knee: a rare cause of recurrent hemarthrosis.

    Science.gov (United States)

    Matsuzaki, Tokio; Akisue, Toshihiro; Kishimoto, Kenta; Kishimoto, Shin-ichiro; Imabori, Masaya; Hara, Hitomi; Okada, Yoshiyuki; Hitora, Toshiaki; Kuroda, Ryosuke; Kurosaka, Masahiro; Yamamoto, Tetsuji

    2012-06-01

    A 20-year-old man presented with pain and recurrent hemarthrosis in the right knee. Magnetic resonance imaging of the knee showed a lesion with homogeneous low signal intensity on T1-weighted images and a heterogeneous, low to high signal intensity on T2-weighted images. At arthroscopy, the mass was located between the posterior cruciate ligament and the posterior knee joint capsule. The tumor was excised through a posterior approach and histologically diagnosed as a nodular fasciitis. Intra-articular nodular fasciitis is a very rare clinicopathologic entity. The current case showed the unique clinical feature of recurrent hemarthrosis at initial presentation, which has not been previously reported.

  2. Intra-articular block for knee arthroscopy: a study on 41 patients

    Directory of Open Access Journals (Sweden)

    Emami A

    2009-07-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: During recent three decades, parallel to the improvement of arthroscopic techniques, intra-articular block by direct injection of anesthetics into the joint has been used in knee arthroscopy. In this study the efficacy of intra- articular block by complex of bupivacaine, lidocaine and adrenaline in knee arthroscopy has been assessed. "n"nMethods: Forty one healthy adults (age range: 18-55 years with knee problems selected for diagnostic arthroscopy. Anesthesia was induced by direct injection of 10ml 2% bupivacaine, 10ml 0.5% lidocaine plus 1/100000 adrenaline into the knee joint.  Duration of operation and volume of serum used for irrigation during the procedure; pain and analgesics requirement, during and after arthroscopy; VAS (Visual Analogue Scale score, at time of discharge from recovery and also patient's and surgeon's satisfaction were assessed. "n"n Results: Sixty eight percent and 29% of cases reported mild and moderate degree of pain perception during arthroscopy, respectively, and only one case for which general anesthesia was performed, reported severe pain. VAS mean was 2.78. Seventy eight percent of cases and the surgeon in 80% of procedures had excellent or good satisfaction with

  3. An intra-articular ganglion cyst in a patient with juvenile idiopathic arthritis.

    Science.gov (United States)

    Deng, Donna Y; Yee, Keolamau; Burkhalter, William; Okimoto, Kelley Chinen; Kon, Kevin; Kurahara, David K

    2014-01-01

    We report an intra-articular ganglion cyst (IAGC) presenting as knee pain and a mass in a patient with longstanding Juvenile Idiopathic Arthritis (JIA). We could not find a similar case of an IAGC occurring in the knee of JIA patients in the literature. IAGC may need to be included as a possibility in patients with inflammatory arthritis with new-onset knee pain, especially in those with a palpable mass. MRI was useful in distinguishing IAGC from more worrisome causes of a knee mass. Orthopedic input was helpful in diagnosis and treatment. In addition, methotrexate therapy was effective in bringing about a long-lasting remission.

  4. Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study.

    Science.gov (United States)

    Aktas, I; Yalcin, S; Sencer, S

    2010-05-01

    This study examined the clinical and radiological effects of intra-articular tenoxicam injection following arthrocentesis and compared them with arthrocentesis alone in patients with disc displacement without reduction (DDwoR). 24 temporomandibular joints (TMJs) in 21 patients with DDwoR were studied. Patients were divided randomly into Group A in which only arthrocentesis was performed (14 TMJs in 14 patients) and Group AT which received arthrocentesis plus intra-articular injection of tenoxicam (10 TMJs in 7 patients). Patients were evaluated before the procedure, on postoperative day 7, then 2, 3, 4 weeks, and 2, 3, 4, 5, 6 months postoperatively. Intensity of joint pain was assessed using a visual analog scale. Maximum mouth opening was recorded at each follow-up. TMJ sounds and palpation scores were noted as positive or negative. Magnetic resonance imaging (MRI) was performed before and 6 months after treatment in both groups. Disc form, disc location during neutral position, reduction with movement, joint effusion, structures of the articular surfaces, and bone marrow anomalies were evaluated all in MRIs. Both treatments succesfully increased maximum mouth opening and reduced TMJ pain; there were no complications. Difference between the groups was not statistically significant and a larger controlled study is necessary to clarify this use of tenoxicam.

  5. Effects of intra articular tramadol on articular cartilage and synovium of rats

    Directory of Open Access Journals (Sweden)

    Musa Kola

    2015-12-01

    Full Text Available Objective: To investigate the effects of intra articular tramadol injection on articular cartilage and synovium in rat knee joint. Methods: After Animal Ethical Committee approval, a total of 20 Sprague-Dawley rats were used and divided into 4 groups. Each group was composed of 5 rats. 0.2 ml of tramadol HCl was injected into the right knee joints and left knee joints of all the rats were considered as control. Control side joints received saline injection. Rats were sacrificed with ketamin on 1st, 7th, 14th and 21st days and knee joints were removed. Obtained tissue samples were decalcified and were dyed with Hematoxylin-eosin and Masson’s trichrome stain and examined by light microscopy for the presence of inflammation in periarticular area and synovia. Results: Congestion of synovial veins and perivascular cell infiltration were observed in tramadol group on days 1 and 7 (P < 0.05. The inflammation process was replaced by fibrosis on day 14 and fibrosis was significantly decreased on day 21. Conclusion: Intra articular tramadol should be used cautiously, keeping in mind that it may cause synovial inflammation in early phases and fibrosis in late phases. J Clin Exp Invest 2015; 6 (4: 337-342

  6. The Effect of Preoperative Intra-Articular Methylprednisolone on Pain after TKA

    DEFF Research Database (Denmark)

    Luna, Iben E; Kehlet, Henrik; Jensen, Claus M

    2017-01-01

    postoperatively. Secondary outcomes included pain at 48 hours, during the first 14 days, sensitization (quantitative sensory testing with pressure pain threshold and wind up from temporal summation) and inflammatory changes (systemic CRP, intra-articular IL-6). No difference in proportion of patients...... with moderate/severe pain was found between MP/placebo groups at 24 hours (67% and 74%, χ(2)=0.2, p=0.63, odds ratio 0.7, 95% CI 0.2 to 2.8) or at 48 hours (57% and 68%, χ(2)=0.5, p=0.46, odds ratio 0.6 95% CI 0.2 to 2.3), and no difference between groups in postoperative sensitization was found (p > 0......In a randomized, double-blinded, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered one week prior to total knee arthroplasty (TKA). Forty-eight patients with high pain...

  7. Stem cells and other innovative intra-articular therapies for osteoarthritis: what does the future hold?

    Directory of Open Access Journals (Sweden)

    Singh Jasvinder A

    2012-05-01

    Full Text Available Abstract Osteoarthritis (OA, the most common type of arthritis in the world, is associated with suffering due to pain, productivity loss, decreased mobility and quality of life. Systemic therapies available for OA are mostly symptom modifying and have potential gastrointestinal, renal, hepatic, and cardiac side effects. BMC Musculoskeletal Disorders recently published a study showing evidence of reparative effects demonstrated by homing of intra-articularly injected autologous bone marrow stem cells in damaged cartilage in an animal model of OA, along with clinical and radiographic benefit. This finding adds to the growing literature showing the potential benefit of intra-articular (IA bone marrow stem cells. Other emerging potential IA therapies include IL-1 receptor antagonists, conditioned autologous serum, botulinum toxin, and bone morphogenetic protein-7. For each of these therapies, trial data in humans have been published, but more studies are needed to establish that they are safe and effective. Several additional promising new OA treatments are on the horizon, but challenges remain to finding safe and effective local and systemic therapies for OA. Please see related article: http://www.biomedcentral.com/1471-2474/12/259

  8. Intra-articular synovial sarcoma treated with a transfemoral amputation: a case report and review of the literature.

    Science.gov (United States)

    Gresswell, Steven D; Corsini, Anthony A; Balsamo, Luke H; Miles, Edward F

    2013-08-01

    A case of monophasic intra-articular synovial sarcoma in the right knee of a 39-year-old active duty serviceman treated with a transfemoral amputation is presented. The patient was evaluated for right knee pain and fullness. After further workup, the patient underwent computed tomography guided biopsy, with the tissue specimen consistent with intra-articular synovial sarcoma. The patient elected for a transfemoral amputation rather than limb or joint-sparing surgery. The gross specimen measured 3.5 × 3.0 × 1.7 cm in the posteromedial knee. No metastatic lesions were seen on positron emission tomography-computed tomography. Chemotherapy and radiation therapy have not been utilized. The transfemoral amputation adds to the uniqueness of this report and is discussed with a review of the multimodality treatment toward intra-articular synovial sarcoma in prior published literature.

  9. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Dong Ho; Choi, Sun Seob; Kim, Soo Jin; Lih, Wang [Dong-A University Medical Center, Busan (Korea, Republic of)

    2015-02-15

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

  10. Horizontal intra-articular patellar dislocation resulting in quadriceps avulsion and medial patellofemoral ligament tear: a case report.

    Science.gov (United States)

    Kramer, Dennis E; Simoni, Michael K

    2013-07-01

    Intra-articular patellar dislocations are rare. We present a 13-year-old boy who sustained a complete horizontal intra-articular patellar dislocation following blunt trauma to the flexed knee. Closed reduction was unsuccessful and open reduction indicated a repairable quadriceps avulsion and medial patellofemoral ligament tear. He is the youngest patient to sustain a quadriceps rupture and the only patient to sustain a medial patellofemoral ligament tear to date. His flexed knee and the horizontally positioned patella (seen on lateral radiograph) were indicative of a complete rotational injury with extensor mechanism involvement. Open reduction allowed for the repair of both injuries and a favorable outcome.

  11. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome.

    Science.gov (United States)

    Ha, Dong-Ho; Choi, Sunseob; Kim, Soo-Jin; Lih, Wang

    2015-01-01

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

  12. Operative management of closed intra-articular fractures of distal end of humerus in adults.

    Science.gov (United States)

    Bhattacharyya, Arunangsu; Jha, Amrish Kumar; Chatterjee, Debdutta; Ghosh, Bappaditya; Roy, Sandip Kumar; Banerjee, Debabrata

    2011-06-01

    This is a study of 60 patients with mean age of 30 years having intra-articular fracture of distal humerus of type C (AO classification). We treated these fractures by open reduction and internal fixation through transolecranon approach. Mean duration of operative time with that of injury was 10 days. In all the cases 1st the intracondylar fracture was fixed followed by reconstruction and stabilisation of medial and lateral pillar by 1/3 tubular plate and 3.5 mm dynamic compressent plate (DCP) or recon plate respectively. Minimum follow-up was of 1 year duration with average follow-up of 3 years. We could achieve 100% union with mean range of movement at the and of 1 year was 20 degree to 110 degree. Two fractures had delayed union, 5 patients had skin complications for which extended dressing was required. None of these patients required SSG or secondary suture.

  13. Combined Intra-Articular and Intravenous Tranexamic Acid Reduces Blood Loss in Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Nielsen, Christian Skovgaard; Jans, Øivind; Ørsnes, Thue;

    2016-01-01

    BACKGROUND: In total knee arthroplasty, both intravenous (IV) and intra-articular (IA) administration of tranexamic acid (TXA) have been shown to reduce blood loss in several randomized controlled trials, although routine use of systemic TXA is considerably more common. However, to our knowledge......-only administration of TXA. METHODS: In this randomized, double-blind, placebo-controlled trial, 60 patients scheduled for total knee arthroplasty were randomized to one of two interventions. The TXA IV and IA group received combined administration of TXA consisting of 1 g administered intravenously preoperatively......, the additional benefit of IA administration of TXA when combined with IV administration, without the use of a tourniquet, has not been previously investigated. Thus, the aim of this study was to evaluate whether combined IV and IA administration of TXA reduced total blood loss compared with IV...

  14. Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia.

    LENUS (Irish Health Repository)

    Leonard, M

    2012-02-01

    The pilon fracture is a complex injury. The purpose of this study was to evaluate the outcome of minimally invasive techniques in management of these injuries. This was a prospective study of closed AO type C2 and C3 fractures managed by early (<36 hours) minimally invasive surgical intervention and physiotherapist led rehabilitation. Thirty patients with 32 intra-articular distal tibial fractures were treated by the senior surgeon (GK). Our aim was to record the outcome and all complications with a minimum two year follow-up. There were two superficial wound infections. One patient developed a non-union which required a formal open procedure. Another patient was symptomatic from a palpable plate inferiorly. An excellent AOFAS result was obtained in 83% (20\\/24) of the patients. Early minimally invasive reduction and fixation of complex high velocity pilon fractures gave very satisfactory results at a minimum of two years follow-up.

  15. Controversies in the management of intra-articular fractures of distal humerus in adults

    Directory of Open Access Journals (Sweden)

    Sudhir Babhulkar

    2011-01-01

    Full Text Available Background: The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra-articular distal humerus fractures (C2 and C3 in adults. Severe comminution, bone loss, and osteoporosis at the site of distal articular fractures of humerus often lead to unsatisfactory results due to inadequate fixation. We hereby report the outcome of a series of intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature. Materials and Methods: One hundred and eighty-four patients of intra-articular fractures of distal humerus (C2 and C3 were operated by posterior transolecranon approach between January 1980 and December 2008. Initially, in the first part Chevron intra-articular osteotomy (n=108 was performed out of which 94 have been published in another publication. In later second part (1993 onward, extra-articular olecranon osteotomy (n=76 was routinely performed. Both columns were stably fixed by orthogonal methods; (n=174 however, during the last 2 years, in 10 patients with severe comminution with bone loss, stabilization was achieved by parallel plating. The osteotomy was routinely stabilized by tension band wiring with two parallel K-wires introduced up to the anterior ulnar cortex. The results were evaluated by the staging system of Caja et al. at a minimum follow-up of 2 years. Results: In the first part of the study (n=94, there was delayed union in 4% (n=4, with the fracture taking more than 20 weeks for union. There was delayed union of ulnar osteotomy (n=3 and failure of one tension band wiring, requiring revision. Some loss of motion was seen in 20% of

  16. Fibroma aponeurótico calcificante intra articular. Presentación de un caso.

    Directory of Open Access Journals (Sweden)

    José Ramón Hernández Puerto

    2010-02-01

    Full Text Available El fibroma aponeurótico juvenil es un tumor infrecuente del tejido blando que se localiza con mayor periodicidad en niños y adolescentes en la región distal de las extremidades, aunque se reportan casos en otras edades y localización. Se presenta un paciente de 18 años de edad, masculino con fibroma aponeurótico calcificante en la rodilla derecha intra articular, con una localización poco común. El diagnóstico se realizó por exéresis quirúrgica del tumor. Se hace referencia al cuadro clínico, terapéutica efectuada y seguimiento por 3 años. Se revisó literatura actualizada referente al tema. Por ser un caso infrecuente se decide su publicación.

  17. Reconstruction of the anterior cruciate ligament: comparison of analgesia using intrathecal morphine, intra-articular morphine and intra-articular levobupivacaine

    Directory of Open Access Journals (Sweden)

    Leandro Queiroz Pinheiro

    2015-06-01

    Full Text Available OBJECTIVE: To compare the analgesic effect of intra-articular administration of morphine and levobupivacaine (separately or in combination with intrathecal administration of morphine in patients undergoing anterior cruciate ligament (ACL reconstruction using autologous grafts from the patellar tendon.METHODS: This was a retrospective analysis on data gathered from the medical files of 60 patients aged 20 to 50 years who underwent knee video arthroscopy for ACL reconstruction. The patients were divided into four groups of 15 individuals (A, B, C and D according to the agent administered into the joint and around the incision: 20 mL of saline solution with 5 mg of morphine in A; 20 mL of 0.5% levobupivacaine solution in B; 10 mL of solution with 2.5 mg of morphine plus 10 mL of 0.5% levobupivacaine solution in C; and morphine administered intrathecally in D.RESULTS: All the groups presented low pain scores during the first 12 h after the surgery. Groups B and C presented significantly greater pain scores than shown by group D (control, 24 h after the surgery. There was no statistical difference in pain scores between group A and group D.CONCLUSION: The patients in group A presented analgesia comparable to that of the patients in group D, whereas the procedure of group C was no capable of reproducing the analgesic effect observed in group D, as observed 24 h after the surgery. Further studies are needed in order to show the exact mechanism of action, along with the ideal dose and concentration for applying opioids to joints.

  18. Intra-articular etanercept treatment for severe diffuse pigmented villonodular knee synovitis

    Directory of Open Access Journals (Sweden)

    C. Giacometti

    2011-09-01

    Full Text Available Pigmented villonodular synovitis (PVNS is a rare pre-malignant disease that require aggressive treatment as surgical synovectomy, eventually followed by radiosynovectomy. Nevertheless, the disease often reoccurs after these treatments. To determine the safety and efficacy of intra-articular (IA TNF-a blockade with etanercept (ETN, before extended arthroscopic synovectomy, in severe PVNS of the knee, two patients, (a 26-year-old man with B27+ undifferentiated spondylarthropathy and a 32-year-old femal with seronegative olygoarthritis, affected by diffuse knee PVNS (diagnosis made by histological examination, resistant to IA corticosteroid injections and to repeated arthroscopic synovectomy, were submitted, after protocol approval by human research committee and patient’s written informed consent to intra-articular etanercept (IA-ETN treatment with a different dosage schedule: 12.5 mg weekly IA-ETN injection for 4 weeks, followed by extended arthroscopic synovectomy and of 25 mg IA-ETN injection for 4 weeks, respectively. Previous DMARDs treatment was continued in stable appropriate doses. Any adverse events were recorded throughout the study. The following parameters were considered as clinical endpoints: 1 Knee Joint Index (KJI: range 0-14; 2 Thompson index (THI: range 0-9 At the study entry and at the end of follow-up, high frequency ultrasound grey scale synovial thickening (US-ST was also assessed. No adverse events were observed due to IA-ETN and to arthroscopic synovectomy. Marked improvement of knee disease activity over time and sustained functional recover was obtained. US-ST evaluation before treatment initiation and at the end of follow-up confirmed the regression of knee joint synovial proliferation

  19. COMPARISON OF ANALGESIC EFFECT OF INTRA-ARTICULAR BUPRENORPHINE AND MORPHINE FOLLOWING ARTHROSCOPIC SURGERY OF KNEE

    Directory of Open Access Journals (Sweden)

    Shashidhar Gowdra Sugandarajappa

    2016-07-01

    Full Text Available BACKGROUND AND AIMS Pain after orthopaedic surgery depends on the site and extent of surgery and the preoperative use of analgesics by the patient. Arthroscopic procedures are routinely performed on outpatient basis and have spared patients large incisions and decreased morbidity compared with open incisions, but has not eliminated pain. At present several techniques are available to treat pain following arthroscopic surgeries; these include the use of opioids, local anaesthetics, NSAIDs, corticosteroids, clonidine and cryotherapy. Here, we compared the analgesic effect of intra-articular administration of morphine, buprenorphine and placebo following arthroscopic surgery of knee. METHODS A prospective, randomised, placebo-controlled double-blind comparative study conducted in 60 patients of either sex who underwent arthroscopic surgery of knee; between the age group of 18 and 65 years and of ASA class I and II physical status were included in the study. Patients were randomly assigned equally to one of the 3 groups of 20 each by a sealed envelope method. The groups were Group A - Patients receiving IA Buprenorphine 100 mcg in 20 mL normal saline. Group B - Patients receiving IA Morphine 3 mg in 20 mL normal saline. Group C - Patients receiving IA 20 mL normal saline as placebo. Parameters monitored were degree of analgesia along with haemodynamic parameters and side effects. Data were analysed using student’s t-test for continuous variables and Chi-Square test. RESULTS We found that 100 mcg buprenorphine when injected intra-articularly produced good and comparable postoperative pain control and reduced supplementary analgesic requirement when compared to other groups. CONCLUSION In summary, this study demonstrated that for eight hours postoperatively 100 mcg buprenorphine provided superior postoperative analgesia to that of 3 mg morphine

  20. Comparing the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery.

    Science.gov (United States)

    Jazayeri, Seyed Mohammad; Mosaffa, Faramarz; Abbasian, Mohammadreza; Hosseinzadeh, Hamid Reza

    2012-01-01

    Intra-articular analgesia is a pain reliever that is frequently administered following arthroscopic knee surgery. The purpose of this study was to compare the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery. For this randomized double blinded clinical trial, 132 patients undergoing minor arthroscopic knee surgery were randomly assigned to receive either; 5 mg morphine or 50 mg tramadol intra-articularly. Pain was evaluated by means of the verbal pain rating score (VRS) preoperatively (at rest and on movement of the knee joint) and postoperatively at 0, 1, 2, 3, 4, 6, 12 and 24 hours. Meanwhile, the time of the first analgesic request and need for supplemental analgesic were also recorded. There was no statistically significant difference in VRS scoring between the two groups during the preoperative period either at rest or on knee movement. Meanwhile, VRS scores did not differ significantly between the morphine and tramadol treated groups postoperatively, except for in the one-hour post-operative scores in which the tramadol-treated group experienced less pain (P tramadol prescribed subjects (P intra-articularly administered morphine and tramadol following minor arthroscopic knee surgeries with a maximum effect 6 hours post injection.

  1. Functional outcome and result of intra-articular injection hyaluronic acid in treatment of osteoarthritis of knee

    Directory of Open Access Journals (Sweden)

    Deepak Chaudhary

    2016-12-01

    Conclusions: Visco-supplementation with intra articular injection hyaluronic acid should be considered as safe and effective modality of treatment in selected group of mild to moderate osteoarthritis before mechanical changes takes place and patient complies with regular exercise, weight control and postural habits. [Int J Res Med Sci 2016; 4(12.000: 5204-5208

  2. Intra-articular delivery of glucosamine for treatment of experimental osteoarthritis created by a medial meniscectomy in a rat model

    NARCIS (Netherlands)

    Gibson, Matthew; Li, Hanwei; Coburn, Jeannine; Moroni, Lorenzo; Nahas, Zayna; Bingham, Clifford; Yarema, Kevin; Elisseeff, Jennifer

    2014-01-01

    Glucosamine (GlcN) is a naturally occurring amino-monosaccharide with putative chondroprotective activity. Optimum responses to GlcN are achieved at concentrations which are impractical with oral dosing. Intra-articular delivery of a bolus dose of GlcN is one way to overcome these pharmacokinetic ob

  3. Comparison of MR arthrography with arthroscopy of the hip for the assessment of intra-articular loose bodies

    Energy Technology Data Exchange (ETDEWEB)

    Neckers, Andrew C. [Columbus Radiology Corporation, Columbus, OH (United States); Polster, Joshua M.; Winalski, Carl S.; Sundaram, M. [The Cleveland Clinic Foundation, Diagnostic Radiology/A21, Cleveland, OH (United States); Krebs, Viktor E. [The Cleveland Clinic Foundation, Department of Orthopedic Surgery, Cleveland, OH (United States)

    2007-10-15

    To assess the specificity and sensitivity of MR arthrography of the hip in comparison with arthroscopy for the evaluation of intra-articular loose bodies. Over a 3-year period, 81 consecutive patients underwent a total of 82 hip arthroscopies by a single orthopedic surgeon for intractable hip pain. Of the 82 arthroscopies, 70 had pre-operative MR arthrograms. Of these, 57 were available for retrospective review, after which they were compared with the operative notes of the subsequent arthroscopies. Of 82 arthroscopies 16 (20%) demonstrated intra-articular loose bodies, while, in the study group, nine of 57 had loose bodies (16%). There was a total of seven discordant cases (five false negatives and two false positives). The sensitivity of MR arthrography for detection of intra-articular loose bodies was 44%, while the specificity was 96%. While the specificity of MR arthrography for the detection of intra-articular loose bodies was high (96%), the sensitivity was not nearly as good (44%). (orig.)

  4. Intra-articular methotrexate associated to lipid nanoemulsions: anti-inflammatory effect upon antigen-induced arthritis

    Directory of Open Access Journals (Sweden)

    Mello SB

    2013-02-01

    Full Text Available Suzana BV Mello,1 Elaine R Tavares,2 Adriana Bulgarelli,2 Eloisa Bonfá,1 Raul C Maranhão2,31Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; 2Lipid Metabolism Laboratory, the Heart Institute (INCOR of the Medical School Hospital, São Paulo, Brazil; 3Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, BrazilObjective: Commercial methotrexate formulations (MTX have poor anti-inflammatory action for intra-articular treatment of rheumatoid arthritis. Our aim was to investigate whether an association between methotrexate and lipidic nanoemulsions (LDE could improve MTX intra-articular action.Methods: For its association to LDE, MTX was previously esterified with dodecyl bromide. LDE-MTX was prepared by high pressure homogenization. Antigen-induced arthritis (AIA was achieved in rabbits sensitized with methylated bovine serum albumin, and the rabbits were subsequently intra-articularly injected with the antigen. Twenty-four hours after AIA induction, groups of four to nine rabbits were intra-articularly injected with increasing doses (0.0625–0.5 µmol/kg of LDE-MTX, and were compared to treatment with 0.5 µmol/kg commercial MTX, LDE alone, and saline (controls. Synovial fluid was collected 48 hours after AIA induction for analysis of protein leakage and cell content. Synovial membranes were collected for histopathology. Uptake of LDE labeled with 3H-cholesteryl ether by the synovial tissue was also determined.Results: Uptake of radioactive LDE by arthritic joints was 2.5-fold greater than by normal joints. Treatment with intra-articular LDE-MTX elicited a clear dose response pattern by reducing the synovial leukocyte infiltrate (P = 0.004 and protein leakage (P = 0.032 when compared with arthritic non-treated joints. In contrast, the intra-articular injection of commercial MTX and LDE did not reduce leukocyte infiltrate or protein leakage. Toxicity to treatment was not observed

  5. Comparison of intra-articular tenoxicam and oral tenoxicam for pain and physical functioning in osteoarthritis of the knee.

    Science.gov (United States)

    Unlu, Zeliha; Ay, Kamuran; Tuzun, Cigdem

    2006-02-01

    This study was designed to compare efficacy of local administration of a nonsteroidal anti-inflammatory drug with systemic administration in patients with osteoarthritis (OA) of the knee. For this purpose, intra-articular tenoxicam and oral tenoxicam therapies were applied and the improvement in control of pain and physical functioning were evaluated. A total of 69 patients with OA of the knee were randomized into three groups. Patients in the first group (41 knees of 23 patients) were treated for 1-3 weeks with once weekly intra-articular injection of tenoxicam 20 mg. Patients in the second group (45 knees of 26 patients) received 20 mg/day tenoxicam orally for 3 weeks and only physical exercises were applied to the third group (32 knees of 20 patients). Physical examination of the knee joint, Western Ontario and McMaster Universities Index and the Lequesne Algofunctional Index were used as outcome measurements at baseline, and the 1st, 3rd and 6th months. More significant improvement in pain and disability parameters was observed in groups 1 and 2 than group 3 compared with baseline measures. Among the patients' responses a few of the differences were statistically significant, more in favour of tenoxicam, and tenoxicam seemed to be superior to exercise alone especially at the final evaluation. There was no significant difference between the oral and intra-articular tenoxicam treatment regimens. The results of this study showed that treatment of OA of the knee with intra-articular tenoxicam is as effective as that with oral tenoxicam. It can be thought that intra-articular administration can be preferred to oral therapy due to minimal possibility of systemic side effects.

  6. Corrective osteotomy assisted by computer simulation for a malunited intra-articular fracture of the distal humerus: two case reports.

    Science.gov (United States)

    Oura, Keiichiro; Kunihiro, Oka; Okada, Kiyoshi; Tanaka, Hiroyuki; Murase, Tsuyoshi

    2016-11-01

    Intra-articular malunion after fractures of the distal humerus can cause pain, stiffness and, consequently, osteoarthritis in the long run. Although corrective osteotomy for intra-articular malunion has been reported, it is still technically challenging and needs careful preoperative evaluation and planning. Here, we present two cases of corrective osteotomy assisted by preoperative three-dimensional (3-D) computer simulation. We present two cases of malunited intra-articular fracture of the distal humerus, which was treated by corrective osteotomy with the aid of 3-D computer simulation. One case was initially treated with closed reduction and pinning, and the other was initially treated with open reduction and internal fixation. Both of them had pain and severely limited range of motion in the elbow due to intra-articular malunion. 3-D models of the bilateral humeri were created on a computer using computed tomography (CT) data. The deformity was analyzed by superimposing the model of the affected humerus on the mirrored model of the contralateral normal humerus. Osteotomy, reduction and fixation were simulated preoperatively on the computer. The actual surgery was performed exactly according to the preoperative 3-D computer simulation. The operative procedures were performed successfully according to the computer simulation. Range-of-motion exercises started 3 days and immediately after the surgery in cases 1 and 2, respectively. Two years after surgery, there were no complaints of pain or instability. The range of elbow motion was 5°-140° and 15°-125° in cases 1 and 2, respectively. Plain radiographs and CT scans showed good reconstruction of the articular surface. 3-D computer simulations can be useful in preoperative planning for intra-articular corrective osteotomy for complex malunion of the distal humerus.

  7. Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Rezasoltani Z

    2017-05-01

    Full Text Available Zahra Rezasoltani,1 Mehrdad Taheri,2 Morteza Kazempour Mofrad,3 Seyed Amir Mohajerani2 1Department of Physical Medicine and Rehabilitation, AJA University of Medical Sciences, 2Department of Anesthesiology and Pain Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, 3Department of Anesthesiology and Pain Medicine, AJA University of Medical Sciences, Tehran, Iran Background: Osteoarthritis (OA is a degenerative disease that can lead to painful and dysfunctional joints. Prolotherapy involves using injections to produce functional restoration of the soft tissues of the joint. Intra-articular injections are controversial because of the introduction of needles into the articular capsule.Objectives: To compare the effect of periarticular versus intra-articular prolotherapy on pain and disability in patients with knee OA.Study design: Randomized double-blind controlled clinical trial.Setting: Single center, university hospital (Imam Hossein Hospital, Tehran, Iran.Methods: A total of 104 patients with chronic knee OA were enrolled. In the intra-articular group, 8 mL of 10% dextrose and 2 mL of 2% lidocaine were injected. Injections were repeated at 1 and 2 weeks after the first injection. In the periarticular group, 5 mL of 20% dextrose and 5 mL of 1% lidocaine were injected subcutaneously at 4 points in the periarticular area. Pain and disability, as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, were recorded at each follow-up visit at 1, 2, 3, 4, and 5 months post-injection.Results: The visual analog scale score was significantly lower in the periarticular compared with the intra-articular group at the 2-, 3-, 4-, and 5-month visits but not at 1 month. Morning stiffness and difficulty in rising from sitting were improved in both groups and were not significantly different in the peri- and intra-articular groups. Pain, joint locking, and limitation scores were all improved in both

  8. Increased localized delivery of piroxicam by cationic nanoparticles after intra-articular injection

    Directory of Open Access Journals (Sweden)

    Kim SR

    2016-11-01

    Full Text Available Sung Rae Kim,1 Myoung Jin Ho,2 Sang Hyun Kim,1 Ha Ra Cho,2 Han Sol Kim,2 Yong Seok Choi,2 Young Wook Choi,1 Myung Joo Kang2 1Division of Pharmaceutical Sciences, College of Pharmacy, Chung-Ang University, Seoul, 2College of Pharmacy, Dankook University, Cheonan, Chungnam, South Korea Abstract: Piroxicam (PRX, a potent nonsteroidal anti-inflammatory drug, is prescribed to relieve postoperative and/or chronic joint pain. However, its oral administration often results in serious gastrointestinal adverse effects including duodenal ulceration. Thus, a novel cationic nanoparticle (NP was explored to minimize the systemic exposure and increase the retention time of PRX in the joint after intra-articular (IA injection, by forming micrometer-sized electrostatic clusters with endogenous hyaluronic acid (HA in the synovial cavity. PRX-loaded NPs consisting of poly(lactic-co-glycolic acid, Eudragit RL, and polyvinyl alcohol were constructed with the following characteristics: particle size of 220 nm, zeta potential of 11.5 mV in phosphate-buffered saline, and loading amount of 4.0% (w/w of PRX. In optical and hyperspectral observations, the cationic NPs formed more than 50 µm-sized aggregates with HA, which was larger than the intercellular gaps between synoviocytes. In an in vivo pharmacokinetic study in rats, area under the plasma concentration–time curve (AUC0–24 h and maximum plasma concentration (Cmax of PRX after IA injection of the cationic NPs were <70% (P<0.05 and 60% (P<0.05, respectively, compared to those obtained from drug solution. Moreover, the drug concentration in joint tissue 24 h after dosing with the cationic NPs was 3.2-fold (P<0.05 and 1.8-fold (P<0.05 higher than that from drug solution and neutrally charged NPs, respectively. Therefore, we recommend the IA cationic NP therapy as an effective alternative to traditional oral therapy with PRX, as it increases drug retention selectively in the joint. Keywords: piroxicam

  9. Intra-Articular Osteotomy for Genu Valgum in the Knee with a Lateral Compartment Deficiency.

    Science.gov (United States)

    Feldman, David S; Goldstein, Rachel Y; Kurland, Adam M; Sheikh Taha, Abdel Majid

    2016-01-20

    A deficiency of the lateral compartment of the knee, often in the setting of skeletal dysplasia, is an intra-articular deformity resulting in genu valgum. Historically, this abnormality has been treated using an extra-articular approach. Lateral hypoplasia of the femoral condyle can be treated with advancement of the lateral femoral condyle without creating a secondary deformity. The purpose of this study was to present the technique and results of lateral condylar advancement, with or without tibial hemiplateau elevation, in patients with intra-articular valgus deformity secondary to skeletal dysplasia. A retrospective review of the cases of five patients, from seven to twenty-one years old, with skeletal dysplasia and unilateral or bilateral severe genu valgum deformity was performed. For all patients, the etiology of the deformity was a deficient lateral compartment of the knee-that is, lateral femoral condylar hypoplasia with or without concomitant lateral hemiplateau depression. Lateral femoral condylar advancement with or without lateral tibial hemiplateau elevation was performed in eight knees. The average tibiofemoral angle was 34.7° of valgus preoperatively and improved to 9.4° of valgus at the most recent follow-up. The average length of follow-up was 2.9 years (range, 1.0 to 5.2 years). The average range of motion at the time of final follow-up was an arc of 108° starting from full extension. All osteotomies healed uneventfully. All five patients were satisfied with both the cosmetic appearance and the function of the involved limb and were able to walk without assistive devices. In patients with a deficient lateral compartment of the knee, lateral femoral condylar advancement with or without hemiplateau elevation allowed correction of severe genu valgum without the creation of an oblique joint line. This technique allows correction of the overall mechanical axis, restoring both function and the cosmetic appearance of the limb. Therapeutic Level IV

  10. The ultrastructure of the intra-articular disc of the temporomandibular joint, with special reference to fibrocartilage.

    Science.gov (United States)

    Berkovitz, B K; Pacy, J

    1999-01-01

    Cells in the intra-articular disc of the temporomandibular joint of the rat, guinea pig, rabbit, ferret, marmoset and sheep were studied at the ultrastructural level. The cells were generally rounded in outline and possessed moderate amounts of roughened endoplasmic reticulum and other organelles associated with protein synthesis and secretion. No intracellular collagen profiles were observed. Many of the cells possessed conspicuous amounts of microfilamentous material. Cell membranes in the rat, guinea pig, rabbit, ferret and sheep were closely applied to the collagen fibrils of the extracellular matrix. Occasionally in these animals, a narrow, irregular space containing microfilamentous material surrounded the cell membrane. Many cells in the marmoset differed from this description in being completely surrounded by an obvious pericellular matrix devoid of collagen fibrils and being comprised of microfilamentous material embedded in an amorphous ground substance. These chondrocyte-like cells in the intra-articular disc of the marmoset differed from chondrocytes in hyaline cartilage by lacking a pericellular capsule.

  11. An outcomes assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles.

    LENUS (Irish Health Repository)

    Kennedy, J G

    2012-02-03

    Thirty-six patients with intra-articular displaced calcaneal fractures were examined to determine both physician- and patient-based outcomes. Three groups were selected. Group A was treated with open reduction and internal fixation, group B was treated with open reduction internal fixation and supplemental bone graft augmentation and the patients in group C were treated with plaster cast immobilisation and no formal operative treatment. All cohorts were well matched for age, sex and severity of injury. Patients were evaluated using both the American Foot and Ankle Society Scoring System (AFASS) and the short form 36 (SF-36). Minimum time to follow up was 4 years. No significant difference was observed between the three groups with regards to pain and functional outcomes using the AFASS score (P>0.05). No difference was observed between the three groups using the SF-36 score (P>0.1). A statistically significant difference was observed, using radiological criteria, between both groups A and B when compared to the non-operative group C. The rate of wound infection in groups A and B was 31.5%. No correlation was found between the SF-36 score and the AFASS score. No correlation was found between the radiological score and either the SF-36 or the AFASS score. This study has found that the conservative treatment of calcaneal fractures can produce satisfactory outcomes with lower morbidity than surgically treated fractures.

  12. Analgesic effect of intra-articular tramadol compared with morphine after arthroscopic knee surgery.

    Science.gov (United States)

    Akinci, Seda B; Saricaoğlu, Fatma; Atay, Ozgur Ahmet; Doral, Mahmut Nedim; Kanbak, Meral

    2005-09-01

    The aim of the study was to compare the analgesic effect of 5 mg intra-articular (IA) morphine with 50 mg IA tramadol. Prospective double-blind randomized trial. Seventy-five patients having elective arthroscopic surgery of the knee were randomized to receive IA tramadol 50 mg (tramadol group), IA morphine 5 mg (morphine group), or IA normal saline (control group), in equivalent volumes (20 mL). The tourniquet was released 10 minutes after analgesic administration. Verbal pain rating score between 0 and 10 (VRS), supplemental analgesic requirements, and incidence of side effects were recorded postoperatively. Results are given as (median [5-95 percentiles]). The control group had a significantly shorter time to first analgesic request (25 min [15-55]) than morphine group, (34 min [15-158], P tramadol group, (33 min [17-728], P tramadol group (VRS 0 [0-9], P = .002). These treatment benefits were especially prominent in the patients who had meniscectomy or in the subgroup of patients with more than 6 months of preoperative pain. There was no statistical difference between the tramadol and morphine groups in the time to first analgesia, postoperative pain scores after arrival at the postanesthesia care unit, consumption of rescue analgesic, or side effects. We conclude that 50 mg IA tramadol provides analgesia equivalent to 5 mg IA morphine. Level II, randomized controlled trial that shows no significant difference and lacks narrow confidence intervals.

  13. Coralline hydroxyapatite is a suitable bone graft substitute in an intra-articular goat defect model.

    Science.gov (United States)

    Koëter, S; Tigchelaar, S J; Farla, P; Driessen, L; van Kampen, A; Buma, P

    2009-07-01

    Intra-articular defects can be filled with an autologous bone graft taken from the iliac crest. This can be indicated after trauma or following correcting osteotomy. Patients may encounter donor site morbidity after this procedure. In this in vivo study, we studied if coralline hydroxyapatite (CHA) is a suitable material to replace autologous bone graft to fill a defect in the femoral trochlea of goats. CHA did not evoke any negative reaction in the synovium, and the articular cartilage was comparable to controls. In the bone graft group, we found scattered areas of (enchondral formed) bone. Most bone graft had been resorbed or remodeled, and the scarce remnants were incorporated into new bone. Resorption of CHA was limited or absent and most CHA was surrounded by new bone. In areas with fragmented CHA, close to the joint surface, numerous giant cells were found. The study shows that in this animal model, CHA inserted in a defect that directly communicates with the joint space incorporates into bone. This study did not show any negative effects of CHA in a joint environment.

  14. Intra-articular infusion: a direct approach to treatment of infected total knee arthroplasty.

    Science.gov (United States)

    Whiteside, L A; Roy, M E; Nayfeh, T A

    2016-01-01

    Bactericidal levels of antibiotics are difficult to achieve in infected total joint arthroplasty when intravenous antibiotics or antibiotic-loaded cement spacers are used, but intra-articular (IA) delivery of antibiotics has been effective in several studies. This paper describes a protocol for IA delivery of antibiotics in infected knee arthroplasty, and summarises the results of a pharmacokinetic study and two clinical follow-up studies of especially difficult groups: methicillin-resistant Staphylococcus aureus and failed two-stage revision. In the pharmacokinetic study, the mean synovial vancomycin peak level was 9242 (3956 to 32 150; sd 7608 μg/mL) among the 11 patients studied. Serum trough level ranged from 4.2 to 25.2 μg/mL (mean, 12.3 μg/mL; average of 9.6% of the joint trough value), which exceeded minimal inhibitory concentration. The success rate exceeded 95% in the two clinical groups. IA delivery of antibiotics is shown to be safe and effective, and is now the first option for treatment of infected total joint arthroplasty in our institution.

  15. Protective effect of low dose intra-articular cadmium on inflammation and joint destruction in arthritis.

    Science.gov (United States)

    Bonaventura, Paola; Courbon, Guillaume; Lamboux, Aline; Lavocat, Fabien; Marotte, Hubert; Albarède, Francis; Miossec, Pierre

    2017-05-25

    Synovium hyperplasia characterizes joint diseases, such as rheumatoid arthritis (RA). The cytotoxic effect of low-dose Cadmium (Cd) was tested in vitro and ex vivo on synoviocytes, the mesenchymal key effector cells of inflammation and proliferation in arthritis. The anti-inflammatory and anti-proliferative effects of Cd were tested in vivo by intra-articular injection in the adjuvant induced arthritis rat joints, where the clinical scores and the consequences of arthritis were evaluated. Cell death through apoptosis was highly induced by Cd in inflammatory synoviocytes (80% reduction of cell viability, p < 0.01). TNF plus IL-17 cytokine combination induced a two-fold increase of Cd cell content by enhancing the ZIP-8 importer and the MT-1 homeostasis regulator expression. Addition of Cd reduced IL-6 production in TNF plus IL-17-activated synoviocytes (up to 83%, p < 0.05) and in ex-vivo synovium biopsies (up to 94%, p < 0.01). Cd-injection in rat joints improved arthritis, reducing clinical scores (arthritic score reduced from 4 to 2, p < 0.01), inflammatory cell recruitment (up to 50%, p < 0.01) and protecting from bone/cartilage destruction. This proof of concept study is supported by the limited Cd spread in body reservoirs, with low-dose Cd providing a safe risk/benefit ratio, without toxic effects on other cell types and organs.

  16. An intra-articular salmon calcitonin-based nanocomplex reduces experimental inflammatory arthritis.

    Science.gov (United States)

    Ryan, Sinéad M; McMorrow, Jason; Umerska, Anita; Patel, Hetal B; Kornerup, Kristin N; Tajber, Lidia; Murphy, Evelyn P; Perretti, Mauro; Corrigan, Owen I; Brayden, David J

    2013-04-28

    Prolonged inappropriate inflammatory responses contribute to the pathogenesis of rheumatoid arthritis (RA) and to aspects of osteoarthritis (OA). The orphan nuclear receptor, NR4A2, is a key regulator and potential biomarker for inflammation and represents a potentially valuable therapeutic target. Both salmon calcitonin (sCT) and hyaluronic acid (HA) attenuated activated mRNA expression of NR4A1, NR4A2, NR4A3, and matrix metalloproteinases (MMPs) 1, 3 and 13 in three human cell lines: SW1353 chondrocytes, U937 and THP-1 monocytes. Ad-mixtures of sCT and HA further down-regulated expression of NR4A2 compared to either agent alone at specific concentrations, hence the rationale for their formulation in nanocomplexes (NPs) using chitosan. The sCT released from NP stimulated cAMP production in human T47D breast cancer cells expressing sCT receptors. When NP were injected by the intra-articular (I.A.) route to the mouse knee during on-going inflammatory arthritis of the K/BxN serum transfer model, joint inflammation was reduced together with NR4A2 expression, and local bone architecture was preserved. These data highlight remarkable anti-inflammatory effects of sCT and HA at the level of reducing NR4A2 mRNA expression in vitro. Combining them in NP elicits anti-arthritic effects in vivo following I.A. delivery.

  17. Blockade of intra-articular adrenergic receptors increases analgesic demands for pain relief after knee surgery.

    Science.gov (United States)

    Kager, Ingo; Mousa, Shaaban A; Sieper, Joachim; Stein, Christoph; Pipam, W; Likar, Rudolf

    2011-10-01

    Activation of opioid receptors on peripheral sensory nerve terminals by opioid peptides that are produced and released from immune cells can result in inhibition of inflammatory pain. This study tests the hypothesis that postoperative pain is attenuated endogenously through a local sympathetic neurotransmitter-activated release of opioids in patients undergoing knee surgery. We examined the expression of opioid peptides and adrenergic receptors in cells infiltrating inflamed synovial tissue and we hypothesized that intra-articular (i.a.) administration of the adrenergic receptor antagonist labetalol will increase postoperative analgesic consumption and/or pain intensity in these patients. In a double-blind, randomized manner, 75 patients undergoing therapeutic knee arthroscopy received i.a. placebo (20 ml saline) or labetalol (2.5 or 5 mg in 20 ml saline) at the end of surgery. Postoperative pain intensity was assessed by visual analog and verbal rating scales at rest and on exertion, and by the consumption of morphine via patient-controlled analgesia. Synovial biopsies were taken during the operation for double-immunofluorescence confocal microscopy studies. Alpha(1)- and beta(2)-adrenergic receptors were co-expressed in opioid peptide-containing cells. No significant difference was seen in pain scores, but patients receiving 2.5 mg labetalol requested significantly higher amounts of morphine. These findings are consistent with the notion that surgical stress induces sympathetically activated release of endogenous opioids from inflammatory cells and subsequent analgesia via activation of peripheral opioid receptors.

  18. Intra-articular psoas tendon release alters fluid flow during hip arthroscopy.

    Science.gov (United States)

    Hanypsiak, Bryan T; Stoll, Marc A; Gerhardt, Michael B; DeLong, Jeffrey M

    2012-01-01

    While not proven definitively, the hypothesis that intra-articular psoas tendon release allows fluid to track into the retroperitoneal space has been widely accepted. This study attempts to identify the path through which fluid enters the pelvis and retroperitoneal space. Six hemi-pelvis human cadaveric specimens were utilized for this study. 3 specimens underwent a capsulotomy and psoas tendon release, while 3 had only a capsulotomy. Arthroscopy fluid was combined with Barium and Methylene blue, and fluid was run at 50 mmHg for 2 hours. A gross dissection was performed at the end of the arthroscopy and the path of fluid flow into the pelvis and throughout the thigh was identified. All 6 specimens showed extravasation of fluid into the pelvis at the 5 minute mark. Specimens with a psoas tendon release showed an altered pattern of fluid flow. In all three of these specimens, the psoas muscle belly was bright blue, along with the remaining tendon. Two of the 3 specimens showed tracking of fluid along the vasculature in both directions. The volume of fluid tracking into the pelvis was increased following a psoas release. Arthroscopy fluid rapidly enters the pelvis following the initiation of hip arthroscopy, regardless of the status of the psoas tendon. Release of the psoas tendon allows fluid to diffuse into the psoas muscle and anterior medial thigh, tracking both proximally and distally along the neurovascular structures, and the volume of fluid tracking into the pelvis is increased following a psoas release.

  19. Intra-articular osteoid osteoma of the calcaneus: a case report and review

    Directory of Open Access Journals (Sweden)

    Tomo Hamada, MD

    2016-09-01

    Full Text Available Osteoid osteoma of the calcaneus is rare and frequently misdiagnosed as arthritis because of similar symptoms. In addition, radiographic findings may be nonspecific, and magnetic resonance imaging (MRI may show a bone marrow edema and changes in adjacent soft tissue. A 19-year-old man presented with a 6-month history of persistent pain and swelling in the left hind foot; diagnostic computed tomography and MRI analyses revealed lesions suggesting an intra-articular osteoid osteoma of the calcaneus. Initial MRI did not show specific findings. On operation, the tumor was removed by curettage; pathologic findings demonstrated woven bone trabeculae surrounded by connective tissue, confirming the diagnosis. To the best of our knowledge, MRI scans in all cases of calcaneal osteoid osteoma reported till 3 months after the injury exhibited a nidus. We believe that calcaneal osteoid osteoma should be considered as a differential diagnosis in patients undergoing MRI 3 months after symptom presentation; early computed tomography is critical in diagnosis.

  20. Safety of intra-articular use of atelocollagen for enhanced tissue repair.

    Science.gov (United States)

    Magarian, Elise M; Vavken, Patrick; Connolly, Susan A; Mastrangelo, Ashley N; Murray, Martha M

    2012-01-01

    Collagen is an important biomaterial in intra-articular tissue engineering, but there are unanswered questions about its safety. We hypothesize that the addition of type-I-collagen for primary repair of the Anterior Cruciate Ligament (ACL) might result in a local and systemic reaction in a porcine model after 15 weeks as demonstrated by joint effusion, synovial thickening, elevated intraarticular and systemic leukocyte counts. Further, this reaction might be aggravated by the addition of a platelet concentrate. Eighteen porcine ACLs were transected and repaired with either sutures (n=6), a collagen sponge (n=6), or a collagen-platelet-composite (CPC; n=6). Twelve intact contralateral knees served as controls (n=12). No significant synovial thickening or joint effusion was seen in the collagen-treated knees. Synovial fluid leukocyte counts showed no significant differences between surgically treated and intact knees, and no differences were seen in leukocyte counts of the peripheral blood. The addition of a platelet concentrate to the knee joint resulted in lower serum levels of IL-1β, but serum levels of TNF-α were not significantly different between groups. In conclusion, the presence of collagen, with or without added platelets, did not increase the local or systemic inflammatory reactions following surgery, suggesting that Type I collagen is safe to use in the knee joint.

  1. Intra-articular sodium hyaluronate injections after arthroscopic debridement forosteoarthritis of the knee: a prospective, randomized, controlled study

    OpenAIRE

    Heybeli, Nurettin; Doral, Mahmut; Atay, Özgür; Leblebicioğlu, Gürsel

    2017-01-01

    Objectives: The purpose of this study was to evaluate the effect of intra-articular hyaluronic acid (HA) injections after arthroscopic debridement on pain and functional parameters in patients with mild-to-moderate knee osteoarthritis.Methods: Sixty-seven patients (21 men, 46 women; mean age 56 years; range 40 to 65 years) who underwent standard arthroscopic debridement for primary knee osteoarthritis of Kellgren-Lawrence grade II-III were randomly assigned to HA injections (n=33) or to only ...

  2. Management of intra-articular fracture of the fingers via mini external fixator combined with limited internal fixation

    Institute of Scientific and Technical Information of China (English)

    LI Wen-jun; TIAN Wen; TIAN Guang-lei; CHEN Shan-lin; ZHANG Chang-qing; XUE Yun-hao; LI Zhong-zhe; ZHU Yin

    2009-01-01

    Background Intra-articular fractures of the fingers are common problems to emergency physicians and hand surgeons.Inappropriate management of these injuries may result in chronic pain,stiffness,deformity,or post traumatic arthritis.Ideal treatment necessitates the restoration of a stable and congruent joint that will allow early mobilization.The purpose of this study was to investigate the results of intra-articular fracture of the fingers by mini external fixator combined with limited internal fixation.Methods From May 2005 to May 2007,a total of 26 patients with intra-articular fracture of the fingers were treated by mini external fixator combined with limited internal fixation.Of the 26 cases,11 involved in metacarpophalangeal joint,and 15 interphalangeal joint in proximal interphalangeal.Kirschner wire,mini wire and absorbable suture were used for limited internal fixation.All patients were followed up and patients were accomplished with total active motion(TAM)of fingers.Results All patients were reviewed by an independent observer.The mean follow up was 13 months(range 9 to 24 months).Subjective,objective and radiographic results were evaluated.X-ray films revealed fracture union and the average radiographic union time was 7 weeks with a range of 5-12 weeks and the phalange shortening or rotation in 2 cases,joint incongruity(less than 1 mm)and joint space narrowing in 3 cases respectively.Phalangeal shortening or rotation was observed in 2 cases and joint incongruity or joint space narrowing was observed in 3 cases.An artificial implant was performed on one case for traumatic arthritis 1.5 years after surgery.Based on TAM the overall good-excellent rate of joint motion function was 80.8%.Conclusion Mini external fixator combined with limited internal fixation is a reliable and effective method for treatment of intra-articular fracture of the fingers.

  3. Intra-articular chromic phosphate (³²P) in the treatment of diffuse pigmented villonodular synovitis.

    Science.gov (United States)

    Zook, Jennifer E; Wurtz, Daniel L; Cummings, Judd E; Cárdenes, Higinia R

    2011-01-01

    Pigmented villonodular synovitis (PVNS) is an uncommon proliferative lesion of synovial tissue. In diffuse PVNS, recurrence rates are high after resection alone. Adjuvant external beam radiation therapy contributes to improved local control. Limited data exist for intra-articular radioisotope therapy after surgical resection. We report institutional experience with intra-articular chromic phosphate ((32)P). Records were reviewed from the Department of Radiation Oncology at Indiana University. Nine cases of PVNS treated with (32)P were identified (mean age=40). Seven patients were treated at time of recurrence and 2 patients were treated prophylactically. Intra-articular injections were performed by accessing the joint space, aspirating joint fluid, reinjecting 1-2 mCi of (32)P, and barbitaging to ensure good distribution in the joint space. No external beam radiation therapy was delivered. One patient was lost to followup. Mean followup of remaining patients was 20 months (range, 2-48). Eleven injections were performed in 9 patients. Eight had PVNS in the knee(s) and 1 patient had involvement of the hip. Two patients were treated more than once, one for a recurrence in the same joint at 13 months and another for PVNS of a contralateral joint. Three clinical recurrences (2, 13, and 28 months) were noted. Two of three recurrences were in patients who had bulky diffuse PVNS at the time of injection. Overall local control was 70%. In patients without bulky diffuse PVNS at the time of injection, local control was 88%. We report success using intra-articular injections of (32)P after synovectomy in patients with PVNS. Copyright © 2011 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  4. Gait Changes Vary Among Horses with Naturally Occurring Osteoarthritis Following Intra-articular Administration of Autologous Platelet Rich Plasma

    Directory of Open Access Journals (Sweden)

    Mustajab Hussain Mirza

    2016-04-01

    Full Text Available Mechanisms to reduce lameness associated with osteoarthritis (OA are vital to equine health and performance. This study was designed to quantify response to autologous, intra-articular platelet-rich plasma (PRP in horses with OA. Kinetic gait analysis was performed on 12 horses with unilateral forelimb lameness and OA in the same limb before and after intra-articular anesthesia (IAA. Radiographs and kinetic data were obtained before, 6 and 16 weeks after PRP administration to same joint 4 weeks after IAA. Statistical evaluations included filtration effect on platelet concentration, relationship between kinetic variable changes after IAA versus PRP in the affected limb, and associations between response to PRP and response to IAA, platelet concentration and radiographic OA. A positive response to IAA or PRP was defined as ≥5% improvement in peak vertical force, vertical impulse or breaking impulse of the affected limb. Out of 10 horses that responded to IAA, 4 responded to PRP at both time points and 2 responded at one. Of 2 horses that did not respond to IAA, one responded to PRP at both time points. Filtration increased platelet concentration significantly. The relationship between kinetic variable alterations of the affected limb after IAA and PRP was not significant, and response to PRP was not associated with response to IAA, platelet concentration or radiographic OA. Changes in kinetic variables following IAA in joints with naturally occurring OA provide a custom standard to assess intra-articular therapy. Kinetic gait changes after intra-articular PRP are variable in horses with moderate to severe forelimb OA.

  5. The Analgesic Effects of Morphine and Tramadol Added to Intra-articular Levobupivacaine-Tenoxicam Combination for Arthroscopic Knee Surgery on Postoperative Pain; a Randomized Clinical Trial

    National Research Council Canada - National Science Library

    Oral, Ebru Gelici; Hanci, Ayse; Ulufer Sivrikaya, Gulcihan; Dobrucali, Hale; Turkoglu Kilinc, Leyla

    2015-01-01

    .... We aimed to compare the effects of intra-articular levobupivacaine-tenoxicam-tramadol and levobupivacaine-tenoxicam-morphine combinations on postoperative pain in patients undergoing elective arthroscopic knee surgery...

  6. The comparison effects of intra-articular injection of different opioids on postoperative pain relieve after arthroscopic anterior cruciate ligament reconstruction: A randomized clinical trial study

    Directory of Open Access Journals (Sweden)

    Hamidreza Arti

    2011-01-01

    Conclusions: Administering 5 mg intra-articular morphine after arthroscopic ACL reconstruction is a valuable choice and is recommended to be added to other local anesthetics administrated drugs after this procedure.

  7. Incongruent reduction following post-traumatic hip dislocations as an indicator of intra-articular loose bodies: A prospective study of 117 dislocations

    Directory of Open Access Journals (Sweden)

    K Karthik

    2011-01-01

    Conclusions: Intra-articular loose bodies were identified by nonconcentric reduction in 12 out of 117 patients with simple hip dislocation. Careful evaluation by fluoroscopy and good quality radiographs are indicated following reduction of hip dislocations.

  8. Symptomatic lumbar facet joint cysts treated by CT-guided intracystic and intra-articular steroid injections

    Energy Technology Data Exchange (ETDEWEB)

    Amoretti, Nicolas; Huwart, Laurent; Amoretti, Marie-Eve; Pellegrin, Amelie; Marcy, Pierre-Yves [Centre Hospital-Universitaire de Nice, Hopital Archet 2, Department of Radiology, Nice (France); Foti, Pauline [Centre Hospital-Universitaire de Nice, Departments of Epidemiology, Nice (France); Boileau, Pascal [Centre Hospital-Universitaire de Nice, Orthopaedic Surgery, Nice (France); Hauger, Olivier [Hopital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Department of Radiology, Bordeaux (France)

    2012-12-15

    To evaluate percutaneous computed tomography (CT)-guided intracystic and intra-articular steroid injections for the treatment of lumbar facet joint cyst causing radicular pain. A single-centre prospective study involving 120 consecutive patients with symptomatic lumbar facet joint cyst-induced radicular pain was done (72 women, 48 men). The average age was 68.2 years (52-84). Patients were treated by percutaneous CT-guided intracystic and intra-articular steroid injections. The clinical course of nerve root pain was evaluated after 1 day, and 1, 3 and 6 months, with long-term follow-up after 12 months. Patient follow-ups in our series show supportive results: within 120 patients, 54% of patients were satisfied with a long-lasting result from the first intra-cystic and intra-articular steroid injections (n = 65), while 20.8% were satisfied with a long-lasting result from a second intervention. Combining these two results shows that 75% of patients were satisfied with a long-lasting result. Our results showed that percutaneous treatment of vertebral lumbar facet joint cysts by double injections is an effective and economic therapeutic technical management among 75% of our patients. Thus we recommend that it should be considered as a first choice of treatment. (orig.)

  9. Effects of intra-articular levobupivacaine, fentanyl-levobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery.

    Science.gov (United States)

    Sayın, Pınar; Dobrucalı, Hale; Türk, Hacer Şebnem; Totoz, Tolga; Işıl, Canan Tülay; Hancı, Ayşe

    2015-01-01

    The aim of this study was to compare the postoperative analgesic efficacy of intra-articularly injected levobupivacaine, levobupivacaine-fentanyl, and levobupivacaine-tramadol combinations. Eighty patients scheduled for elective knee arthroscopy were divided randomly into 4 groups of 20 patients each. Group 1 (the control group) received intra-articular saline, Group 2 received levobupivacaine 2.5 mg/ml, Group 3 received levobupivacaine 2.5 mg/ml + tramadol 50 mg, and Group 4 received levobupivacaine 2.5 mg/ml + fentanyl l50 mcg. All patients were operated on under general anesthesia, and a total of 20 ml study solution was injected: 7 ml subcutaneously before surgery and 13 ml intra-articularly upon completion of surgery. For postoperative, pain visual analogue scale (VAS) was assessed at the 1st, 2nd, 4th, 8th, 12th, and 24th hours postoperatively. Patients with a VAS score over 5 received diclofenac sodium, and the need for rescue analgesics was recorded. At the 1st, 2nd, 4th, 8th, 12th, and 24th postoperative hours, Group 3 and Group 4 had statistically significant lower VAS scores of pain (p0.05). The results indicated that levobupivacaine combined with either fentanyl or tramadol decreased rescue analgesic requirements when compared to levobupivacaine alone.

  10. Intra-articular lignocaine as a means of analgesia during manual reduction of acute anterior shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Manoj Kadel

    2016-11-01

    Full Text Available Background & Objectives: Acute anterior shoulder dislocation needs prompt reduction of the dislocation. The ideal reduction method should be simple, fast, effective and non- traumatic, with minimal pain, and should not cause further injury to the affected shoulder. Intra-articular local lignocaine injection is a means of achieving analgesia with less complication, and allowing prompt patient discharge of patient after reduction. The study was conducted with objective to evaluate the effectiveness of intra-articular lignocaine for reduction of acute anterior shoulder dislocation.Materials & Methods: Twenty- one cases of acute anterior shoulder dislocation were reduced using intra-articular local lignocaine injection as a method of analgesia by modified Hippocrates method.Results: The mean age was 44.71 years ± SD 20.14 while 11 cases were reduced with one to six hours of injury. Pain assessed through application of a visual analogue scale during the maneuver revealed scores ranging from two to eight with mean score of 4.29 ± SD 1.55.Conclusion: This method is not only safe and effective but also reduces hospital stay and has negligible adverse effects making it a popular choice for most orthopedists.

  11. Comparative Study of the Use of Intra-articular and Systemic Meloxicam to Control Experimentally Induced Osteoarthritis in Rabbit Knees

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    Valeria Trombini Vidotto

    2013-12-01

    Full Text Available Objective: This study aimed to evaluate morphologic changes, as well as chondroprotective and intra-articular effects of meloxicam on joint repair in rabbits induced by experimental trochleoplasty, minimizing possible adverse side effects. Methods: Thirty-five rabbits were divided into four groups: the control group, which did not undergo surgery, and operated groups, which used different ways of administering the anti-inflammatory agent: systemic, 0.2 mg/kg; intra-articular, 0.5 mg/kg; positive group control, without meloxicam. Each operated group was divided according to the periods of 7 or 30 days evaluation after surgery. Results: Regarding macroscopic and histological evaluation of cartilage, after 30 days, most animals showed almost complete joint repair, the presence of few or no inflammatory cells; whereas part of the animals treated with meloxicam presented necrosis in the trochlear ridge and absence of inflammatory cells after 7 days. In positive control group, it was observed moderate inflammation and connective tissue proliferation. None of the animals in the operated groups showed irregularities 30 days after surgery. Conclusion: Either intra-articular or systemic, meloxicam revealed to be favorable to be used for joint repair and control of inflammatory reaction.

  12. Protective Effect of Surgery Against Early Subtalar Arthrodesis in Displaced Intra-articular Calcaneal Fractures: A Meta-Analysis.

    Science.gov (United States)

    Liu, Yueju; Li, Zhi; Li, Heng; Zhang, Yingze; Wang, Pengcheng

    2015-11-01

    The aim of this study is to determine whether surgery offers protection against early subtalar arthrodesis in displaced intraarticular calcaneal fractures. Systematic review and meta-analysis: searches of electronic databases 1980 to August 2014, checking of reference lists, hand searching of journals, and contact with experts. Randomized controlled trials (RCTs) in which surgical treatment was compared with nonsurgical treatment of displaced intra-articular calcaneal fractures from 1980 to 2014. The modified Jadad scale was used for trial quality and effective data were pooled for meta-analysis. Study results related to early subtalar arthrodesis were extracted and risk assessment was combined with surgical treatment and nonsurgical treatment. The primary analysis included 4 studies and 966 participants. The estimated overall risk ratio was 4.40 (95% confidence interval 2.67-7.39), indicating the incidence of early subtalar arthrodesis in nonsurgical group is 4.4 times the surgical group. The results showed that surgical treatment was superior to nonsurgical treatment in protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures (Z = 5.600, P < 0.001).Surgery offers protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures.

  13. Analgesic Effect of Intra-Articular Injection of Temperature-Responsive Hydrogel Containing Bupivacaine on Osteoarthritic Pain in Rats

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    Taemin Kim

    2015-01-01

    Full Text Available The present study examined the analgesic effects of slow-releasing bupivacaine from hydrogel on chronic arthritic pain in rats. Osteoarthritis (OA was induced by monosodium iodoacetate (MIA injection into the right knee joint. Hydrogel (HG: 20, 30, and 50 μL and temperature-sensitive hydrogel containing bupivacaine (T-gel: 20, 30, and 50 μL were injected intra-articularly 14 days after MIA injection. Behavioral tests were conducted. The rats showed a significant decrease in weight load and paw withdrawal threshold (PWT. Intra-articular 0.5% bupivacaine (10 and 20 μL significantly reversed MIA-induced decreased PWT, with no effect on weight load. In normal rats, hydrogel did not produce significant changes in PWT but at 30 and 50 μL slightly decreased weight bearing; T-gel did not cause any changes in both the weight load and PWT. In OA rats, T-gel at 20 μL had a significant analgesic effect for 2 days, even though T-gel at 50 μL further reduced the weight load, demonstrating that intra-articular T-gel (20 μL has long-lasting analgesic effects in OA rats. Thus, T-gel designed to deliver analgesics into the joint cavity could be an effective therapeutic tool in the clinical setting.

  14. Analgesic control after hip arthroscopy: a randomised, double-blinded trial comparing portal with intra-articular infiltration of bupivacaine.

    LENUS (Irish Health Repository)

    Baker, Joseph F

    2011-06-07

    Abstract: The optimum anaesthetic and analgesic management following hip arthroscopy is yet to be determined. There is, in addition, some concern over the use of intraarticular local anaesthetic. We compared the analgesic efficacy of intra-articular infiltration compared with portal infiltration of bupivacaine following hip arthroscopy. Patients were randomised to receive either 10ml of 0.25% bupivacaine either into the joint or around the portal sites following completion of surgery. 73 patients were recruited (40 intra-articular). The portal infiltration group required significantly more rescue analgesia immediately after surgery (2.33mg vs.0.57mg, p=0.036). Visual Analogue Scale pain scores were not significantly different at 1 and 2 hours following surgery, but at 6 hours the portal group had significantly lower VAS scores (p=0.0036). We believe that the initial pain following surgery results from capsular injury and this explains the need for more rescue analgesia in the portal infiltration group. Further work is needed to establish the ideal regimen. A combination of portal and intra-articular infiltration may be the most efficacious.

  15. Intra-articular Loose Body with Concomitant Bankart Lesion after a Traumatic Shoulder Dislocation: A Case Report.

    Science.gov (United States)

    Lim, Jason B T; Tan, Andrew H C

    2017-01-01

    The spectrum of pathoanatomic lesions encountered in anterior shoulder dislocation is broad. There could be a presence of loose bodies, chondral and osteochondral, in the shoulder joint and also concomitant rotator cuff partial tears resulting from acute and chronic shoulder instability. We present one case report of a 46-year-old male Chinese with an uncommon case of Bankart lesion, with a full thickness chondral defect over the superior glenoid articular surface manifesting as a large intra-articular loose cartilaginous body. The patient presented with persistent shoulder pain with signs of shoulder instability. He underwent arthroscopic repair of his Bankart lesion with the removal of intra-articular loose body. We aim to discuss the diagnosis, radiological imaging, as well as, arthroscopic treatment of loose body in the glenohumeral joint due to anterior shoulder dislocation in our report. In our case report, we highlight the importance to identify other associated injuries from the history and examination after an episode of traumatic anterior shoulder dislocation. Arthroscopic treatment is a useful minimally invasive option to remove the large fragment of intra-articular loose body and also repair the Bankart lesion in the same setting. Both of these lesions must be treated as they are crucial for pain relief, as well as stabilizing the shoulder, to prevent further episodes of dislocation.

  16. The comparison effects of intra-articular injection of different opioids on postoperative pain relieve after arthroscopic anterior cruciate ligament reconstruction: A randomized clinical trial study

    OpenAIRE

    Hamidreza Arti; Seyed Abdoulhossein Mehdinasab

    2011-01-01

    Background: Pain after knee surgery, if not relieved, it would lead to a more severe and prolonged pain that can delay the patients recovery and rehabilitation. The effect of pain relief by some drugs after intra-articular injection has been shown. This study compared the effect of intra-articular injection of opioids (morphine, pethidine, methadone, and tramadol) on postoperative relieving pain after arthroscopic anterior cruciate ligament (ACL) reconstruction. Methods: 150 candidate pat...

  17. Intra-articular therapy with infliximab in psoriatic arthritis: efficacy and safety in refractory monoarthritis

    Directory of Open Access Journals (Sweden)

    A. Minosi

    2011-06-01

    Full Text Available Objective: To evaluate efficacy and safety of intra-articular therapy (IA with infliximab (IFX, in patients with psoriatic arthritis (PsA and refractory monoarthritis. Methods: Four male and 1 female aged from 25 to 71 years and disease duration from 1 to 25 years, affected by PsA (CASPAR criteria were observed . All patients were treated with immunomodulators (methotrexate, leflunomide, cyclosporin A, 3/5 with concomitant steroids, 4/5 with NSAID’s. Only 1 patient were treated with IFX 5 mg/kg IV every 6 weeks. Before the IFX injection an amount of synovial fluid was aspired from the inflamed site and the anti-TNF injection was echographic guided. Patients were evaluated at regular intervals through clinical and echographic examination and retreated in case of flare. Results: At follow-up visit after 7 days, in all patients treated with the first injection was detected total regression of the inflammation and no new inflamed synovial fluid was observed; power doppler examination shows reduction of local vascularization. Two patients experienced full remission after 6 months and only one injection, 1 patient (arthritis of the wrist was in remission after 2 injections (3 months of interval. In 2 patients with knee arthritis and important synovial hypertrophy good results obtained after the first injection were not maintained afterwards and second injection was ineffective: these patients were evaluated for surgical intervention. Conclusions: Local injections of IFX were safe and well tolerated in all patients. The efficacy in short term was observed in all cases; our supposition is that presence of synovial hypertrophy is cause of worsening.

  18. Treatment of erosive osteoarthritis of the hands by intra-articular infliximab injections: a pilot study.

    Science.gov (United States)

    Fioravanti, Antonella; Fabbroni, Marta; Cerase, Alfonso; Galeazzi, Mauro

    2009-06-01

    Our pilot study aimed to investigate the efficacy and tolerability of intra-articular (i.a.) injections of infliximab as a therapy for erosive osteoarthritis of the hands. Ten women with bilateral involvement of the hands and typical erosive osteoarthritis radiographic findings were enrolled and followed for 12 months. All the patients were refractory to conventional drugs. Treatment consisted in monthly i.a. injections of 0.2 ml of infliximab (0.1 mg/ml) in each affected proximal and distal interphalangeal joint of the most involved hand, identified on the basis of clinical and radiological examinations. The other hand was treated with physiological saline (control). The patients did not know which hand was receiving infliximab. Clinical response was evaluated at enrollment, after 6 and 12 months. Posteroanterior radiographs of both hands were obtained at baseline and 12 months later. At 6 months all the patients experienced relief from spontaneous pain and pain on lateral pressure in the hand treated with infliximab and these findings became statistically significant after 1 year. No important modifications were recognized in the hand treated with physiological saline. The anatomical lesion progression system radiological score indicated a reduction, even if not statistically significant, in the hand treated with infliximab and a tendency to slow worsening in the hand treated with physiological saline at 12-month follow-up. No local or systemic adverse reactions were recorded. Our study shows the symptomatic effect and a possible disease modifying action of i.a. infliximab in erosive osteoarthritis of the hands.

  19. Reduced mandibular growth in experimental arthritis in the temporomandibular joint treated with intra-articular corticosteroid.

    Science.gov (United States)

    Stoustrup, Peter; Kristensen, Kasper D; Küseler, Annelise; Gelineck, John; Cattaneo, Paolo M; Pedersen, Thomas K; Herlin, Troels

    2008-04-01

    The aim of this investigation was to study the effect of intra-articular (i.a.) corticosteroid injections (IACIs) in the temporomandibular joint (TMJ) on mandibular development in antigen-induced TMJ arthritis. Ten-week-old female New Zealand white rabbits (n = 42) were randomly divided into four groups: group A, control (no injections); group B, placebo (repeated i.a. TMJ saline injections); group C, untreated arthritis (repeated induction of TMJ arthritis); and group D, steroid (repeated induction of TMJ arthritis + IACI). All animals had two tantalum implants inserted in the right side of the mandible serving as stable landmarks for later growth analysis. One implant was inserted close to the symphysis and one in the molar region. Computerized tomographic (CT) full-head scans were carried out at 14 (T1) and 26 (T2) weeks of age. (Dropout of animals at T2; group C, n = 7, and group D, n = 3.) Absolute and relative intra- and inter-group growth variations were evaluated during the growth period by comparison of CT scans. One-way analysis of variance was used for T1 statistical analysis, and absolute intra-group and relative inter-group growth differences between T1 and T2 were evaluated by Student's t-tests. At T2, the animals in the group A had greater sagittal and vertical mandibular growth compared with the other three groups. TMJ arthritis caused diminished mandibular growth. However, relative mandibular growth was significantly less in group D. The findings of this study do not indicate a positive long-term effect in the use of IACI in the TMJ as an early treatment intervention against TMJ inflammation in growing individuals.

  20. Viscosupplementation with intra-articular hyaluronic acid for treatment of osteoarthritis in the elderly.

    Science.gov (United States)

    Abate, M; Pulcini, D; Di Iorio, A; Schiavone, C

    2010-01-01

    Osteoarthritis (OA) is very disabling condition in the elderly. The current therapeutic approaches (analgesics, NSAIDs, COX-2 inhibitors, steroids) do not delay the OA progression or reverse joint damage. Moreover, they may cause relevant systemic side effects. Hyaluronic acid (HA) is a physiologic component of the synovial fluid and is reduced in OA joints. Therefore, intra-articular injection of HA, due to its viscoelastic properties and protective effect on articular cartilage and soft tissue surfaces of joints, can restore the normal articular homoeostasis. These effects are evident when HA is properly administered into the articular space; therefore, the use of "image-guided" infiltration techniques is mandatory. Viscosupplementation (VS), with different HA preparations (Low and High molecular weight), can be considered when the patient has not found pain relief from other therapies or is intolerant to analgesics or NSAIDs. A 3-5 doses regimen is usually recommended with 1 week interval between each injection. Several studies have shown the efficacy of HA for the treatment of knee OA, with positive effects on pain, articular function (Western Ontario and Mc Master Universities Osteoarthritis Index [WOMAC], Lequesne Index [LI], Range of Motion [ROM]), subjective global assessment and reduction in NSAIDs consumption. In general, the benefit is evident within 3 months and persists in the following 6-12 months. Encouraging but inconclusive results have also been observed for the treatment of shoulder, carpo-metacarpal, hip and ankle OA. However there is the need of better designed studies to prove the effectiveness of these medications, in order to rule out a placebo effect. The therapy is well tolerated with absence of systemic side effects and only with limited local discomfort.

  1. Increased localized delivery of piroxicam by cationic nanoparticles after intra-articular injection

    Science.gov (United States)

    Kim, Sung Rae; Ho, Myoung Jin; Kim, Sang Hyun; Cho, Ha Ra; Kim, Han Sol; Choi, Yong Seok; Choi, Young Wook; Kang, Myung Joo

    2016-01-01

    Piroxicam (PRX), a potent nonsteroidal anti-inflammatory drug, is prescribed to relieve postoperative and/or chronic joint pain. However, its oral administration often results in serious gastrointestinal adverse effects including duodenal ulceration. Thus, a novel cationic nanoparticle (NP) was explored to minimize the systemic exposure and increase the retention time of PRX in the joint after intra-articular (IA) injection, by forming micrometer-sized electrostatic clusters with endogenous hyaluronic acid (HA) in the synovial cavity. PRX-loaded NPs consisting of poly(lactic-co-glycolic acid), Eudragit RL, and polyvinyl alcohol were constructed with the following characteristics: particle size of 220 nm, zeta potential of 11.5 mV in phosphate-buffered saline, and loading amount of 4.0% (w/w) of PRX. In optical and hyperspectral observations, the cationic NPs formed more than 50 μm-sized aggregates with HA, which was larger than the intercellular gaps between synoviocytes. In an in vivo pharmacokinetic study in rats, area under the plasma concentration–time curve (AUC0–24 h) and maximum plasma concentration (Cmax) of PRX after IA injection of the cationic NPs were <70% (P<0.05) and 60% (P<0.05), respectively, compared to those obtained from drug solution. Moreover, the drug concentration in joint tissue 24 h after dosing with the cationic NPs was 3.2-fold (P<0.05) and 1.8-fold (P<0.05) higher than that from drug solution and neutrally charged NPs, respectively. Therefore, we recommend the IA cationic NP therapy as an effective alternative to traditional oral therapy with PRX, as it increases drug retention selectively in the joint. PMID:27895468

  2. Primary subtalar arthrodesis for the treatment of comminuted intra-articular calcaneal fractures.

    Science.gov (United States)

    Potenza, V; Caterini, R; Farsetti, P; Bisicchia, S; Ippolito, E

    2010-07-01

    We report the short- and mid-term results in six patients (seven feet) affected by markedly comminuted intra-articular calcaneal fractures (Sanders type IV), treated by primary subtalar arthrodesis. The average age at surgery was 40 years. In all patients, arthrodesis of the subtalar joint was performed using a limited lateral approach to the calcaneus; it was stabilised with two or three cannulated screws. No patient had a preliminary reduction and internal fixation of the fracture. The time from injury to surgery averaged 20 days because all of the patients had associated visceral and/or other skeletal injuries. All of the patients were followed up clinically and radiographically 2 times, at an average of 12 months and 53 months after surgery. At the short-term follow-up, the mean AOFAS score was 70 points; the X-rays showed a complete fusion of the subtalar joint in all seven feet, without any sign of osteoarthritis of the calcaneo-cuboid and the talo-navicular joints. In all cases, an altered shape of the calcaneus was present. At the mid-term follow-up, the mean AOFAS score increased to 85 points; in one patient, radiographic signs of osteoarthritis of the calcaneo-cuboid and the talo-navicular joints were present and, in another patient, only talo-navicular joint was present, although both patients were free from pain. The difference between the two AOFAS scores was statistically significant. We believe that primary subtalar arthrodesis performed for markedly comminuted Sanders type IV calcaneal fractures yielded good mid-term results, and it is especially indicated when surgical treatment is delayed for whatever reason. A preliminary open reduction and internal fixation to restore the normal height of the calcaneus before performing the subtalar arthrodesis, as suggested by several authors, does not seem indispensable to obtain good clinical results. 2009 Elsevier Ltd. All rights reserved.

  3. Chitosan-clodronate nanoparticles loaded in poloxamer gel for intra-articular administration.

    Science.gov (United States)

    Russo, E; Gaglianone, N; Baldassari, S; Parodi, B; Croce, I; Bassi, A M; Vernazza, S; Caviglioli, G

    2016-07-01

    This work was based on the study of an intra-articular delivery system constituted by a poloxamer gel vehiculating clodronate in chitosan nanoparticles. This system has been conceived to obtain a specific and controlled release of clodronate in the joints to reduce the arthritis rheumatoid degenerative effect. Clodronate (CLO) is a first-generation bisphosphonate with anti-inflammatory properties, inhibiting the cytokine and NO secretion from macrophages, therefore causing apoptosis in these cells. This is related to its ability to be metabolized by cells and converted into a cytotoxic intermediate as a non-hydrolysable analogue of ATP. Chitosan (CHI) was used to develop nanosystems, by ionotropic gelation induced by clodronate itself. A fractional factorial experimental design allowed us to obtain nanoparticles, the diameter of which ranged from 200 to 300nm. Glutaraldehyde was used to increase nanoparticle stability and modify the drug release profile. The zeta potential value of crosslinked nanopaparticles was 21.0mV±1.3, while drug loading was 31.0%±5.4 w/w; nanoparticle yield was 18.2%±1.8 w/w, the encapsulation efficiency was 48.8%±9.9 w/w. Nanoparticles were homogenously loaded in a poloxamer sol, and the drug delivery system is produced in-situ after local administration, when sol become gel at physiological temperature. The properties of poloxamer gels containing CHI-CLO nanoparticles, such as viscosity, gelation temperature and drug release properties, were evaluated. In vitro studies were conducted to evaluate the effects of these nanoparticles on a human monocytic cell line (THP1). The results showed that this drug delivery system is more efficient, with respect to the free drug, to counteract the inflammatory process characteristic of several degenerative diseases.

  4. A Three-Dimensional Finite Element Analysis of Displaced Intra-Articular Calcaneal Fractures.

    Science.gov (United States)

    Xu, Can; Liu, Hua; Li, Mingqing; Wang, Chenggong; Li, Kanghua

    A better understanding of displaced intra-articular calcaneal fractures, their effect on joint mechanics, and the relationship between altered mechanics and osteoarthritis could aid in the development or refinement of treatment methods. Finite element modeling is accepted as the reference standard for evaluating joint contact stresses. The objective of the present study was to analyze the in vivo joint mechanical data from finite element modeling for normal and injured subtalar joints. A 3-dimensional model of the ankle-hindfoot was developed and validated. Both height loss and width increases in the calcaneus were simulated. Next, they were used to investigate the relationship between calcaneal height or width and the contact mechanics of the posterior facet of the subtalar joint. The contact area/joint area ratio increased in the subtalar joint with injury when the calcaneal width increased. Moreover, the peak contact pressure and the proportion of the area under high contact pressure (>6 MPa) increased. The contact area/joint area ratio decreased with reduced calcaneal height, but the peak contact pressure remained almost constant. The width increases of the calcaneus somewhat limited the subtalar joint motion, especially for eversion; however, the height loss mostly resulted in subtalar rotatory instability. The height loss diminished the subtalar joint's stability in eversion, internal rotation, and external rotation. The results of the present study support the advisability of surgery for these complex injuries. Reestablishing the calcaneal height and width could restore the normal kinematics and contact stress distribution in the subtalar joint, improve the tibiotalar position, and diminish long-term degeneration in the ankle.

  5. Bupivacaina ou bupivacaina e morfina intra-articular pós reconstrução do LCA Intra-articular bupivacaine or bupivacaine and morphine after ACL reconstruction

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Danieli

    2012-01-01

    Full Text Available OBJETIVO: A cirurgia de reconstrução do LCA é hoje uma das mais realizadas e o controle da dor pós-operatória faz parte das prioridades do cirurgião. Dentro do arsenal de analgesia temos a aplicação intra-articular de drogas, sendo a mais estudada a bupivacaina associada ou não a morfina. Neste estudo comparamos a aplicação de bupivacaina associada ou não a morfina com grupo controle, após reconstrução do LCA com enxerto de tendões flexores. MÉTODOS: Quarenta e cinco pacientes foram randomizados em três grupos, sendo que no grupo I foi aplicado ao fim da cirurgia 20ml de soro fisiológico intra-articular, no grupo II 20ml de bupivacaina 0,25% e no grupo III bupivacaina 0,25% associado a 1mg de morfina. Os grupos foram avaliados quanto ao grau de dor pela escala analógica visual com 6, 24 e 48 horas de pós-operatório. RESULTADOS: O grupo III teve menos dor em todos os momentos, porém a dor não foi tão intensa em todos os grupos a ponto de necessitar medicações extras além do protocolo estabelecido. CONCLUSÃO: A aplicação intra-articular destas medicações pós-reconstrução do LCA com enxerto dos tendões flexores quando realizada sob anestesia raquideana não traz vantagens suficientes para fazer seu uso regularmente. Nível de Evidência II, Ensaio Clínico Randomizado de Menor Qualidade.OBJECTIVE: Reconstructive surgery of the ACL is one of the most commonly performed surgeries today and the control of postoperative pain is part of the priorities of the surgeon. Within the arsenal of analgesia we have the intra-articular application of drugs, and the most studied one is bupivacaine with or without morphine. This study compared the application of bupivacaine with or without morphine with a control group after ACL reconstruction with flexor tendon graft. METHODS: Forty-five patients were randomized into three groups: in group I, 20 ml of saline were applied intra-articularly at the end of the surgery; in group II

  6. Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee

    Directory of Open Access Journals (Sweden)

    Poupak Rahimzadeh

    2014-01-01

    Full Text Available Background: Osteoarthritis is one of the most common diseases and the knee is the most commonly affected joint. Intra-articular prolotherapy is being utilized in acute and chronic pain management setting. This study was designed to compare the efficacy of three methods of intra-articular knee joint therapies with erythropoietin, dextrose, and pulsed radiofrequency. Materials and Methods: After approval by the Ethics Committee and explaining the therapeutic method to volunteers, 70 patients who were suffering from primary knee osteoarthrosis went through one of the treatment methods (erythropoietin, dextrose, and pulsed radiofrequency. The study was double-blind randomized clinical trial performed from December 2012 to July 2013. Patients′ pain level was assessed through the visual analog pain scale (VAS, and range of motion (ROM was measured by goniometric method. Furthermore, patients′ satisfaction was assessed before and after different treatment methods in weeks 2, 4, and 12. For analysis, Chi-square, one-way ANOVA, and repeated measured ANOVA were utilized. Results: The demographic results among the three groups did not indicate any statistical difference. The mean VAS in erythropoietin group in the 2 nd , 4 th , and 12 th weeks was 3.15 ± 1.08, 3.15 ± 1.08, and 3.5 ± 1.23, respectively (P ≤ 0.005. Knee joint ROM in the erythropoietin group in the 2 nd , 4 th , and 12 th weeks was 124 ± 1.50, 124 ± 1.4, and 123 ± 1.53 respectively (P ≤ 0.005. Satisfaction score in the 12 th week in erythropoietin group was extremely satisfied 15%, satisfied 55%, and moderately satisfied 30%, (P = 0.005. No specific side-effects were observed. Conclusion: Intra-articular prolotherapy with erythropoietin was more effective in terms of pain level reduction and ROM improvement compared with dextrose and pulsed radiofrequency.

  7. Estudo comparativo da analgesia entre bupivacaína e morfina intra-articular em osteoartrite de joelho Estudio comparativo de la analgesia entre bupivacaína y morfina intra-articular en osteoartritis de la rodilla Intra-articular bupivacaine and morphine for knee osteoarthritis analgesia. Comparative study

    Directory of Open Access Journals (Sweden)

    Miriam C B Gazi

    2005-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A osteoartrite é a mais freqüente entre as doenças articulares em pessoas idosas. O objetivo do estudo foi comparar o efeito analgésico da bupivacaína e da morfina por via intra-articular em pacientes portadores de osteoartrite de joelho. MÉTODO: Foram avaliados 39 pacientes em estudo duplamente encoberto, divididos de forma aleatória, em dois grupos: os do G1 (n = 18 receberam 1 mg (1 mL de morfina diluída em 9 mL de solução fisiológica a 0,9% e os do G2 (n = 21, 25 mg (10 mL de bupivacaína a 0,25% sem vasoconstritor, por via intra-articular. A intensidade da dor foi avaliada pela escala numérica e verbal nos momentos 0, 30, 60 minutos e 7 dias, em repouso e em movimento. Foram avaliados a necessidade de complementação analgésica com paracetamol (500 mg, a dose total de analgésico utilizado, a duração da analgesia e a qualidade da analgesia (pelo paciente. RESULTADOS: Dos 39 pacientes, 31 completaram o estudo. Não houve diferença significativa da intensidade da dor em repouso e em movimento entre os dois grupos nos momentos estudados. Não houve diferença entre os dois grupos no tempo entre a administração da solução e a necessidade de complementação analgésica. A dose média do paracetamol utilizada no primeiro dia da semana foi de 796 mg do G1 e de 950 mg no G2; a complementação na semana foi de 3578 mg no G1 e 5333 mg no G2. CONCLUSÕES: O efeito analgésico de 1 mg de morfina e de 25 mg de bupivacaína a 0,25% sem vasoconstritor intra-articular foram semelhantes.JUSTIFICATIVA Y OBJETIVOS: La osteoartritis es la más frecuente entre las enfermedades articulares en personas de edad. El objetivo del estudio fue comparar el efecto analgésico de la bupivacaína y de la morfina por vía intra-articular en pacientes portadores de osteoartritis de rodilla. MÉTODO: Fueron evaluados 39 pacientes en estudio doblemente encubierto, divididos de forma aleatoria, en dos grupos: los del G1 (n = 18

  8. Symptomatic Lumbar Facet Synovial Cysts: Clinical Outcomes Following Percutaneous CT-Guided Cyst Rupture with Intra-articular Steroid Injection.

    Science.gov (United States)

    Haider, Steffen J; Na, Nu R; Eskey, Clifford J; Fried, Jessica G; Ring, Natalie Y; Bao, Mike H; Pastel, David A

    2017-08-01

    To evaluate clinical outcomes following percutaneous rupture of symptomatic lumbar facet synovial cysts (LFSCs) with intra-articular steroid injection. In this retrospective review, 44 consecutive patients with symptomatic LFSCs received primary treatment with CT-guided synovial cyst rupture with intra-articular steroid injection. Outcomes questionnaires were obtained before and 1, 4, 26, and 52 weeks after LFSC rupture. Assessment included pain medication use and numeric rating scale (NRS), Oswestry Disability Index (ODI), and 12-item short form health survey (SF-12) physical and mental composite scores (PCS and MCS). Clinical endpoint was 52-week survey response or surgery. LFSC rupture was technically successful in 84% (37/44) of cases. Clinical endpoint was reached in 68% (30/44) of patients with 82% overall 1-year follow-up. Lumbar spine surgery was performed in 25% (11/44) of patients within 1 year after procedure. Mean NRS, ODI, and SF-12 PCS demonstrated significant improvement at all follow-up time points (P < .001). At 52-week follow-up, NRS decreased from 8.1 to 3.7 (P < .001), ODI improved from 35 to 24 (P = .006), and SF-12 PCS improved from 31 to 42 (P < .001). Daily pain medication decreased from 71% (31/44) of patients before procedure to 29% (9/26) at 52-week follow-up (P = .012). History of prior lumbar intervention was associated with poorer LFSC rupture success (P = .025) and ODI (P = .047). NRS, ODI, and SF-12 PCS indices improved and pain medication use decreased significantly at all time points over 1-year follow-up after percutaneous rupture of symptomatic LFSCs with intra-articular steroid injection. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  9. Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis

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    Mesut Erbas

    2015-10-01

    Full Text Available ABSTRACTBACKGROUND AND OBJECTIVES:Tenoxicam is widely used in osteoarthritis treatment and we aimedto compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthri-tis treatment.METHODS: This study was performed between 2011 and 2012 by retrospectively analyzing andcomparing the findings of 60 patients who were clinically and radiologically diagnosed with kneedegenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in thestudy were divided into two groups. The first group (tenoxicam IA, n = 30 included patientfindings of those subjected to intra-articular injection of 20 mg tenoxicam to the knee oncea week for three weeks and the second group (oral tenoxicam, n = 30 included patients whowere administered 20 mg oral tenoxicam once a day for three weeks. All patients were clini-cally evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatmentaccording to specified criteria.RESULTS AND CONCLUSIONS: Twenty two of 60 patients included in the study were male and 38were female. In both groups significant improvements were detected in all of the observedparameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physicalactivity, knee stiffness and Lequesne index scores and in the evaluations performed in 1st week,1st month and 3rd month with respect to pre-treatment values. Besides, a better complianceto treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed.Intra-articular tenoxicam administration could be thought as an alternative treatment methodin patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemicgastrointestinal system side effects and those who have difficulties in adapting to treatment.

  10. Disposition of isoflupredone acetate in plasma, urine and synovial fluid following intra-articular administration to exercised Thoroughbred horses.

    Science.gov (United States)

    Knych, Heather K; Harrison, Linda M; White, Alexandria; McKemie, Daniel S

    2016-01-01

    The use of isoflupredone acetate in performance horses and the scarcity of published pharmacokinetic data necessitate further study. The objective of the current study was to describe the plasma pharmacokinetics of isoflupredone acetate as well as time-related urine and synovial fluid concentrations following intra-articular administration to horses. Twelve racing-fit adult Thoroughbred horses received a single intra-articular administration (8 mg) of isoflupredone acetate into the right antebrachiocarpal joint. Blood, urine and synovial fluid samples were collected prior to and at various times up to 28 days post drug administration. All samples were analyzed using liquid chromatography-Mass Spectrometry. Plasma data were analyzed using a population pharmacokinetic compartmental model. Maximum measured plasma isoflupredone concentrations were 1.76 ± 0.526 ng/mL at 4.0 ± 1.31 h and 1.63 ± 0.243 ng/mL at 4.75 ± 0.5 h, respectively, for horses that had synovial fluid collected and for those that did not. The plasma beta half-life was 24.2 h. Isoflupredone concentrations were below the limit of detection in all horses by 48 h and 7 days in plasma and urine, respectively. Isoflupredone was detected in the right antebrachiocarpal and middle carpal joints for 8.38 ± 5.21 and 2.38 ± 0.52 days, respectively. Results of this study provide information that can be used to regulate the use of intra-articular isoflupredone in the horse.

  11. Combination of Intra-Articular and Intraosseous Injections of Platelet Rich Plasma for Severe Knee Osteoarthritis: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Mikel Sánchez

    2016-01-01

    Full Text Available The aim of this study was to assess a novel approach to treating severe knee osteoarthritis by targeting synovial membrane, superficial articular cartilage, synovial fluid, and subchondral bone by combining intra-articular injections and intraosseous infiltrations of platelet rich plasma. We explored a new strategy consisting of intraosseous infiltrations of platelet rich plasma into the subchondral bone in combination with the conventional intra-articular injection in order to tackle several knee joint tissues simultaneously. We assessed the clinical outcomes through osteoarthritis outcome score (KOOS and the inflammatory response by quantifying mesenchymal stem cells in synovial fluid. There was a significant pain reduction in the KOOS from baseline (61.55±14.11 to week 24 (74.60±19.19, after treatment (p=0.008, in the secondary outcomes (symptoms, p=0.004; ADL, p=0.022; sport/rec., p=0.017; QOL, p=0.012, as well as VAS score (p<0.001 and Lequesne Index (p=0.008. The presence of mesenchymal stem cells in synovial fluid and colony-forming cells one week after treatment decreased substantially from 7.98±8.21 MSC/μL to 4.04±5.36 MSC/μL (p=0.019 and from 601.75±312.30 to 139.19±123.61  (p=0.012, respectively. Intra-articular injections combined with intraosseous infiltrations of platelet rich plasma reduce pain and mesenchymal stem cells in synovial fluid, besides significantly improving knee joint function in patients with severe knee osteoarthritis. This trial is registered on EudraCT with the number 2013-003982-32.

  12. Is intra-articular pathology associated with MCL edema on MR imaging of the non-traumatic knee?

    Energy Technology Data Exchange (ETDEWEB)

    Blankenbaker, Donna G.; De Smet, Arthur A. [University of Wisconsin Medical School, Division of Musculoskeletal Imaging, Department of Radiology, Madison (United States); Fine, Jason P. [University of Wisconsin, Department of Statistics, Madison (United States); University of Wisconsin, Department of Biostatistics and Informatics, Madison (United States)

    2005-08-01

    Edema surrounding the medial collateral ligament (MCL) is seen on MR imaging in patients with MCL injuries and in patients with radiographic osteoarthritis in the non-traumatic knee. Because we noted MCL edema in patients without prior trauma or osteoarthritis, we studied the association between intra-articular pathology and MCL edema in patients without knee trauma. We evaluated the MR examinations of 247 consecutive patients (121 male, 126 female with a mean age of 44 years) without recent trauma for the presence of edema surrounding the MCL, meniscal and ACL tears, medial meniscal extrusion, medial compartment chondromalacia, and osteoarthritis. The percentages of patients illustrating MCL edema with and without each type of pathology were compared using Fisher's exact test to determine if there was a statistically significant association. We found MCL edema in 60% of 247 patients. MCL edema was present in 67% of patients with medial meniscal tears, 35% with lateral meniscal tears, 100% with meniscal extrusion of 3 mm or more, 78% with femoral chondromalacia, 82% with tibial chondromalacia, and 50% with osteoarthritis. The percentage of patients with edema increased with the severity of the chondromalacia. These associations were all statistically significant (p <0.02). The mean age of those with MCL edema was 49.7 years compared with 34.9 years without MCL edema (p <0.001). Patient gender and ACL tear did not correlate with MCL edema. Nine (4%) of the 247 patients had MCL edema without intra-articular pathology. None of these 9 patients had MCL tenderness or joint laxity on physical examination. We confirmed that MCL edema is associated with osteoarthritis, but is also associated with meniscal tears, meniscal extrusion, and chondromalacia. In addition, MCL edema can be seen in patients without intra-articular pathology, recent trauma or MCL abnormality on physical examination. (orig.)

  13. Investigation of the immune response to autologous, allogeneic, and xenogeneic mesenchymal stem cells after intra-articular injection in horses.

    Science.gov (United States)

    Pigott, John H; Ishihara, Akikazu; Wellman, Maxey L; Russell, Duncan S; Bertone, Alicia L

    2013-11-15

    Mesenchymal stem cells have demonstrated immunomodulatory capabilities as well as modest efficacy in animal models of joint injury, warranting further study as a potential treatment of joint disease. The goal of the study was to investigate the blood and synovial immune and histologic response to intra-articular injection of autologous, allogeneic, and xenogeneic bone marrow-derived mesenchymal stem cells (MSC) in horses. The study group consisted of 6 five-year-old Thoroughbred mares that had been injected previously with 15 million, genetically modified autologous, allogeneic, or xenogeneic MSC into the fetlock joints. One group of autologous cells was genetically modified to permit MSC biolocalization in the synovium. To assess response to the injection, synovial biopsies were obtained via arthroscopy 60 days after MSC injection for gross, histologic and molecular analyses. Peripheral blood mononuclear cells were isolated from each horse 120 days after MSC injection and co-cultured with a monolayer of each MSC group to permit quantification of activated CD4+ lymphocytes and cytokine release (ELISA) upon re-exposure to MSC. Arthroscopic examination revealed normal synovium with no grossly detrimental effect to the synovium or cartilage. Intra-articular MSC produced a persistent mononuclear infiltrate for at least 60 days, mostly perivascular, identified as CD3+ lymphocytes. An immune response (significant increase in CD4+ lymphocytes) was detected upon re-exposure to xenogeneic but not to allogeneic or autologous MSC. An inflammatory cytokine release from peripheral blood mononuclear cell/MSC co-cultures was present in all MSC groups but was significantly greater in the xenogeneic group. In conclusion, intra-articular injection of MSC, regardless of cell origin, incited a persistent mononuclear synovitis demonstrating a sustained biologic influence of these cells. Allogeneic cells did not elicit a detectable immune response upon re-exposure using our methods

  14. Usefulness of intra-articular bupivacain and lidocain adjunction in MR or CT arthrography: A prospective study in 148 patients

    Energy Technology Data Exchange (ETDEWEB)

    Mosimann, Pascal J., E-mail: pascal.mosimann@chuv.ch [Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne (Switzerland); Richarme, Delphine; Becce, Fabio; Knoepfli, Anne-Sophie; Mino, Vincent; Meuli, Reto [Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne (Switzerland); Theumann, Nicolas [Department of Radiology, Clinique Hirslanden Bois-Cerf, 1006 Lausanne (Switzerland)

    2012-09-15

    Purpose: To evaluate the influence of shorter- and longer-acting intra-articular anaesthetics on post-arthrographic pain. Materials and methods: 154 consecutive patients investigated by MR or CT arthrographies were randomly assigned to one of the following groups: 1 – intra-articular contrast injection only; 2 – lidocain 1% adjunction; or 3 – bupivacain 0.25% adjunction. Pain was assessed before injection, at 15 min, 4 h, 1 day and 1 week after injection by visual analogue scale (VAS). Results: At 15 min, early mean pain score increased by 0.96, 0.24 and 0 in groups 1, 2 and 3, respectively. Differences between groups 1 and 3 and 1 and 2 were statistically significant (p = 0.003 and 0.03, respectively), but not between groups 2 and 3 (p = 0.54). Delayed mean pain score increase was maximal at 4 h, reaching 1.60, 1.22 and 0.29 in groups 1, 2 and 3, respectively. Differences between groups 1 and 2 and 2 and 3 were statistically significant (p = 0.002 and 0.02, respectively), but not between groups 1 and 2 (p = 0.46). At 24 h and 1 week, the interaction of local anaesthetics with increase in pain score was no longer significant. Results were independent of age, gender and baseline VAS. Conclusion: Intra-articular anaesthesia may significantly reduce post-arthrographic pain. Bupivacain seems to be more effective than lidocain to reduce both early and delayed pain.

  15. Changes in ultrasound assessed markers of inflammation following intra-articular steroid injection combined with exercise in knee osteoarthritis

    DEFF Research Database (Denmark)

    Henricsdotter, C; Ellegaard, K; Klokker, L;

    2016-01-01

    in inflammation markers assessed by ultrasound imaging (US) in KOA secondary to intra-articular corticosteroid injection given prior to exercise therapy. DESIGN: This study is a sub-study to a larger clinical trial which compared the clinical effects of steroid injection in KOA to placebo injection, both given...... prior to exercise therapy. The US outcomes were changes from baseline in US-assessed synovial size, Doppler activity presence in the synovial membrane, and numbers of US-detected Baker's cysts. US was performed at baseline, week 14 (exercise stop), and week 26 (follow-up). RESULTS: Fifty participants...

  16. Influence of an intra-articular lipopolysaccharide challenge on markers of inflammation and cartilage metabolism in young horses.

    Science.gov (United States)

    Lucia, J L; Coverdale, J A; Arnold, C E; Winsco, K N

    2013-06-01

    Nineteen weanling Quarter Horses (225 to 380 kg) were used in a randomized complete block design to investigate the effects of intra-articular lipopolysaccharide (LPS) to induce acute joint inflammation in young horses. Horses were blocked by age, BW, and sex and were randomly assigned to 1 of 3 treatments for a 35-d experiment. Treatments included intra-articular injection of 0.25 ng (n = 7) or 0.50 ng (n = 6) of LPS obtained from Escherichia coli O55:B5 or sterile lactated Ringer's solution (n = 6; control) into the radial carpal joint. Synovial fluid was obtained at preinjection h 0 and 2, 6, 12, 24, 168, and 336 h postinjection and was analyzed for PGE2, carboxypeptide of type II collagen (CPII), and collagenase cleavage neopeptide (C2C) biomarkers via commercial ELISA kits. Rectal temperature (RT), heart rate (HR), respiratory rate (RR), and carpal circumference were recorded before each sample. Lameness scores on a 0 to 5 scale were conducted after arthrocentesis. Data were analyzed using PROC MIXED procedure of SAS. Linear and cubic effects were tested in the form of contrasts. Clinical assessment of HR, RR, and RT were not influenced by treatment (P ≤ 0.16). All horses exhibited increased lameness scores over time (P ≤ 0.01), and horses receiving LPS, regardless of dose, had greater recorded lameness scores at 12 and 24 h postinjection (P ≤ 0.05). Joint circumference increased (P ≤ 0.01) across treatments in response to repeated arthrocentesis. Mean synovial fluid PGE2 concentrations increased linearly with increasing levels of LPS administration (P ≤ 0.01). Additionally, regardless of treatment, PGE2 increased over time and peaked at 12 h postinjection (P ≤ 0.01) and remained elevated above baseline at 336 h postinduction. Synovial concentrations of anabolic CPII increased linearly (P ≤ 0.01) with increasing dosage of LPS and increased (P ≤ 0.01) over 24 h in all horses, beginning at 6 h and peaking at 24 h postinjection. Concentrations of

  17. A new building block: costo-osteochondral graft for intra-articular incongruity after distal radius fracture.

    Science.gov (United States)

    Tang, Chris Yuk Kwan; Fung, Boris; Poon, T L; Fok, Margaret

    2014-01-01

    Even with the invention of locking plates, intra-articular fractures of distal radius with extreme comminution remain a challenge for orthopaedic surgeons. Osteochondral graft is a potential choice to reconstruct the articular defect. We report a patient who had a fracture of distal radius with costo-osteochondral graft for articular reconstruction which has not yet been described in the English literature. At nine-year follow-up, he was pain free and had full range of movement of the wrist. The authors suggest that costo-osteochondral graft could be an option with satisfactory result.

  18. Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints

    Science.gov (United States)

    Walker, J. A.; Ewald, T. J.; Lewallen, E.; Van Wijnen, A.; Hanssen, A. D.; Morrey, B. F.; Morrey, M. E.; Abdel, M. P.

    2017-01-01

    Objectives Sustained intra-articular delivery of pharmacological agents is an attractive modality but requires use of a safe carrier that would not induce cartilage damage or fibrosis. Collagen scaffolds are widely available and could be used intra-articularly, but no investigation has looked at the safety of collagen scaffolds within synovial joints. The aim of this study was to determine the safety of collagen scaffold implantation in a validated in vivo animal model of knee arthrofibrosis. Materials and Methods A total of 96 rabbits were randomly and equally assigned to four different groups: arthrotomy alone; arthrotomy and collagen scaffold placement; contracture surgery; and contracture surgery and collagen scaffold placement. Animals were killed in equal numbers at 72 hours, two weeks, eight weeks, and 24 weeks. Joint contracture was measured, and cartilage and synovial samples underwent histological analysis. Results Animals that underwent arthrotomy had equivalent joint contractures regardless of scaffold implantation (-13.9° versus -10.9°, equivalence limit 15°). Animals that underwent surgery to induce contracture did not demonstrate equivalent joint contractures with (41.8°) or without (53.9°) collagen scaffold implantation. Chondral damage occurred in similar rates with (11 of 48) and without (nine of 48) scaffold implantation. No significant difference in synovitis was noted between groups. Absorption of the collagen scaffold occurred within eight weeks in all animals Conclusion Our data suggest that intra-articular implantation of a collagen sponge does not induce synovitis or cartilage damage. Implantation in a native joint does not seem to induce contracture. Implantation of the collagen sponge in a rabbit knee model of contracture may decrease the severity of the contracture. Cite this article: J. A. Walker, T. J. Ewald, E. Lewallen, A. Van Wijnen, A. D. Hanssen, B. F. Morrey, M. E. Morrey, M. P. Abdel, J. Sanchez-Sotelo. Intra-articular

  19. The Effectiveness of Ultrasound-Guided Steroid Injection for Femoroacetabular Impingement: A Comparison between the Extra-Articular and Intra-Articular Approaches

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Chang Ho; Lee, Joon Woo [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2013-03-15

    To assess the effectiveness of pain control using ultrasound-guided steroid injection by the extra-articular and intra-articular approaches to femoroacetabular impingement patients. From September through December 2010, 18 patients with clinical suspicion of femoroacetabular impingement syndrome underwent ultrasound-guided steroid and local anesthetics injection: a total of 20 cases, including 16 cases of ipsilateral and 2 cases of bilateral injection. Extra-articular or intra-articular approach was selected for each patient, randomly and alternately. Nine cases were performed by extra-articular approach and 11 cases were performed by intra-articular approach. Every patient was observed in the outpatient clinic and visual analogue scale (VAS) was taken and compared before and after the procedure in all patients. Pre-injection average VAS value of extra-articular approached cases was 5.22 {+-} 1.99 and post-injection average VAS value was 4.11 {+-} 1.96, which is statistically insignificant (p < 0.156). The average VAS value of intra-articular approached cases was decreased from 5.72 {+-} 2.15 to 2.91 {+-} 2.30 after injection, which is statistically significant (p < 0.006). Ultrasound guided intra-articular approached steroid and local anesthetics injection could be effective in controlling pain for patients with femoroacetabular impingement syndrome.

  20. Análise da sintomatologia em pacientes com disfunções intra-articulares da articulação temporomandibular Analysis of symptomatology in patients with intra-articular disorders of the temporomandibular joint

    Directory of Open Access Journals (Sweden)

    Sílvio Henrique de Paula DONEGÁ

    1997-01-01

    Full Text Available Foi realizado estudo analisando a sintomatologia em pacientes com disfunções intra-articulares da articulação temporomandibular. A queixa mais citada foi de dor na região pré-auricular (40,7%. Sintomatologia dolorosa articular (63,2% e ruídos articulares (83,3% foram os achados mais comuns ao exame clínico. Os ruídos articulares mais freqüentes foram os estalos (66,6%. Dor muscular ocorreu, em especial, nos músculos pterigóideo medial e lateral e na inserção do temporal. Houve decréscimo na amplitude para a protrusão dentre os movimentos mandibulares máximosThe study analyzed the symptomatology in patients with intra-articular disorders of the temporomandibular joint. The most frequent complaint was pain in the preauricular region (40.7%. Articular pain (63.2% and articular sounds (83.3% were the most common findings during clinical examination. Muscular pain occurred particularly in the medial and lateral pterygoid muscles and at the insertion of the temporalis muscle. The most frequent articular sound was clicking (66.6%. There was a decrease in extent of protrusion among the mandibular border positions.

  1. Intra-articular injection of tenoxicam in rats: assessment of the local effects on the articular cartilage and synovium.

    Science.gov (United States)

    Ozyuvaci, H; Bilgic, B; Ozyuvaci, E; Altan, A; Altug, T; Karaca, C

    2004-01-01

    This study investigated the possible local adverse effects of intra-articular administration of tenoxicam in the rat knee joint. A total of 50 rats were given 0.25 ml of a standard preparation of tenoxicam by injection into the right knee joint and 0.25 ml of 0.9% saline solution by injection into the left knee joint as a control. Groups of 10 rats were killed 24 h, 48 h, 7 days, 14 days and 21 days after tenoxicam administration. Two rats were sham operated; one was killed on the first day and the other on the second day after this procedure. All the joints were prepared and sectioned for histological examination. Tissue loss and oedema were observed in the specimens obtained 24 h and 48 h after treatment with tenoxicam. No pathological changes were observed in the 7-day, 14-day and 21-day specimens, or in the control joints. Caution should be exercised when using intra-articular tenoxicam for post-operative analgesia.

  2. Treatment of intra-articular distal radius fractures by the volar intrafocal Kapandji method: a case series.

    Science.gov (United States)

    Rubin, Guy; Chezar, Avi; Rinott, Micha; Bor, Noam; Rozen, Nimrod

    2013-06-01

    At present, the most common treatment for intra-articular fractures with a volar fragment is open reduction and internal fixation with a volar locking plate. This manuscript describes and evaluates the safety and efficacy of a modified Kapandji technique with insertion of a volar Kirschner wire for osteosynthesis of intra-articular distal radius fractures with a volar fragment. Four patients treated with the "volar Kapandji technique" completed follow-up of at least 12 (12 to 54) months. The mean age was 43 (23 to 53) years. The mean Disability of the Arm, Shoulder, and Hand score was 21.7 (0 to 41) and the mean Patient-Rated Wrist Evaluation score was 12.9 (0 to 25.8). The mean loss of flexion was 13.7 (0 to 30) degrees, the mean loss of extension was 10 (0 to 30) degrees, the mean loss of supination was 0 degrees, and the mean loss of pronation was 10 (0 to 20) degrees. There was no loss in dorsal angulation, radial inclination, or radial length compared with the other hand. No early or late complications were recorded.

  3. Hyaluronic acid-coated bovine serum albumin nanoparticles loaded with brucine as selective nanovectors for intra-articular injection

    Directory of Open Access Journals (Sweden)

    Chen Z

    2013-10-01

    Full Text Available Zhipeng Chen,* Juan Chen,* Li Wu, Weidong Li, Jun Chen, Haibo Cheng, Jinhuo Pan, Baochang CaiDepartment of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China*These authors contributed equally to this workObjective: To evaluate the potential of hyaluronic acid (HA-coated bovine serum albumin nanoparticles (BSANPs as a novel chondrocyte-targeting drug-delivery nanomedicine.Methods: The HA-BSANPs were characterized by dynamic light scattering, transmission electron microscopy, differential scanning calorimetry, and X-ray diffraction. Fluorescence imaging was used to visualize the distribution of nanoparticles after intra-articular injection. The chondrocyte-targeting efficiency and cellular uptake mechanism of HA-BSANPs were investigated using endocytic inhibitors.Results: HA-BSANPs were successfully prepared with HA coating the surface and amorphous drug in the core. Compared with BSANPs, HA-BSANPs exhibited improved uptake by chondrocytes through a receptor-mediated active uptake mechanism. The endocytosis process of BSANPs and HA-BSANPs involved clathrin-mediated endocytosis, caveolae-mediated endocytosis, and macropinocytosis. No apparent thickening or hyperplasia of the synovium was observed in either BSANPs or HA-BSANPs. The HA-BSANPs could reside in the articular cavity of rats for more than 14 days, which was significantly longer than BSANPs.Conclusion: HA-BSANPs are a promising carrier for articular-related diseases due to elongated articular residence and improved chondrocytic accumulation.Keywords: chondrocyte, intra-articular injection, hyaluronic acid, BSA, nanoparticles

  4. Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review

    Directory of Open Access Journals (Sweden)

    Eduardo Machado

    2013-10-01

    Full Text Available INTRODUCTION: In some cases, conservative treatment of internal derangements of the Temporomandibular Joint (TMJ is considered little responsive. Thus, it is necessary to accomplish treatments that aim at reducing pain and improve patients' functions who present arthrogenic temporomandibular disorders. OBJECTIVE: This study, by means of a systematic review of the literature, aimed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ. METHODS: Carry out a research in the following databases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs, and BBO, considering publications issued between 1966 and October of 2010, focusing on randomized or quasi-randomized controlled clinical trials, single or double-blind. RESULTS: After applying the inclusion criteria we collected 9 articles, 7 of which were randomized controlled double-blind clinical trials and 2 randomized controlled single-blind clinical trials. CONCLUSION: After analyzing the literature, it was found that intra-articular injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ. However, further randomized controlled clinical trials, with representative samples and longer follow-up time must be carried out in order to assess the real effectiveness of this technique.

  5. Protoporphyrin IX distribution after intra-articular and systemic application of 5-aminolevulinic acid in healthy and arthritic joints

    Science.gov (United States)

    Huettmann, Gereon; Hendrich, Christian; Birngruber, Reginald; Lehnert, Christiane; Seara, Jose; Siebert, Werner E.; Diddens, Heyke C.

    1996-04-01

    Arthroscopic synovectomy, which is limited today to the large joints, is an important early treatment of rheumatoid arthritis (RA). Photodynamic therapy (PDT) is potentially to be a less invasive method of removing the synovial membrane. Therefore, in a rabbit model of RA, the accumulation of the photosensitizer Protoporphyrin IX (PPIX) after intra-articular and systemic application of ALA into arthritic rabbit knee joints was studied in skin, patella, synovial tissue, and meniscus by fluorescence microscopy. PPIX fluorescence was measured in biopsies taken at different times after application of neutral and acid ALA solutions. Significant PPIX fluorescence was observed in the synovial membrane and skin 2 and 4 hours after application. Using intra-articular application, ALA solutions prepared with pH 5.5 were at least as efficient as neutral solutions in sensitizing the synovial membrane. Skin also showed PPIX within 4 hours after application. After 24 hours, a marginal PPIX fluorescence was detected in these tissues. On the other hand, in cartilage and meniscus significant PPIX accumulation was still observed 24 hours after ALA injection. Systemic application of ALA also showed a good accumulation of PPIX. Further experiments are needed to show whether accumulation of the photosensitizer and tissue selectivity are sufficient for a successful treatment of rheumatoid synovitis.

  6. Osteoarthritis in horses - Part 2: a review of the intra-articular use of corticosteroids as a method of treatment

    Directory of Open Access Journals (Sweden)

    Maria Verônica de Souza

    Full Text Available ABSTRACT: The problem considered in this review is related to the frequent use of corticosteroids (COs (i.e. steroids in the practice of equine medicine and surgery as a therapeutic strategy in the treatment of degenerative joint disease, commonly known as osteoarthritis (OA. This disease is one of the most common among the equine musculoskeletal diseases, and is clinically characterized by pain, lameness, joint effusion at the initial stage, which usually reduces with the progression of the disease, and reduced physical performance. Although steroids are considered excellent drugs in the control of clinical signs resulting from osteoarthritis, they also influence cellular activity through activation of various signaling mechanisms. However, they can cause adverse effects when administered intra-articularly, since they are immunosuppressive drugs of many cell types. They are also incriminated as suppressors of the chondrocyte matrix synthetic activities, which may contribute to 'arthropathy by corticosteroids', which can also be associated with cumulative injury resulting from improper use (dose and frequency of application of already damaged joints. The objective of this article is to review information about the advantages and disadvantages of intra-articular COs for treatment of the disease in horses. In addition, some important information of other species is also presented.

  7. Intra-articular Administration of Chitosan Thermosensitive In Situ Hydrogels Combined With Diclofenac Sodium-Loaded Alginate Microspheres.

    Science.gov (United States)

    Qi, Xiaole; Qin, Xiaoxue; Yang, Rong; Qin, Jiayi; Li, Wenyan; Luan, Kun; Wu, Zhenghong; Song, Li

    2016-01-01

    The aims of this study were to prepare fine intra-articular-administrated chitosan thermosensitive hydrogels combined with alginate microspheres and to investigate the possibility of those hydrogels as a drug delivery system for promoting the anti-inflammation effect. Diclofenac sodium containing alginate microspheres was prepared by a modified emulsification and/or gelation method and then dispersed into injectable thermosensitive hydrogels, consisting of chitosan and β-glycerophosphate. The final combined hydrogels were evaluated in terms of their morphology properties, rheological properties, in vitro drug release, and in vivo biocompatibility and pharmacodynamics behaviors. The optimized formulation exhibited sol-gel transition at 31.72 ± 0.42°C and quickly turned into gel within 5 min, with sustained drug release characteristics followed Ritger-Peppas equation, which could prolong the in vitro drug release to 5 days. In addition, the anti-inflammation efficacy of the combined hydrogels in rabbits with experimental rheumatoid arthritis was higher than that of drug solution and pure chitosan hydrogels. Those results demonstrated that these combined hydrogels could become a potential drug delivery system for improving the therapeutic effect of diclofenac sodium and suggested an important technology platform for intra-articular administration.

  8. Intra-Articular Hyaluronic Acid Compared to Traditional Conservative Treatment in Dogs with Osteoarthritis Associated with Hip Dysplasia

    Science.gov (United States)

    Carapeba, Gabriel O. L.; Cavaleti, Poliana; Brinholi, Rejane B.

    2016-01-01

    The purpose of this study was to compare the efficacy of the intra-articular (IA) hyaluronic acid injection to traditional conservative treatment (TCT) in dogs with osteoarthritis (OA) induced by hip dysplasia. Sixteen dogs were distributed into two groups: Hyal: IA injection of hyaluronic acid (5–10 mg), and Control: IA injection with saline solution (0.5–1.0 mL) in combination with a TCT using an oral nutraceutical (750–1000 mg every 12 h for 90 days) and carprofen (2.2 mg/kg every 12 h for 15 days). All dogs were assessed by a veterinarian on five occasions and the owner completed an assessment form (HCPI and CPBI) at the same time. The data were analyzed using unpaired t test, ANOVA, and Tukey's test (P < 0.05). Compared with baseline, lower scores were observed in both groups over the 90 days in the veterinarian evaluation, HCPI, and CPBI (P < 0.001). The Hyal group exhibited lower scores from 15 to 90 and 60 to 90 days, in the CBPI and in the veterinarian evaluation, respectively, compared to the Control group. Both treatments reduced the clinical signs associated with hip OA. However, more significant results were achieved with intra-articular hyaluronic acid injection. PMID:27847523

  9. Modulation of Synovial Fluid-Derived Mesenchymal Stem Cells by Intra-Articular and Intraosseous Platelet Rich Plasma Administration

    Directory of Open Access Journals (Sweden)

    Emma Muiños-López

    2016-01-01

    Full Text Available The aim of this study was to evaluate the effect of intra-articular (IA or a combination of intra-articular and intraosseous (IO infiltration of Platelet Rich Plasma (PRP on the cellular content of synovial fluid (SF of osteoarthritic patients. Thirty-one patients received a single infiltration of PRP either in the IA space (n=14 or in the IA space together with two IO infiltrations, one in the medial femoral condyle and one in the tibial plateau (n=17. SF was collected before and after one week of the infiltration. The presence in the SF of mesenchymal stem cells (MSCs, monocytes, and lymphocytes was determined and quantified by flow cytometry. The number and identity of the MSCs were further confirmed by colony-forming and differentiation assays. PRP infiltration into the subchondral bone (SB and the IA space induced a reduction in the population of MSCs in the SF. This reduction in MSCs was further confirmed by colony-forming (CFU-F assay. On the contrary, IA infiltration alone did not cause variations in any of the cellular populations by flow cytometry or CFU-F assay. The SF of osteoarthritic patients contains a population of MSCs that can be modulated by PRP infiltration of the SB compartment.

  10. Ozonoterapia sistémica e intra-articular en la artritis de la articulación temporomandibular por artritis reumatoide

    OpenAIRE

    Ivonne Méndez-Pérez; Alejandro del Cerro-Montesino; Roosevelt Cámbara-Peña; Julio Martínez-Godíne; Silvia Menéndez-Cepero

    2010-01-01

    Se estudió el efecto de la ozonoterapia intra-articular combinada con la vía sistémica (vía rectal) y se comparó con la sola aplicación por vía intra-articular en pacientes con artritis de la articulación temporomandibular (ATM) por artritis reumatoide (AR) mediante la evaluación clínica del dolor a la masticación, chasquido y trismo. Fueron estudiados veinte pacientes, divididos en dos grupos de diez cada uno, el primero recibió ozonoterapia intra-articular (concentración de ozono 10 mg/L y ...

  11. A Case Report of Intra-articular Bee Venom Pharmacopuncture combining with oriental medical treatment for Acute Traumatic Partial Tear of Meniscus.

    Directory of Open Access Journals (Sweden)

    Lee Jae-Hoon

    2010-12-01

    Full Text Available This case was report of intra-articular bee venom pharmacopuncture injection on the patient with Acute Traumatic Partial tear of meniscus. We used intra-articular bee venom pharmacopuncture injection to Acute Traumatic Partial tear of meniscus diagnosed by symptoms and MR imaging. Be under treatment if necessary we prescribed herbal medication and physiotherapy. The state of patient was measured by Visual Analog Scale(VAS and Walking time and Western Ontario and McMaster Universities(WOMAC Index score. After several times of treatments, noticeable reduction of pain was measured and increased time of walking on floor and decreased WOMAC score. This results suggest that intra-articular bee venom pharmacopuncture injection are effective to treatments of Acute Traumatic Partial tear of meniscus.

  12. The Use of Calcaneal Anatomic Plate in Arthroscopically-assisted Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures

    Institute of Scientific and Technical Information of China (English)

    WANG Hong; ZHANG Qingsong; DUAN Deyu; YAN Lijun

    2006-01-01

    To discuss and evaluate the method and effect of using calcaneal anatomic plate in treatment of intra-articular fractures of the calcaneus with assistant of arthroscope, 86 intra-articular fractures of the calcaneus in 78 patients were reduced by open reduction, and rigid fixation was made with calcaneal anatomic plate under assistant of arthroscope. The average follow-up duration was 18 months (range 12-30 months). The effect of treatment was evaluated according to AOFAS and X-ray before and after operation. The results showed that 86 patients have obtained satisfactory reduction according to X-ray, and there was significant difference before and after operation (P<0.01), the total excellent and fine rate was 91.86 %. Treating intra-articular fractures of the calcaneus with calcaneal anatomic plate under arthroscope may provide more chance to achieve anatomical reconstruction, which can lead to satisfied recovery of function and few complication.

  13. Prolonged naproxen joint residence time after intra-articular injection of lipophilic solutions comprising a naproxen glycolamide ester prodrug in the rat

    DEFF Research Database (Denmark)

    Thing, Mette; Lu, Yi; Agårdh, Li;

    2013-01-01

    Intra-articular injection of oil solutions of lipophilic prodrugs that rapidly degrade to their parent compound in synovial fluid may constitute a feasible approach to increase the joint residence time of non-steroidal anti-inflammatory drugs. In this in vivo study, oil solutions of the N......,N-diethyl glycolamide ester prodrug of naproxen (16mg/ml) were injected into the rat knee joint by dosing 6μl formulation per 100g body weight. The sustained release properties were compared to those of intra-articularly injected aqueous and oil solutions of naproxen by monitoring the naproxen serum concentrations over...... time. Two oils, medium-chain triglycerides and castor oil, differing with respect to viscosity were tested. After intra-articular administration of oil prodrug solutions, a significant increase in the time to maximum naproxen serum concentration from around 40 to 245min, an increase in the MRTj from...

  14. Appropriateness of clinical and organizational criteria for intra-articular injection therapies in osteoarthritis: A Delphi method consensus initiative among experts in Italy

    Directory of Open Access Journals (Sweden)

    Marco Paoloni

    2015-06-01

    Full Text Available OBJECTIVE: The aim of the study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile, as well as the medico-legal and organizational aspects of intra-articular injection therapies for osteoarthritis. METHODS: A committee of 10 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Fifty-two clinicians from a large number of Italian medical centers specialized in intra-articular injection therapy took part in a Delphi process aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical device choice; treatment efficacy; and appropriate setting. CONCLUSIONS: The consensus statements developed by a large number of experts may be used as a practical reference tool to help physicians treat osteoarthritis patients by means of intra-articular injection therapies.

  15. Efficacy and safety of combining intra-articular methylprednisolone and anti-TNF agent to achieve prolonged remission in patients with recurrent inflammatory monoarthritis.

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2012-02-01

    OBJECTIVE: To control local inflammation, the role of intra-articular corticosteroid is well established; similarly, with time there are more reports on the experience of intra-articular anti-TNF agent for localized joint inflammation. The aim of this study was to assess the safety, local tolerability and clinical response after combining intra-articular administration of corticosteroids and anti-TNF agents for recurrent inflammatory monoarthritis. METHODS: Patients with recurrent monoarthritis of the knee were recruited from our inflammatory arthritis clinics. These patients required intra-articular corticosteroids every 8-12 weeks, with good short-term results. Five such consecutive patients were invited to partake in this study. Patients were maintained on their baseline immunosuppressive therapy. After aspiration of knee joint, the involved joint was injected with 80mg of methylprednisolone mixed with 5ml of lignocaine 1%; this was followed by the injection of an anti-TNF agent. RESULTS: In majority of our patients (three out of five), combining anti-TNF agent and methylprednisolone led to prolonged anti-inflammatory response, and these patients remain in remission to date (mean follow-up of 12 months). These responders were noted to be naive to anti-TNF therapy. Conversely, the remaining two patients were found to be on baseline systemic anti-TNF therapy, and both of them failed to respond either partly or completely. CONCLUSION: Combining intra-articular corticosteroid and anti-TNF agent has proved to be safe in our cohort of patients. We conclude that in particular subset of patients who suffer from recurrent inflammatory monoarthritis or oligoarthritis, combination therapy of intra-articular corticosteroids and anti-TNF agents appears attractive and promising.

  16. Uso de plasma rico em plaquetas intra-articulares como tratamento pós-cirúrgico da ruptura do ligamento cruzado cranial num cão

    OpenAIRE

    R. F. Silva; Carmona,J.U.; Rezende, C. M. F.

    2012-01-01

    Relata-se o caso de um cão que recebeu injeções intra-articulares de plasma rico em plaquetas (PRP) durante o pós-operatório do tratamento cirúrgico de ruptura do ligamento cruzado cranial (RLCCr). Os resultados clínicos e da avaliação da marcha mediante plataforma de força neste paciente sugerem a utilização de injeções intra-articulares de PRP como terapia pós-cirúrgica no tratamento da RLCCr.

  17. Uso de plasma rico em plaquetas intra-articulares como tratamento pós-cirúrgico da ruptura do ligamento cruzado cranial num cão

    Directory of Open Access Journals (Sweden)

    R.F. Silva

    2012-08-01

    Full Text Available Relata-se o caso de um cão que recebeu injeções intra-articulares de plasma rico em plaquetas (PRP durante o pós-operatório do tratamento cirúrgico de ruptura do ligamento cruzado cranial (RLCCr. Os resultados clínicos e da avaliação da marcha mediante plataforma de força neste paciente sugerem a utilização de injeções intra-articulares de PRP como terapia pós-cirúrgica no tratamento da RLCCr.

  18. Combination Intravenous and Intra-Articular Tranexamic acid compared with Intravenous Only Administration and No Therapy in Total Knee Arthroplasty: A Case Series Study

    Directory of Open Access Journals (Sweden)

    Chris Buntting

    2016-07-01

    This study supports the existing literature and suggests that the use of IV Tranexamic acid alone or in combination with intra-articular dose in TKA may reduce the requirement for transfusion (Level IV evidence. Furthermore, this study suggests that the use of tranexamic acid as a combination of Intravenous and intra-articular administration has no effect on range of motion, or medical complications during hospital stay. Although it was not a statistically significant finding, our study suggested a trend towards a greater reduction in haemoglobin and haematocrit fall in the combination therapy group when compared to IV Tranexamic acid alone

  19. Análise da sintomatologia em pacientes com disfunções intra-articulares da articulação temporomandibular Analysis of symptomatology in patients with intra-articular disorders of the temporomandibular joint

    OpenAIRE

    DONEGÁ,Sílvio Henrique de Paula; Cardoso, Renato [UNIFESP; Antonio Sílvio Fontão PROCÓPIO; Luz,João Gualberto de Cerqueira

    1997-01-01

    Foi realizado estudo analisando a sintomatologia em pacientes com disfunções intra-articulares da articulação temporomandibular. A queixa mais citada foi de dor na região pré-auricular (40,7%). Sintomatologia dolorosa articular (63,2%) e ruídos articulares (83,3%) foram os achados mais comuns ao exame clínico. Os ruídos articulares mais freqüentes foram os estalos (66,6%). Dor muscular ocorreu, em especial, nos músculos pterigóideo medial e lateral e na inserção do temporal. Houve decréscimo ...

  20. [Reconstruction of calcaneal thalamus and subtalar arthrodesis to treat old antiquated intra-articular calcaneal fractures of Sanders type III].

    Science.gov (United States)

    Sun, Qing-Peng

    2013-11-01

    To observe the outcome of treatment for serious old intra-articular calcaneal fracture by reconstruction of calcaneal thalamus and subtalar arthrodesis and to summarize the operative indications and its attention points. From March 2006 to July 2011,26 patients with Sanders type III old intra-articular calcaneal fracture were treated including 15 males and 11 females with an average age of 34 years old ranging from 27 to 45 years old. The clinical courses ranged from 7 to 24 months with an average of 18 months. Before the operation,X-ray and CT showed that Gissane angle increased while Böhler angle decreased,and calcaneus broadened,bulging on both sides. After the operations,all patients tested by imaging examination, and the width of calcaneus, the height of calcaneal thalamus, the Böhler angle and Gissane angle were measured to compare with the preoperative data. Besides, for identification of improvement of the operation,the functions of patient's feet after the operation were graded according to AOFAS Ankle-Hindfoot Scale to compare with preoperative data. Among them, 24 patients were followed-up from 5 to 26 months with an average of 19 months. X-rays confirmed that all cases healed successfully. There were no serious infection, and only one skin necrosis case. Sural neurocutaneous island flap was used to repair the skin with success. According to AOFAS Ankle-Hindfoot Scale, the total score increased from preoperative (41.00 +/- 8.22) to postoperative (79.04 +/- 7.46). There were 3 cases of excellent result, 15 cases of good result,and 6 cases of fair result. Postoperative width of calcaneus, the height of thalamus, Böhler angle and Gissane angle were better than that of preoperative data, and had statistical significance between two groups. Subtalar arthrodesis with the reconstruction of calcaneal thalamus is an effective way to treat old intra-articular calcaneal fractures. It can correct the calcaneal deformity, restore the shape of foot and improve the

  1. A Patient with Fatal Necrotizing Fasciitis following the Use of Intra-Articular Sodium Hyaluronate Injections: A Case Report

    Directory of Open Access Journals (Sweden)

    Shanti Virupannavar

    2013-01-01

    Full Text Available Introduction. Osteoarthritis, a degenerative joint disease, is a key cause of disability around the world and an ever-growing public health concern. Intra-articular hyaluronic acid viscosupplementation is used as a conservative option for osteoarthritis knee pain relief (McArthur et al., 2012; Hootman and Helmick, 2006; Huang el al., 2011. In general, the literature has shown an excellent safety profile for this treatment modality (McArthur et al., 2012; Clegg et al., 2013; Hammesfahr et al., 2003; Neustadt et al., 2005; Cohen et al., 2008; Neustadt, 2003; Jüni et al., 2007; Peterson and Hodler, 2011. Case Presentation. In this report, we describe a case of a woman who had received multiple sodium hyaluronate injections and developed severe necrotizing fasciitis near the injection site. Conclusion. We recommend that clear guidelines for clean technique be put in place for use with sodium hyaluronate injections and consideration of full sterile technique in immunosuppressed patients.

  2. A Patient with Fatal Necrotizing Fasciitis following the Use of Intra-Articular Sodium Hyaluronate Injections: A Case Report.

    Science.gov (United States)

    Virupannavar, Shanti; Guggenheim, Carla

    2013-01-01

    Introduction. Osteoarthritis, a degenerative joint disease, is a key cause of disability around the world and an ever-growing public health concern. Intra-articular hyaluronic acid viscosupplementation is used as a conservative option for osteoarthritis knee pain relief (McArthur et al., 2012; Hootman and Helmick, 2006; Huang el al., 2011). In general, the literature has shown an excellent safety profile for this treatment modality (McArthur et al., 2012; Clegg et al., 2013; Hammesfahr et al., 2003; Neustadt et al., 2005; Cohen et al., 2008; Neustadt, 2003; Jüni et al., 2007; Peterson and Hodler, 2011). Case Presentation. In this report, we describe a case of a woman who had received multiple sodium hyaluronate injections and developed severe necrotizing fasciitis near the injection site. Conclusion. We recommend that clear guidelines for clean technique be put in place for use with sodium hyaluronate injections and consideration of full sterile technique in immunosuppressed patients.

  3. Sustentaculum Lunatum: Appreciation of the Palmar Lunate Facet in Management of Complex Intra-Articular Fractures of the Distal Radius.

    Science.gov (United States)

    Paryavi, Ebrahim; Christian, Matthew W; Eglseder, W Andrew; Pensy, Raymond A

    2015-09-01

    Fracture of the distal radius is the most common wrist injury. Treatment of complex intra-articular fractures of the distal radius requires an accurate diagnosis of the fracture pattern and a thoughtful approach to fixation. We propose a new term, sustentaculum lunatum, for the palmar lunate facet. The sustentaculum lunatum deserves specific attention because of its importance in load transmission across the radiocarpal joint. It is also key to restoring the anatomy of the palmar distal radial metaphysis during internal fixation. We provide a review of the structure and function of the sustentaculum lunatum and describe fixation techniques. This article is intended to promote awareness of this fragment in the treatment of fractures of the distal radius.

  4. Pain perception in knees with circumscribed cartilage lesions is associated with intra-articular IGF-1 expression

    DEFF Research Database (Denmark)

    Schmal, Hagen; Niemeyer, Philipp; Südkamp, Norbert P;

    2011-01-01

    (IKDC) score. Synovial concentrations of aggrecan, insulin-like growth factor (IGF)-I, basic fibroblast growth factor (bFGF), interleukin (IL)-1β, bone morphogenetic protein (BMP)-2, and BMP-7 were determined by enzyme-linked immunosorbent assay. RESULTS: Pain strength showed a highly significant......BACKGROUND: Circumscribed cartilage defects are considered as prearthritic lesions and lead to differential intra-articular cytokine expression. Mechanisms of associated pain development and influence of smoking behavior are not yet fully understood in humans. PURPOSE: This study aimed to reveal......, IGF-1, and bFGF was significantly diminished compared to nonsmokers (P growth factor-I is present in knees with circumscribed cartilage lesions in a size-dependent manner. IGF-1 levels correlated with indicators of pain perception; smoking negatively influenced...

  5. Clinical benefit of intra-articular saline as a comparator in clinical trials of knee osteoarthritis treatments

    DEFF Research Database (Denmark)

    Altman, Roy D; Devji, Tahira; Bhandari, Mohit;

    2016-01-01

    OBJECTIVES: Hyaluronic acid and corticosteroids are common intra-articular (IA) therapies widely used for the management of mild to moderate knee osteoarthritis (OA). Many trials evaluating the efficacy of IA administered therapies commonly use IA saline injections as a placebo comparator arm....... Using a systematic review and meta-analysis, our objective was to assess the clinical benefit associated with use of IA saline in trials of IA therapies in the treatment of patients with painful knee OA. METHODS: MEDLINE and Embase databases were searched for articles published up to and including...... in the meta-analysis. Based on data with moderate inconsistency IA saline was found to significantly improve short-term knee pain in 32 studies involving 1705 patients (SMD = -0.68; 95% CI: -0.78 to -0.57; P IA injection...

  6. Intra-articular morphine versus bupivacaine for knee motion among patients with osteoarthritis: randomized double-blind clinical trial

    Directory of Open Access Journals (Sweden)

    Miriam Bellini Gazi

    Full Text Available CONTEXT AND OBJECTIVE: Osteoarthritis causes pain and disability in a high percentage of elderly people. The aim of the present study was to assess the efficacy of intra-articular morphine and bupivacaine on the joint flexion and extension angles of patients with knee osteoarthritis. DESIGN AND SETTING: A randomized double-blind study was performed at a pain clinic of Universidade Federal de São Paulo. METHODS: Thirty-nine patients with pain for more than three months, of intensity greater than three on a numerical scale (zero to 10, were included. G1 patients received 1 mg (1 ml of morphine diluted in 9 ml of saline, intra-articularly, and G2 patients received 25 mg (10 ml of 0.25% bupivacaine without epinephrine. Pain was assessed on a numerical scale and knee flexion and extension angles were measured after administration of the drugs at rest and during movement. The total amount of analgesic supplementation using 500 mg doses of paracetamol was also determined. RESULTS: No significant difference in pain intensity was observed between G1 and G2. Significant decreases in pain at rest and during movement and significant increases in mean flexion and extension angles were observed in both groups, with no significant difference between the two groups. The mean total amount of paracetamol used over a seven-day period was 3578 mg in G1 and 5333 mg in G2 (P = 0.2355; Mann-Whitney test. CONCLUSION: The analgesic effects of 1 mg of morphine and 25 mg of 0.25% bupivacaine were similar among patients with osteoarthritis of the knee.

  7. Evaluation of a Single Intra-Articular Injection of Autologous Protein Solution for Treatment of Osteoarthritis in a Canine Population.

    Science.gov (United States)

    Wanstrath, Audrey W; Hettlich, Bianca F; Su, Lillian; Smith, Ashley; Zekas, Lisa J; Allen, Matthew J; Bertone, Alicia L

    2016-08-01

    To evaluate the safety and efficacy of an intra-articular injection of autologous protein solution (APS) for treatment of canine osteoarthritis (OA). Prospective, randomized, blinded, placebo-controlled pilot clinical trial. Client-owned dogs with single limb lameness because of OA in a stifle or elbow joint (n=21). Lame dogs, confirmed with OA by physical and lameness examination and imaging, were randomly assigned to control or treatment groups. Owners, blinded to treatment, scored pain (University of Pennsylvania Canine Brief Pain Inventory) and lameness severity (Hudson Visual Analogue Scale [HVAS]). Weight-bearing was assessed by kinetic gait analysis. Dogs were injected intra-articularly with APS (treatment group) or saline solution (control group). Evaluations were performed before injection, and 2 and 12 weeks post-injection. Compared to pretreatment values, APS treatment data showed a significant improvement in week 12 pain scores (improved 25.6% over baseline), lameness scores (improved 15% over baseline) and peak vertical force (PVF; N/kg; increased 14.9% of baseline), as well as vertical impulse (Ns/kg) and PVF normalized to stance time (N/kg/s). Control group dogs improved at week 2 in owner assigned indices, but not force plate values and had no significant improvement in scores or force plate values from pretreatment values at 12 weeks. APS injection reduced pain and lameness scores and increased weight-bearing associated with the OA-affected joint in dogs at 12 weeks providing preliminary evidence that APS therapy may be beneficial in the treatment of OA in dogs and supporting pursuit of additional studies. © Copyright 2016 by The American College of Veterinary Surgeons.

  8. The results of knee manipulation for stiffness after total knee arthroplasty with or without an intra-articular steroid injection

    Directory of Open Access Journals (Sweden)

    Sharma Vineet

    2008-01-01

    Full Text Available Background: Stiffness after total knee arthroplasty (TKA requiring manipulation has a reported incidence of 1.3-54%. The purpose of this study was to compare the incidence of stiffness warranting manipulation using two different pain management protocols. We also studied the effect of an intra-articular injection of local anesthetic and steroid given at the time of manipulation on the range-of-motion (ROM at last follow-up. Materials and Methods: A total of 286 TKAs (248 patients between January 2002 and December 2003 were compared to a second group of 292 TKAs (251 patients between January 2004 and March 2006. The first group received patient-controlled analgesia (PCA for postoperative pain management. The second group had a peri-articular injection of a steroid-containing local anesthetic at the time of surgery, but no postoperative PCA. All patients undergoing manipulation in the second group also received a similar intra-articular injection at the time of manipulation as well. Only patients with minimum 12 months follow-up after manipulation were included in the study. Results: The overall incidence of stiffness requiring manipulation in both groups was similar at 2.4% and 2.1%, respectively ( P = 0.1. The end results of manipulation with and without injection showed a significantly higher final ROM in patients who had had an injection at the time of manipulation ( P = 0.001. The difference was due to the fact that patients who had an injection lost no motion from that achieved at the time of manipulation. Conclusion: We were unable to demonstrate a significant reduction in the incidence of stiffness after TKA using a modern pain management protocol. However, injection of a local anesthetic and steroid at the time of manipulation did have a significant influence on preserving the ROM that was obtained at the time of manipulation.

  9. Individual patient data meta-analysis of trials investigating the effectiveness of intra-articular glucocorticoid injections in patients with knee or hip osteoarthritis

    DEFF Research Database (Denmark)

    van Middelkoop, Marienke; Dziedzic, Krysia S; Doherty, Michael

    2013-01-01

    -analysis to quantify the effect modified by the predictors using individual patient data (IPD) is suggested. The initiative to collect and analyze IPD in OA research is commenced by the OA Trial Bank. The study aims are therefore: to evaluate the efficacy of intra-articular glucocorticoids for knee or hip OA...

  10. Prolonged naproxen joint residence time after intra-articular injection of lipophilic solutions comprising a naproxen glycolamide ester prodrug in the rat

    DEFF Research Database (Denmark)

    Thing, Mette; Lu, Yi; Agårdh, Li

    2013-01-01

    ,N-diethyl glycolamide ester prodrug of naproxen (16mg/ml) were injected into the rat knee joint by dosing 6μl formulation per 100g body weight. The sustained release properties were compared to those of intra-articularly injected aqueous and oil solutions of naproxen by monitoring the naproxen serum concentrations over...

  11. The Analgesic Effects of Morphine and Tramadol Added to Intra-articular Levobupivacaine-Tenoxicam Combination for Arthroscopic Knee Surgery on Postoperative Pain; a Randomized Clinical Trial.

    Science.gov (United States)

    Oral, Ebru Gelici; Hanci, Ayse; Ulufer Sivrikaya, Gulcihan; Dobrucali, Hale; Turkoglu Kilinc, Leyla

    2015-06-01

    Arthroscopic knee surgery is commonly performed as an outpatient procedure and is often associated with postoperative pain. We aimed to compare the effects of intra-articular levobupivacaine-tenoxicam-tramadol and levobupivacaine-tenoxicam-morphine combinations on postoperative pain in patients undergoing elective arthroscopic knee surgery. A total of 90 ASA I-II patients undergoing elective arthroscopic meniscectomy under general anesthesia were enrolled. The participants were randomly allocated to three groups to receive the following intra-articular medications after completion of the surgery and before deflation of the tourniquet: Group S, 20 mL of saline; Group T, 35 mg of levobupivacaine, 20 mg of tenoxicam, and 100 mg of tramadol in 20 mL saline; and Group M, 35 mg of levobupivacaine, 20 mg of tenoxicam, and 4 mg of morphine in 20 mL saline. Visual analogue scale values at rest (VASr) and at active flexion of knee (VASa) at postoperation hours 1, 2, 4, 8, 12, and 24, duration of analgesia, total analgesic consumption, and number of rescue analgesia at 24 hours were evaluated. VASr and VASa were significantly higher in group S in comparison to other groups (P Intra-articular levobupivacaine-tenoxicam-morphine combination provides effective pain relief, longer analgesic duration, and less analgesic requirement when compared with intra-articular levobupivacaine-tenoxicam-tramadol combination and saline after knee arthroscopic surgery.

  12. One intra-articular injection of hyaluronan prevents cell death and improves cell metabolism in a model of injured articular cartilage in the rabbit

    NARCIS (Netherlands)

    Jansen, Edwin J. P.; Ernans, Pieter J.; Douw, Conny M.; Guidemond, Nick A.; Van Rhijn, Lodewijk W.; Bulstra, Sjoerd K.; Kuijer, Roell

    2008-01-01

    The purpose of this study was to determine the effect of one intra-articular injection of hyaluronan on chondrocyte death and metabolism in injured cartilage. Twenty-three 6-month-old rabbits received partial-thickness articular cartilage defects created on each medial femoral condyle. In order to e

  13. Delayed Gadolinium-Enhanced Magnetic Resonance Imaging (dGEMRIC) of Hip Joint Cartilage: Better Cartilage Delineation after Intra-Articular than Intravenous Gadolinium Injection

    DEFF Research Database (Denmark)

    Boesen, M.; Jensen, K.E.; Quistgaard, E.;

    2006-01-01

    PURPOSE: To investigate and compare delayed gadolinium (Gd-DTPA)-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) in the hip joint using intravenous (i.v.) or ultrasound-guided intra-articular (i.a.) Gd-DTPA injection. MATERIAL AND METHODS: In 10 patients (50% males, mean age 58...

  14. Methods and Variables Associated with the Risk of Septic Arthritis Following Intra-Articular Injections in Horses: A Survey of Veterinarians.

    Science.gov (United States)

    Gillespie, Caroline C; Adams, Stephen B; Moore, George E

    2016-11-01

    To determine common methods for intra-articular injections and variables associated with the risk of septic arthritis following intra-articular injection in the horse. Cross-sectional survey. Equine veterinarians. A link to an online survey was distributed to equine practitioners in 2014. Responses for descriptive data were tabulated. Data on infection rates obtained from medical records were analyzed. Variables associated with the risk of septic arthritis were determined using χ(2) or Fisher's exact tests and logistic regression. Common current methods for intra-articular injections were determined from 241 surveys. Sixty-four of 241 surveys (26.6%) contained data with numbers of joints injected and number of infections obtained from review of medical records. Eight different injection methods were used by more than 2/3 of responding veterinarians. A total of 67 out of 319,760 injected joints reported became septic following injection, giving an incidence of 2.10 septic joints per 10,000 intra-articular injections. Based on multivariate analysis, infection rates were significantly lower when veterinarians prepared their own injection sites (OR=0.10) and had veterinarians. The low reported incidence of infection may be related to the large number of practitioners frequently using common methods. © Copyright 2016 by The American College of Veterinary Surgeons.

  15. Comparison between oral and intra-articular antinociceptive effect of dexketoprofen and tramadol combination in monosodium iodoacetate-induced osteoarthritis in rats.

    Science.gov (United States)

    Cialdai, Cecilia; Giuliani, Sandro; Valenti, Claudio; Tramontana, Manuela; Maggi, Carlo Alberto

    2013-08-15

    Dexketoprofen and tramadol, alone or in combination, were evaluated after oral or intra-articular administration on knee osteoarthritis nociception induced by intra-articular (i.ar.) monosodium iodoacetate (MIA, 1 mg/25 µl) in the rat right knee while the left knee received saline (25 µl). Seven days after MIA treatment, dexketoprofen, tramadol, their combination or the vehicle were administered. Nociception was evaluated as alteration in hind limb weight distribution with Incapacitance tester at different time-points after drug administration. Oral dexketoprofen (0.1-1 mg/kg) or tramadol (0.5-5 mg/kg) induced maximal antinociception at 1 and 5 mg/kg, respectively. Their combination dose-dependently increased the intensity and duration of antinociception, that was additive and lasted up to 3 days. Also the intra-articular administration of dexketoprofen or tramadol (10-100 µg/25 µl) inhibited MIA-induced nociception, and the combination of the lower doses (10 µg/25 µl) produced a long lasting more than additive antinociceptive effect indicating a synergistic interaction between the two drugs. This effect was significantly reduced by naloxone (10 μg/25 μl, i.ar.) co-administered with both compounds. The intra-articular administration of both drugs at 10 µg/25 µl in the contralateral control knee joint provoked a marked synergistic antinociceptive effect indicating significant systemic diffusion through synovial membrane. The oral or intra-articular combination of dexketoprofen and tramadol produced additive or synergistic antinociceptive effects, respectively, in the model of MIA-induced osteoarthritis in rats, that might allow to obtain therapeutic advantages with lower side effects. © 2013 Elsevier B.V. All rights reserved.

  16. Outcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective Study

    Directory of Open Access Journals (Sweden)

    Panigrahi

    2016-08-01

    Full Text Available Background Scapula fractures occur in approximately 1% of all fractures and constitute about 3% - 5% of all injuries of the shoulder joint. Objectives This study aimed to evaluate the clinical outcomes of 20 surgically treated patients with displaced glenoid fractures after stabilization with distal radius plate. Methods Between 2012 and 2015, at 2 centers (HMCH & SHCE of Bhubaneswar Odisha, we stabilized 20 scapular intra-articular fractures surgically with distal radius locking plate and studied the outcome of the surgeries. The outcome of the 20 fractures was determined using the Constant and Murley score. Both shoulders were assessed and the score on the injured side was given as a percentage of that on the uninjured side. Results The median score was 88% (mean 65%, range 30 to 100. The median score for strength was 21/25 (mean 19, range 0 to 25 and that for pain 11/15 (mean 11, range 5 to 15. The median functional score was 16/20 (mean 15, range 0 to 20. The mean range of active abduction of the shoulder was 135° (20 to 180, the mean range of flexion 138° (20 to 180 and the mean range of external rotation 38° (0 to 100. Five patients showed excellent result; 11 patients showed good result; three patients showed fair result and one patient had poor outcome according to the Constant-Murley score. A superficial infection settled with antibiotics after operation in one patient whose score at final follow-up was 96%. In one patient, delayed healing was reported because of infection. One patient with stiffness of the shoulder at six weeks underwent manipulation under anesthesia with a follow-up score of 81%. Conclusions Various fixation modalities have been described in the literature, however fixation of intra-articular fracture of glenoid with distal radius locking plate for articular reconstruction in the presented series provides good functional outcome with early restoration of the range of motion of the shoulder.

  17. Interrelationship between temporomandibular joint osteoarthritis (OA) and cervical spine pain: Effects of intra-articular injection with hyaluronic acid.

    Science.gov (United States)

    Guarda-Nardini, Luca; Cadorin, Cristina; Frizziero, Antonio; Masiero, Stefano; Manfredini, Daniele

    2017-09-01

    The aim of this study was to evaluate cervical spine pain and function after five sessions of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) osteoarthritis. Forty-nine patients, (79% females, aged between 43-81 years), affected by TMJ osteoarthritis and concurrent cervical spine pain and limited function were recruited. All patients underwent a cycle of five weekly arthrocenteses and viscosupplementation with 1 ml of medium molecular weight HA according to the single-needle arthrocentesis technique. Outcome variables were TMJ pain (VAS), cervical active ranges of motion, cervical disability (NPDS), and presence of painful palpation sites. Assessments were carried out at baseline and at one, three and six months after the end of treatment protocol. A significant reduction over time was shown both in TMJ pain levels and in NPDS values with respect to baseline (p < 0.001). Most parameters of active cervical range of motion showed an improvement with time. Benefits remained stable throughout six months after the viscosupplementation protocol. A protocol of TMJ intra articular arthrocentesis and viscosupplementation improved cervical function and reduced disability in patients with concurrent cervical spine pain. These findings add to the complex amount of literature on the relationship between temporomandibular disorders and cervical spine disorders.

  18. Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images

    Energy Technology Data Exchange (ETDEWEB)

    Suojaervi, Nora; Lindfors, N. [Helsinki University Central Hospital, Department of Hand Surgery, Helsinki (Finland); Sillat, T.; Koskinen, S.K. [HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, Department of Radiology, Helsinki (Finland)

    2015-12-15

    Operative treatment of an intra-articular distal radius fracture is one of the most common procedures in orthopedic and hand surgery. The intra- and interobserver agreement of common radiographical measurements of these fractures using cone beam computed tomography (CBCT) and plain radiographs were evaluated. Thirty-seven patients undergoing open reduction and volar fixation for a distal radius fracture were studied. Two radiologists analyzed the preoperative radiographs and CBCT images. Agreement of the measurements was subjected to intra-class correlation coefficient and the Bland-Altman analyses. Plain radiographs provided a slightly poorer level of agreement. For fracture diastasis, excellent intraobserver agreement was achieved for radiographs and good or excellent agreement for CBCT, compared to poor interobserver agreement (ICC 0.334) for radiographs and good interobserver agreement (ICC 0.621) for CBCT images. The Bland-Altman analyses indicated a small mean difference between the measurements but rather large variation using both imaging methods, especially in angular measurements. For most of the measurements, radiographs do well, and may be used in clinical practice. Two different measurements by the same reader or by two different readers can lead to different decisions, and therefore a standardization of the measurements is imperative. More detailed analysis of articular surface needs cross-sectional imaging modalities. (orig.)

  19. Open drainage, intra-articular and systemic antibiotics in the treatment of septic arthritis/tenosynovitis in horses.

    Science.gov (United States)

    Schneider, R K; Bramlage, L R; Mecklenburg, L M; Moore, R M; Gabel, A A

    1992-11-01

    Open drainage was used to treat 26 horses with persistent or severe septic arthritis/tenosynovitis. Infected synovial structures were drained through a small (3 cm) arthrotomy incision that was left open and protected by a sterile bandage. Joint lavage was performed in all 26 horses. In addition to systemic antibiotics, 23 of these horses were also treated with intra-articular antibiotics; amikacin (17 horses), gentamycin (2 horses), cefazolin (2 horses), and 2 horses were injected at different times with gentamycin and amikacin. The infection was eliminated from the involved synovial structures in 25 of 26 horses; 24 survived and were released from the hospital. The arthrotomy incisions healed by granulation in 16 horses; in 9 horses the arthrotomy incision was sutured closed once the infection was eliminated. Seventeen horses returned to soundness and resumed athletic function. Open drainage was an effective method of achieving chronic drainage from a joint or tendon sheath. It is indicated in horses that have established intra-synovial infections or in horses that do not respond to joint lavage through needles.

  20. Intra-articular injection of parathyroid hormone in the temporomandibular joint as a novel therapy for mandibular asymmetry.

    Science.gov (United States)

    Wan, Qilong; Li, Zu-Bing

    2010-04-01

    Mandibular asymmetry (MA) is one of the most common craniofacial malformations. However, there is no optimal technique for this malformation nowadays. A novel technique for both children and adults with less disadvantages is a must. Parathyroid hormone (PTH) is a straight-chain polypeptide secreted by the parathyroid gland that regulates calcium metabolism. PTH has both anabolic and catabolic effects on bone formation, depending on its mode of administration. Furthermore, the mandible is characterized by the most delayed growth and the most postnatal growth of all the facial bones. The condyle, the major growth site of mandible, grows by proliferation of cartilage in the condylar head and endochondral bone formation. Condylar cartilage is present throughout postnatal life, taking part in endochondral ossification and having a special multidirectional capacity for growth potential and remodeling throughout life. Based on the double effects of PTH on bone formation and characters of mandibular development and growth, it is hypothesized that intermittent or/and continuous intra-articular injection of PTH in the temporomandibular joint be a novel therapy for mandibular asymmetry for both children and adults. It can achieve early treatment of MA to avoid many secondary deformities and keep away from many complications resulting from current techniques or systematic administration of PTH.

  1. MANAGEMENT OF PRIMARY FROZEN SHOULDER PROSPECTIVE EVALUATION OF FUNCTIONAL OUTCOME BETWEEN HYDRODILATATION AND INTRA-ARTICULAR STEROID INJECTION

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    Dinesh Mitra R. P

    2017-01-01

    Full Text Available BACKGROUND The aim of this prospective randomized control study is to compare the functional outcome between hydrodilatation and intraarticular steroid injection in patients with primary frozen shoulder. MATERIALS AND METHODS A total number of 52 patients who attended the orthopaedic outpatient between November 2014 and January 2016 were included in this study. The patients were categorized into two groups. Group I patients were treated with hydrodilatation method and Group II patients were treated with intra-articular steroids. Both the group of patients were advised to perform home exercise programs. The patients were assessed at baseline (before the procedure at two weeks, six weeks, three months and six months. All patients were evaluated for functional improvement by measuring the range of active movements and Constant and Murley shoulder outcome scores. RESULTS Up to three months patients treated with hydrodilatation have significantly better functional outcome as evaluated by active range of movements and Constant and Murley score. But at six months there is no significant difference in functional outcome between two methods of treatment. CONCLUSION There was improvement in functional outcome in both the methods of treatment. But patients treated by hydrodilatation showed more significant increase in functional outcome for the first three months. Home exercise forms an integral part in the management of primary frozen shoulder.

  2. Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Mi, Bobin; Liu, Guohui; Zhou, Wu; Lv, Huijuan; Liu, Yi; Zha, Kun; Wu, Qipeng; Liu, Jing

    2017-07-01

    The purpose of this meta-analysis was to compare the blood loss and complications of intra-articular (IA) with intravenous (IV) tranexamic acid (TXA) for total knee arthroplasty (TKA). A comprehensive search of studies was conducted to identify related articles in Pubmed, Embase, Cochrane central Register of Controlled Trials, springerLink, OVID and the Research published from January 1980 to September 2016. All studies that compared IA TXA with IV TXA application on TKA were included. Main outcomes of the two methods were collected and analyzed by using Review Manager 5.3. There were 16 randomized controlled trials with 1308 cases met the criteria. Compared with IV TXA, IA TXA had similar blood volume of drainage, hidden blood loss, transfusion rate and complications (P > 0.05). IA TXA had lower total blood loss than IV TXA, and there was significant difference (P  0.05) when compared with IA TXA. Both IA TXA and single dose of IV TXA are effective in reducing total blood loss and postoperative hemoglobin drop without increasing complications of DVT or PE. The current meta-analysis suggests that 1.5 g TXA by IA administration or 1 g TXA by IV administration 10 min before tourniquet deflation is effective and safe in patients undergoing TKA.

  3. Recurrence of an intra-articular osteoid osteoma of the great toe: a case report and review of the literature

    Science.gov (United States)

    Torrent, Josep; Bailez, Alberto; Asuncion, Jordi

    2017-01-01

    Osteoid osteoma (OO) is a benign tumor that it is not generally seen in the foot and even less frequently in the phalanx (2–4%). The diagnosis when its location is intra-articular is a challenge and often delayed because the symptoms mimic a real arthritis. We report a clinical case involving a 16-year-old male patient who complained of persistent pain of the interphalangeal joint (IPJ) of the left hallux. A juxta-articular OO of the condyle of the proximal phalanx was identified. The patient underwent surgery that included tumor removal preserving the articular cartilage. After a non-complete nidus resection, there was a recurrence. The patient underwent surgery with a removal en-block of the distal part of the proximal phalanx and fusion of the IPJ with interposition of a tricortical autograft. After a follow-up of 30 months, the X-ray showed total arthrodesis of the joint without signs of recurrence or pain. PMID:28064244

  4. Effect of intra-articular hyaluronic injection on postural stability and risk of fall in patients with bilateral knee osteoarthritis.

    Science.gov (United States)

    Khalaj, Nafiseh; Abu Osman, Noor Azuan; Mokhtar, Abdul Halim; George, John; Abas, Wan Abu Bakar Wan

    2014-01-01

    Knee osteoarthritis is a common cause of disability which influences the quality of life. It is associated with impaired knee joint proprioception, which affects postural stability. Postural stability is critical for mobility and physical activities. Different types of treatment including nonsurgical and surgical are used for knee osteoarthritis. Hyaluronic acid injection is a nonsurgical popular treatment used worldwide. The aim of this study was to demonstrate the effect of hyaluronic acid injections on postural stability in individuals with bilateral knee osteoarthritis. Fifty patients aged between 50 and 70 years with mild and moderate bilateral knee osteoarthritis participated in our study. They were categorized into treatment (n = 25) and control (n = 25) groups. The treatment group received five weekly hyaluronic acid injections for both knees, whereas the control group did not receive any treatment. Postural stability and fall risk were assessed using the Biodex Stability System and clinical "Timed Up and Go" test. All the participants completed the study. The treatment group showed significant decrease in postural stability and fall risk scores after five hyaluronic acid injections. In contrast, the control group showed significant increase. This study illustrated that five intra-articular hyaluronic acid injections could significantly improve postural stability and fall risk in bilateral knee osteoarthritis patients. This trial is registered with: NCT02063373.

  5. Effect of Intra-Articular Hyaluronic Injection on Postural Stability and Risk of Fall in Patients with Bilateral Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Nafiseh Khalaj

    2014-01-01

    Full Text Available Knee osteoarthritis is a common cause of disability which influences the quality of life. It is associated with impaired knee joint proprioception, which affects postural stability. Postural stability is critical for mobility and physical activities. Different types of treatment including nonsurgical and surgical are used for knee osteoarthritis. Hyaluronic acid injection is a nonsurgical popular treatment used worldwide. The aim of this study was to demonstrate the effect of hyaluronic acid injections on postural stability in individuals with bilateral knee osteoarthritis. Fifty patients aged between 50 and 70 years with mild and moderate bilateral knee osteoarthritis participated in our study. They were categorized into treatment (n=25 and control (n=25 groups. The treatment group received five weekly hyaluronic acid injections for both knees, whereas the control group did not receive any treatment. Postural stability and fall risk were assessed using the Biodex Stability System and clinical “Timed Up and Go” test. All the participants completed the study. The treatment group showed significant decrease in postural stability and fall risk scores after five hyaluronic acid injections. In contrast, the control group showed significant increase. This study illustrated that five intra-articular hyaluronic acid injections could significantly improve postural stability and fall risk in bilateral knee osteoarthritis patients. This trial is registered with: NCT02063373.

  6. The Analgesic Effects of Morphine and Tramadol Added to Intra-articular Levobupivacaine-Tenoxicam Combination for Arthroscopic Knee Surgery on Postoperative Pain; a Randomized Clinical Trial

    OpenAIRE

    Oral, Ebru Gelici; Hanci, Ayse; Ulufer Sivrikaya, Gulcihan; Dobrucali, Hale; Turkoglu Kilinc, Leyla

    2015-01-01

    Background: Arthroscopic knee surgery is commonly performed as an outpatient procedure and is often associated with postoperative pain. Objectives: We aimed to compare the effects of intra-articular levobupivacaine-tenoxicam-tramadol and levobupivacaine-tenoxicam-morphine combinations on postoperative pain in patients undergoing elective arthroscopic knee surgery. Materials and Methods: A total of 90 ASA I-II patients undergoing elective arthroscopic meniscectomy under general anesthesia were...

  7. Comparative study in patients with symptomatic internal derangements of the temporomandibular joint: analgesic outcomes of arthrocentesis with or without intra-articular morphine and tramadol.

    Science.gov (United States)

    Sipahi, A; Satilmis, T; Basa, S

    2015-04-01

    Our aim was to find out whether pain was better controlled if morphine or tramadol was injected intra-articularly after arthrocentesis with Ringer's lactate in patients with painful temporomandibular joints (TMJ). This placebo-controlled, double-blind study involved 30 patients who had not responded to conservative treatment and who were divided randomly into 3 groups of 10 patients each. All patients had arthrocentesis, and the drugs were given as intra-articular injections immediately after the procedure. One group was give 5% Ringer's lactate 1ml, the second morphine 1mg, and the third tramadol 50mg. Visual analogue scales (VAS) for pain were recorded at maximum mouth opening and at rest before intra-articular injection and after 15 and 30min; at 1, 2, 3, 8, 12, 24, 36 and 48h; and at 1, 3, and 6 monthly follow-up. The mean (SD) VAS decreased from 6.90 (1.45) to 2.6 (2.5) in the control group, from 7.30 (1.64) to 1.20 (0.79) in the morphine group (p=0.005), and from 7.10 (1.73) to 1.50 (1.78) in the tramadol group (p=0.005). We conclude that morphine given by intra-articular injection after arthrocentesis gives a significant, sustained (6 months) improvement in pain relief compared with simple arthrocentesis alone. The effect was similar with tramadol except that it was shorter lived. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. The Effects of Supplemental Intra-Articular Lubricin and Hyaluronic Acid on the Progression of Post-Traumatic Arthritis in the Anterior Cruciate Ligament Deficient Rat Knee

    Science.gov (United States)

    Teeple, Erin; Elsaid, Khaled A.; Jay, Gregory D.; Zhang, Ling; Badger, Gary J.; Akelman, Matthew; Bliss, Thomas F.; Fleming, Braden C.

    2010-01-01

    Background Lubricin and hyaluronic acid lubricate articular cartilage and prevent wear. Because lubricin loss occurs following ACL injury, intra-articular lubricin injections may reduce cartilage damage in the ACL deficient knee. Purpose To determine if lubricin and/or hyaluronic acid supplementation will reduce cartilage damage in the ACL deficient knee. Study Design Controlled laboratory study Methods 36 male rats, 3 months old, underwent unilateral ACL transection. They were randomized to four treatments: 1) saline (PBS), 2) hyaluronic acid (HA), 3) purified human lubricin (LUB), and 4) LUB and HA (LUB+HA). Intra-articular injections were given twice weekly for four weeks starting one week after surgery. Knees were harvested one week following final injection. Radiographs of each limb and synovial fluid lavages were obtained at harvest. Histology was performed to assess cartilage damage using Safranin O/Fast green staining. Radiographs were scored for the severity of joint degeneration using the modified Kellgren-Lawrence scale. Synovial fluid levels of sulfated glycosaminoglycan, collagen II breakdown, IL-1β, TNF-α and lubricin were measured using ELISA. Results Treatment with LUB or LUB+HA significantly decreased radiographic and histologic scores of cartilage damage (p=0.039, p=0.015, respectively) when compared to the PBS and HA conditions. There was no evidence of an effect of HA nor was the LUB effect HA dependent suggesting that the addition of HA did not further reduce damage. The synovial fluid of knees treated with LUB had significantly more lubricin in the synovial fluid at euthanasia, though there were no differences in the other cartilage metabolism biomarkers. Conclusions Supplemental intra-articular LUB reduced cartilage damage in the ACL transected rat knee 6 weeks after injury, while treatment with HA did not. Clinical Relevance Although longer-term studies are needed, intra-articular supplementation (tribosupplementation) with lubricin

  9. Effect of Bushen Shujin Decoction combined with intra-articular injection of sodium hyaluronate treatment on early and middle stage knee osteoarthritis progress in elderly

    Institute of Scientific and Technical Information of China (English)

    Yu-Xiang Niu

    2016-01-01

    Objective:To analyze the effect of Bushen Shujin Decoction combined with intra-articular injection of sodium hyaluronate treatment on early and middle stage knee osteoarthritis progress in the elderly. Methods:A total of 102 elderly patients with early and middle stage knee osteoarthritis who received treatment in our hospital from November 2012 to January 2015 were selected as research subjects and randomly divided into observation group and control group, each group with 51 cases. Control group received intra-articular injection of sodium hyaluronate treatment and observation group received Bushen Shujin Decoction combined with intra-articular injection of sodium hyaluronate treatment. Differences in levels of inflammation-related factors and immunity-related factors in serum and synovial fluid of two groups were compared. Results:TNF-αα, IL-1β, iNOS, bFGF, MMP-3 and TIMP-1 levels in serum and synovial fluid of observation group after treatment were lower than those of control group (P<0.05);TGF-β1 and IGF-1 levels in serum and synovial fluid of observation group after treatment were lower than those of control group (P<0.05);CD4+CD25+CD127low/-Treg ratios in serum of observation group 1 month and 3 months after treatment were higher than those of control group (P<0.05). Conclusions:Elderly patients with early and middle stage knee osteoarthritis are accompanied by abnormality of a variety of factors and immune level, Bushen Shujin Decoction combined with intra-articular injection of sodium hyaluronate treatment can optimize patients’ systemic state, inhibit disease progression and promote joint function recovery.

  10. Clinical and radiographic outcome of a treat-to-target strategy using methotrexate and intra-articular glucocorticoids with or without adalimumab induction

    DEFF Research Database (Denmark)

    Hørslev-Petersen, K; Hetland, M L; Ørnbjerg, L M;

    2016-01-01

    OBJECTIVES: To study clinical and radiographic outcomes after withdrawing 1 year's adalimumab induction therapy for early rheumatoid arthritis (eRA) added to a methotrexate and intra-articular triamcinolone hexacetonide treat-to-target strategy (NCT00660647). METHODS: Disease-modifying antirheuma......OBJECTIVES: To study clinical and radiographic outcomes after withdrawing 1 year's adalimumab induction therapy for early rheumatoid arthritis (eRA) added to a methotrexate and intra-articular triamcinolone hexacetonide treat-to-target strategy (NCT00660647). METHODS: Disease......-modifying antirheumatic drug (DMARD)-naive patients with eRA started methotrexate (20 mg/week) and intra-articular triamcinolone (20 mg/ml) for 2 years. In addition, they were randomised to receive placebo adalimumab (DMARD group, n=91) or adalimumab (40 mg/every other week) (DMARD+adalimumab group, n=89) during....... RESULTS: One year after adalimumab withdrawal, treatment profiles and clinical responses did not differ between groups. In the DMARD/DMARD+adalimumab groups, the median 2-year methotrexate dose was 20/20 mg/week (p=0.45), triple DMARD therapy had been initiated in 33/27 patients (p=0.49), adalimumab...

  11. Microstructure of Temporomandibular Joint Cartilage after Intra-Articular Betamethasone Sodium Phosphate/Betamethasone Dipropionate Injection during the Early Stage of Experimental Osteoarthrosis

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    Irina N. Kostina

    2014-06-01

    Full Text Available Objective: to study the morphological changes in cartilage after a single intra-articular betamethasone sodium phosphate (BSP/betamethasone dipropionate (BDP injection during the early stage of experimental osteoarthrosis (OA of the temporomandibular joint (TMJ. Material and Methods: The experiment was performed on 18 male rabbits aged 6 months .The first group consisted of 9 healthy rabbits. The second group included 9 rabbits with mechanically induced TMJ OA. For 5 days, 3 hours daily, a load (with a force of 200N on the TMJ was imposed. In the left TMJ of the second group of rabbits, betamethasone was injected intra-articularly in different doses: 0.1 ml (n=3, 0.3 ml (n=3, and 0.5 ml (n=3. The right TMJ was used for comparison. A combined anesthesia was applied each experimental day. Rabbits of both groups were sacrificed on days 7, 14, and 30 with introductory combined anesthesia and intravenous injection of Zoletil 100® 20 mg/kg to stop their breathing. Results: Betamethasone caused destruction of the chondrocytes, fragmentation of collagen fibers, deficit of proteoglycans (PGs and glycosaminoglycans (GAGs, thinning of the cartilage, and contributed to the progression of TMJ OA. Conclusion: The optimal dose of BSP/BDP for intra-articular injection in the early stages of TMJ OA must be within the range of 0.1-0.3 ml|0.7-1.5 mg.

  12. Evaluation of Pain Regression in Patients with Temporomandibular Dysfunction Treated by Intra-Articular Platelet-Rich Plasma Injections: A Preliminary Report

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    M. Pihut

    2014-01-01

    Full Text Available Objective. The objective of this study was to evaluate the regression of temporomandibular pain as a result of intra-articular injections of platelet-rich plasma (PRP to patients with temporomandibular joint dysfunction previously subjected to prosthetic treatment. Materials and Methods. The baseline study material consisted of 10 patients, both males and females, aged 28 to 53 years, previously treated due to painful temporomandibular joint dysfunction using occlusal splints. All patients were carried out to a specialist functional assessment of the dysfunction using the Polish version of the RDC/TMD questionnaire axis I and II. Intra-articular injections were preceded by a preparation of PRP. The injection sites were determined by the method used during arthroscopic surgical procedures. Following aspiration, 0.5 mL of plasma was injected into each temporomandibular joint. Results. The comparison of the intensity of pain during all examinations suggests a beneficial effect of the procedure being performed as the mean VAS score was 6.5 at examination I, 2.8 at examination II, and 0.6 at examination III. Conclusion. Application of the intra-articular injections of platelet-rich plasma into the temporomandibular joints has a positive impact on the reduction of the intensity of pain experienced by patients treated for temporomandibular joint dysfunction.

  13. Intra-articular epithelioid sarcoma showing mixed classic and proximal-type features: report of 2 cases, with immunohistochemical and molecular cytogenetic INI-1 study.

    Science.gov (United States)

    Kosemehmetoglu, Kemal; Kaygusuz, Gulsah; Bahrami, Armita; Raimondi, Susana C; Kilicarslan, Kasim; Yildiz, Yusuf; Folpe, Andrew L

    2011-06-01

    Epithelioid sarcoma, a rare sarcoma with epithelial differentiation, most often occurs in the distal extremities; however, it may occur in essentially any location. With the recent recognition that the loss of expression of the tumor-suppressor gene INI-1 may be associated with epithelioid sarcoma, it has become clear that epithelioid sarcoma may occur in previously unsuspected locations such as bone. Only 2 cases of intra-articular epithelioid sarcoma have been previously reported. We retrieved 2 intra-articular cases coded as epithelioid sarcoma from our archives. Both expressed cytokeratins (AE1/AE3 and OSCAR), CD34, vimentin, and epithelial membrane antigen, and showed complete loss of expression of INI-1. Fluorescence in situ hybridization was performed on formalin-fixed, paraffin-embedded sections by using a laboratory-developed dual-color probe containing INI1 (CTD-2511E13 and CTD-2034E7) (22q11.2) (OR) and PANX2 (RPCI3-402G11) (22q13.33) (GR) probes as control. Both cases occurred in a clearly intra-articular location in the knee. Case 1 was that of a 19-year-old man with a long-standing history of pain and limited joint function. This patient was disease free after amputation. Case 2 was that of a 60-year-old woman. Follow-up information available for this patient showed bilateral subpleural metastases. Morphologically, case 1 showed features of proximal-type epithelioid sarcoma, whereas case 2 showed mixed features of classic and proximal-type epithelioid sarcoma. Immunohistochemistry showed complete loss of INI-1 protein in both cases; fluorescence in situ hybridization analyses were negative for INI-1 gene deletion. Herein, we have reported 2 cases of intra-articular epithelioid sarcoma, showing morphologic and immunohistochemical features identical to those of epithelioid sarcoma in conventional locations, including loss of INI-1 expression. Intra-articular epithelioid sarcoma should be distinguished from malignant pigmented villonodular synovitis and

  14. Clinical efficacy of intra-articular injections in knee osteoarthritis: a prospective randomized study comparing hyaluronic acid and betamethasone

    Science.gov (United States)

    Trueba Davalillo, Cesáreo Ángel; Trueba Vasavilbaso, Cesáreo; Navarrete Álvarez, José Mario; Coronel Granado, Pilar; García Jiménez, Ozcar Alejandro; Gimeno del Sol, Mercedes; Gil Orbezo, Félix

    2015-01-01

    Background Osteoarthritis (OA) is the most common joint disease and leading cause of disability. Intra-articular (IA) administration of hyaluronic acid (HA) or corticosteroids (CS) have been previously studied, though using insufficient number of patients or short follow-up periods. Objective We evaluate HA and CS in patients with knee OA in terms of clinical efficacy over 12 months. Methods We used a prospective, randomized study with parallel groups. Randomized patients received IA injections of HA or betamethasone (BM). The primary outcomes were improvement in pain using Visual Analog Scale and function in the Western Ontario and McMaster University Osteoarthritis Index (Likert scale). Follow-up visits were scheduled at 3 months, 6 months, 9 months, and 12 months. Results A total of 200 patients were included. Pain was significantly reduced in both groups at the first follow-ups. At 12 months, the mean pain reduction in the HA group was 33.6% (95% CI: 31.1–36.1) compared to 8.2% (95% CI: 5.2–11.1) in BM (P<0.0001). Function improvement was higher in HA through every visit, and mean improvement at 12 months was 47.5% (95% CI: 45.6–49.3) in HA patients vs 13.2% (95% CI: 11.4–14.9) in the BM group (P<0.0001). All patients from both groups achieved the Minimal Clinically Important Improvement (MCII) for both pain and function up to 6 months. At 9 months and 12 months, the MCII figures were higher in HA group with ≥80% compared to ≤10% in BM group (P<0.0001). Adverse reactions were rare and related to the administration procedure. Conclusion Both treatments effectively controlled OA symptoms. BM showed higher short-term effectiveness, while HA showed better long-term effectiveness, maintaining clinical efficacy in a large number of patients 1 year after administration.

  15. Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear.

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    Krych, Aaron J; Griffith, Timothy B; Hudgens, Joshua L; Kuzma, Scott A; Sierra, Rafael J; Levy, Bruce A

    2014-04-01

    Intra-articular (IA) hip cortisone injection is commonly performed as a therapeutic modality in patients with femoral acetabular impingement (FAI). To our knowledge, there is no published data evaluating the clinical benefit of these injections. The purpose of this study was to assess the efficacy of therapeutic IA cortisone injection in these patients. At our institution, patients with FAI and labral tear prospectively recorded their numerical rating scale (NRS) pain scores pre-injection, during post-injection anaesthetic phase, and at 14 days post-injection. From this cohort, all patients treated with guided IA cortisone injection, no radiographic evidence of arthritis (Tönnis grade 0 or 1) and pain relief during the anaesthetic phase of the IA injection were included. An absolute change of two points on the NRS score was considered the minimal amount of clinically significant pain relief. Pain scores were compared between the different types of steroid injected. Fifty-four patients (35 females, 19 males) with a mean age of 32 ± 12 years were included. Average median pre-injection NRS score was 7.0 (range 2.5-10.0), post-injection anaesthetic phase was 1.0 (range 0.0-5.0), and 14 day post-injection was 5.0 (range 0.0-10.0). As a group, NRS scores significantly diminished from post-injection anaesthetic phase to 14 days post-injection (p cortisone injection has limited clinical benefit as a therapeutic modality. However, anaesthetic-only IA injections for patients who may be candidates for hip arthroscopy can be a useful diagnostic tool.

  16. Evaluation of analgesic efficacy of intra-articular bupivacaine, bupivacaine plus fentanyl, and bupivacaine plus tramadol after arthroscopic knee surgery.

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    Mitra, Sukanya; Kaushal, Harpreet; Gupta, Ravi K

    2011-12-01

    To compare the efficacy of intra-articular (IA) bupivacaine, bupivacaine-fentanyl, and bupivacaine-tramadol for relief of postoperative pain after arthroscopic knee surgery. In a randomized double-blind design, 60 adult American Society of Anesthesiologists class I or class II patients undergoing elective arthroscopic knee surgery under general anesthesia were randomized to 3 groups: all received 30 mL of 0.25% bupivacaine, plus either 1 mL of normal saline solution (group I), 1 mL (50 μg) of fentanyl (group II), or 1 mL (50 mg) of tramadol (group III). Pain was assessed by use of a 100-mm visual analog scale (VAS) at 0, 1, 2, 4, 6, and 8 hours postoperatively. Intramuscular diclofenac sodium was used as rescue analgesic. Postoperative adverse effects were noted. The mean VAS pain scores were the lowest for group II, intermediate for group III, and highest for group I. There was a significant main effect for group differences on pain scores (F = 41.138, P tramadol were better than IA bupivacaine, and bupivacaine with fentanyl was better than that with tramadol. However, both the combinations were comparable to each other with regard to the secondary outcome measure (supplementary analgesic requirement). Thus IA bupivacaine-fentanyl appears to be the best combination for relief of postoperative pain in patients undergoing arthroscopic knee surgery, followed by IA bupivacaine-tramadol. Level I, randomized controlled trial. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Relationship between intra-articular adhesions and disc position in temporomandibular joints: Magnetic resonance and arthroscopic findings and clinical results.

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    Millon-Cruz, Alejandrina; Martín-Granizo, Rafael; Encinas, Alejandro; Berguer, Alberto

    2015-05-01

    The objective of this study was to evaluate the relationship between intra-articular adhesions (IA) and disc position on magnetic resonance imaging (MRI) and direct arthroscopic vision, and to compare the presence of IA and clinical symptoms in patients diagnosed with internal derangements (ID) of temporomandibular joint (TMJ), along with their clinical outcomes. A total of 67 patients (134 TMJs) were included in the study. All patients were refractory to previous conservative treatment, and MRI was performed before surgery in all cases. The incidence of IA was evaluated in relation to disc displacement, type of displacement (with or without reduction), and stage of ID according to the Wilkes-Bronstein classification. Patients were divided into an adhesion and non-adhesion group. The association between the two groups with respect to preoperative clinical parameters (maximal interincisal opening, locking duration, joint pain, patient age) and postoperative parameters at 6 and 12 months was evaluated. The incidence of IA was 44% and the most common location was the anterior recess of the joint. IA were found in 58.3% of the joints with disc displacement without reduction, and in 28.9% of those with disc displacement with reduction (p joints with well-positioned discs, adhesions were found in 15% of the cases. Patient age and locking duration were significantly higher in the adhesions group (p joints with well-positioned discs or displacement with reduction, which leads to the hypothesis that disc hypomobility is an important factor in the genesis of adhesions. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  18. Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

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    Boesen, Mikael [Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen (Denmark)], E-mail: parker@frh.regioh.dk; Jensen, Karl Erik [State Hospital, Department of Radiology, MRI Division, Copenhagen (Denmark)], E-mail: karl.erik.Jensen@rh.regionh.dk; Torp-Pedersen, Soren [Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen (Denmark); Cimmino, Marco A. [Rheumatologic Clinic, Department of Internal Medicine, University of Genoa (Italy)], E-mail: cimmino@unige.it; Danneskiold-Samsoe, Bente; Bliddal, Henning [Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen (Denmark)

    2009-02-15

    Objective: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). Methods: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg/ml), 0.5 ml Lidocaine (5 mg/ml) and 0.15 ml gadolinium (Omniscan 0.5 mmol/ml). The drug solution was placed in the central proximal part of the wrist between the distal radius and the lunate bone. Coronal and axial MRI sequences were performed after the injection to visualize the distribution. Carpal distribution (radio-carpal, inter-carpal, and carpo-metacarpal) as well as radio-ulnar distribution was recorded. Full distribution in one compartment was given the value 1, partial distribution 0.5 and no distribution 0. A sum of the total distribution for all four compartments was calculated and correlated to the clinical parameters and the MRI OMERACT scores. Results: No uniform pattern was seen in the distribution of the contrast. Only two patients had full contrast distribution to all four compartments, and the mean distribution count for all patients was 2.4 (range 0.5-4). The distribution count correlated with the MRI OMERACT synovitis score (r = 0.60, p = 0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. Conclusion: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased with the MRI synovitis score, while no association was found with the erosion- and bonemarrow oedema score. These results indicate that a single injection into a standard injection site in the proximal part of the wrist cannot be assumed to distribute - and treat - the whole joint.

  19. Predictors of response to intra-articular steroid injections in patients with osteoarthritis of the knee joint.

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    Fatimah, Nibah; Salim, Babur; Raja, Ejaz-Ul-Haq; Nasim, Amjad

    2016-10-01

    This study aimed to determine the factors associated with response to intra-articular steroid injection (IASI) in patients with knee joint osteoarthritis. One hundred seventy-four female patients, age ranging from 30 to 80 years, diagnosed to have osteoarthritis of the knee joint, were given IASI. Response to IASI was assessed by using WOMAC and VAS at 2 weeks, 4 weeks and 3 months. At 3 months, the subjects were categorized as responders, partial responders and non-responders to treatment by IASI. Various factors were narrowed down to see their effect on response, namely age, BMI, smoking habits, comorbidities, presence of clinical effusion, radiographic score, local knee tenderness, range of movement and socioeconomic status. One hundred twenty-four patients completed the study. 16.1 % showed 50 % or more improvement in WOMAC score at 3 months post IASI therapy, whereas 38.7 % of OA patients had more than 50 % improvement in VAS score. Out of all factors, range of movement, local knee tenderness and radiographic score of the affected joint are the three parameters which can predict the improvement in WOMAC score after 3 months of IASI therapy (P = 0.013, P = 0.045 and P = 0.000, respectively). Age of the patient can predict improvement in VAS at 3 months post IASI (P = 0.027). We conclude that age, range of movement, local knee tenderness and radiographic score of the affected joint can predict response to IASI after 3 months of IASI therapy.

  20. Ação da Betametasona em Ratas Prenhes: Impacto sobre os Níveis de Corticosterona e Glândulas Adrenais Maternas e Fetais Effect of Betamethasone on Pregnant Rats: Impact on Corticosterone Level and Maternal and Fetal Adrenal Glands

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    Eduardo de Souza

    2001-12-01

    Full Text Available Objetivo: a utilização repetitiva do corticóide antenatal objetivando acelerar a maturidade pulmonar fetal tem sido muito empregada no risco de parto prematuro, o que nos motivou a estudar a dosagem de corticosterona no termo e aspectos morfológicos das glândulas adrenais maternas e fetais de ratas albinas submetidas à ação da betametasona na segunda metade da prenhez, para verificar conseqüências dessa terapêutica. Métodos: utilizamos 30 ratas prenhes, distribuídas em 3 grupos numericamente iguais. As do Grupo I receberam betametasona nos dias 11, 12, 18 e 19 da prenhez. As do Grupo II receberam água destilada nesses dias (grupo controle, e as do Grupo III não receberam qualquer medicamento, constituindo grupo controle de estresse. Foram todas sacrificadas no 20º dia de prenhez, quando dosamos a corticosterona no sangue das matrizes e extirpamos as glândulas adrenais maternas e fetais para exame de microscopia óptica. Resultados: a dosagem de corticosterona plasmática foi significantemente menor no grupo tratado com betametasona (4,8 mg/dL, quando comparada aos grupos controles (17,7 e 26,8 mg/dL. À microscopia óptica observou-se intensa vacuolização citoplasmática na zona fasciculada das adrenais maternas e fetais no grupo que utilizou a betametasona, indicando intensa supressão adrenal secundária ao uso do medicamento. Conclusões: o uso repetitivo e prolongado de corticóides, em ratas prenhes, para acelerar a maturidade pulmonar fetal determina supressão adrenal materna e fetal.Purpose: the repetitive use of antenatal corticosteroid therapy for acceleration of fetal lung maturation has been common in cases at risk of preterm delivery. We studied the corticosterone levels at term and the morphologic aspects in the maternal and fetal adrenal glands submitted to the effect of betamethasone in the second half of rat pregnancy in order to verify its consequences. Methods: thirty female pregnant rats were divided into

  1. Cationic PLGA/Eudragit RL nanoparticles for increasing retention time in synovial cavity after intra-articular injection in knee joint

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    Kim SR

    2015-08-01

    Full Text Available Sung Rae Kim,1 Myoung Jin Ho,2 Eugene Lee,3 Joon Woo Lee,3 Young Wook Choi,1 Myung Joo Kang21College of Pharmacy, Chung-Ang University, Dongjak-gu, Seoul, 2College of Pharmacy, Dankook University, Dongnam-gu, Cheonan, Chungnam, 3Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Gyeonggi-do, South KoreaAbstract: Positively surface-charged poly(lactide-co-glycolide (PLGA/Eudragit RL nanoparticles (NPs were designed to increase retention time and sustain release profile in joints after intra-articular injection, by forming micrometer-sized electrostatic aggregates with hyaluronic acid, an endogenous anionic polysaccharide found in high amounts in synovial fluid. The cationic NPs consisting of PLGA, Eudragit RL, and polyvinyl alcohol were fabricated by solvent evaporation technique. The NPs were 170.1 nm in size, with a zeta potential of 21.3 mV in phosphate-buffered saline. Hyperspectral imaging (CytoViva® revealed the formation of the micrometer-sized filamentous aggregates upon admixing, due to electrostatic interaction between NPs and the polysaccharides. NPs loaded with a fluorescent probe (1,1'-dioctadecyl-3,3,3',3' tetramethylindotricarbocyanine iodide, DiR displayed a significantly improved retention time in the knee joint, with over 50% preservation of the fluorescent signal 28 days after injection. When DiR solution was injected intra-articularly, the fluorescence levels rapidly decreased to 30% of the initial concentration within 3 days in mice. From these findings, we suggest that PLGA-based cationic NPs could be a promising tool for prolonged delivery of therapeutic agents in joints selectively.Keywords: PLGA, Eudragit RL, hyaluronic acid, cationic nanoparticles, intra-articular injection, electrostatic interaction

  2. Intra-articular injection of synovium-derived mesenchymal stem cells and hyaluronic acid promote regeneration of massive cartilage defects in rabbits

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    Vyacheslav Ogay

    2014-01-01

    Full Text Available Introduction: The purpose of this study was to investigate whether intra-articular injection of synovium-derived mesenchymal stem cells (SD MSCs with low molecular weight hyaluronic acid (HA could promote regeneration of massive cartilage in rabbits. Material and methods: The SD MSCs were harvested from the knees of 10 Flemish giant rabbits, expanded in culture, and characterized. A reproducible 4-mm cylindrical defect was created in the intercondylar groove area using a kit for the mosaic chondroplasty of femoral condyle COR (De Puy, Mitek. The defect was made within the cartilage layer without destruction of subchondral bone. Two weeks after the cartilage defect, SD MSCs (2 × 106 cell/0.15 ml were suspended in 0.5% low molecular weight HA (0.15 ml and injected into the left knee, and HA solution (0.30 ml alone was placed into the right knee. Cartilage regeneration in the experimental and control groups were evaluated by macroscopically and histologically at 10, 30, and 60 days. Results: On day 10, after intra-articular injection of SD MSCs, we observed an early process of cartilage regeneration in the defect area. Histological studies revealed that cartilage defect was covered by a thin layer of spindle-shaped undifferentiated cells and proliferated chodroblasts. In contrast, an injection of HA did not induce reparation of cartilage in the defect area. At 30 days, macroscopic observation showed that the size of cartilage defect after SD MSC injection was significantly smaller than after HA injection. Histological score was also better in the MSC- treated intercondylar defect. At 60 days after MSC treatment, cartilage defect was nearly nonexistent and looked similar to an intact cartilage. Conclusion: Thus, intra-articular injection of SD MSCs can adhere to the defect in the intercondylar area, and promote cartilage regeneration in rabbits.

  3. Contribution of MRI and CT arthrography to the diagnosis of intra-articular tendinopathy of the long head of the biceps.

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    Nourissat, G; Tribot-Laspiere, Q; Aim, F; Radier, C

    2014-12-01

    Clinical diagnosis of biceps tendinopathy is difficult to make because of the poor sensitivity of existing clinical tests. The goal of this study was to determine whether MRI or CT arthrogram could contribute to the diagnosis of tendinopathy in the intra-articular portion of the long head of biceps (LHB), while using macroscopic findings during shoulder arthroscopy as a reference. A prospective, single-centre study was performed over a 4-month period. The radiology part of the study was carried out by a radiologist experienced in shoulder imaging. The arthroscopy part of the study was conducted while the biceps was being evaluated for treatment purposes. The study included 87 patients having an average age of 45.7 years (range 17-78). Fifty-eight patients underwent CT arthrography and 38 underwent an MRI. Seven patients underwent both imaging exams. One patient was removed from the study because of a spontaneous LHB rupture. The demographics of the two study populations were equivalent. For the diagnosis of tendinopathy of the intra-articular portion of the long head of biceps, the CT arthrogram had a sensitivity of 71.43%, specificity of 100%, positive predictive value of 100% but a negative predictive value of 67.74%. For the diagnosis of tendinopathy of the intra-articular portion of the long head of biceps, the MRI had a sensitivity of 42.85%, specificity of 75%, positive predictive value of 50% but a negative predictive value of 69.23%. This study showed that radiological diagnosis of tendinopathy of the long head of biceps remains challenging. Nevertheless, CT arthrography is more sensitive and specific than MRI in identifying this disorder. III (case-control study). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  4. Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management.

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    Toon, Dong Hao; Premchand, Rex Antony Xavier; Sim, Jane; Vaikunthan, Rajaratnam

    2017-02-02

    To evaluate the functional and radiographic outcomes, as well as the treatment costs, of closed displaced intra-articular distal radius fractures treated with either open reduction internal fixation (ORIF) with volar locking plates or nonoperative treatment with plaster cast immobilisation. A total of 60 patients (32 receiving ORIF, 28 receiving nonoperative treatment) with closed intra-articular distal radius fractures were included. The mean age was 52.1 and 57.4, respectively. Functional and radiographic assessments were carried out at 12 months post-injury. Patients' treatment costs, median salaries and lengths of medical leave were obtained. DASH and MAYO wrist score in the ORIF group did not differ significantly from those in the nonoperative group. Apart from superior ulnar deviation in the ORIF group (p = 0.0096), differences in the range of motion of the injured wrists were not significant. Similarly, there were no significant differences in grip strength and visual analog scale for pain. Volar tilt (p = 0.0399), radial height (p = 0.0087), radial inclination (p = 0.0051) and articular step-off (p = 0.0002) were all significantly superior in the ORIF group. There was a 37-fold difference in mean treatment costs between ORIF (SGD 7951.23) and nonoperative treatment (SGD 230.52). Our study shows no difference in overall functional outcomes at 12 months for closed displaced intra-articular distal radius fractures treated with either ORIF with volar locking plates or plaster cast immobilisation, and this is independent of radiographic outcome. A longer follow-up, nevertheless, is needed to determine whether the development of post-traumatic arthritis will have an effect on function. The vast difference in treatment costs should be taken into consideration when deciding on the treatment option. Level 3.

  5. Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery

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    Recep Aksu

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: In this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intra-articular bupivacaine carried out with bupivacaine. METHODS: In the first group of patients 20 mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB were applied, while 20 mL 0.25% bupivacaine was given via intra-articular (IA administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia (PCA with morphine was used in all three groups for postoperative analgesia. RESULTS: In the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24 h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6 h and the same was true for total morphine consumption in 24 h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2 h and lower than the control group in the 4th and 6th hours (p < 0.05. In the IA group, VASr and VASm scores in the 2nd, 4th and 6th hours were lower than in the control group (p < 0.05. CONCLUSION: Interscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia.

  6. Ozonoterapia sistémica e intra-articular en la artritis de la articulación temporomandibular por artritis reumatoide

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    Ivonne Méndez-Pérez

    2010-01-01

    Full Text Available Se estudió el efecto de la ozonoterapia intra-articular combinada con la vía sistémica (vía rectal y se comparó con la sola aplicación por vía intra-articular en pacientes con artritis de la articulación temporomandibular (ATM por artritis reumatoide (AR mediante la evaluación clínica del dolor a la masticación, chasquido y trismo. Fueron estudiados veinte pacientes, divididos en dos grupos de diez cada uno, el primero recibió ozonoterapia intra-articular (concentración de ozono 10 mg/L y volumen de 3 mL, a razón de dos aplicaciones por semana, durante cinco semanas, y el segundo, terapia combinada (igual al primer grupo más ozono administrado por insuflación rectal, a una concentración de 30 hasta 40 mg/L y un volumen de 100 hasta 200 mL, veinte aplicaciones. Se evaluó el grosor del cartílago articular (por ultrasonido, al inicio y al final del tratamiento al igual que los síntomas clínicos: dolor a la masticación, chasquido y trismo. Como resultado, se obtuvo una disminución significativa de todos los síntomas estudiados, así como del grosor del cartílago articular diagnosticado en el estudio ultrasonográfico, teniendo una respuesta más rápida en el grupo de la terapia combinada. Se concluyó que ambas formas de tratamiento demuestran efectos beneficiosos en la artritis de la articulación temporomandibular de pacientes con artritis reumatoide, aunque la terapia combinada resulta la más eficiente, resultado que no ha sido reportado con anterioridad.

  7. Pain relief after Arthroscopic Knee Surgery: A comparison of intra-articular ropivacaine, fentanyl, and dexmedetomidine: A prospective, double-blinded, randomized controlled study

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    Mohammed Babrak Manuar

    2014-01-01

    Full Text Available Background: Postoperative pain is very common distressing symptom after any surgical procedure. Different drugs in different routes have been used for controlling post-arthroscopic pain. No one proved to be ideal. We have compared the analgesic effect of ropivacaine, fentanyl, and dexmedetomidine when administered through the intra-articular route in arthroscopic knee surgery. Materials and Methods: From March 2008 to July 2010, 99 patients undergoing arthroscopic knee surgery were randomly assigned into three groups (A,B,C in a prospective double-blinded fashion. Group A received 10 ml of 0.75% ropivacaine, where Group B received 50 μg fentanyl, and Group C received 100 μg of dexmedetomidine through the intra-articular route at the end of procedure. Pain assessed using visual analog scale and diclofenac sodium given as rescue analgesia when VAS >4. Time of first analgesia request and total rescue analgesic used in 24 hours were calculated. Results: Demographic profiles are quite comparable among the groups. Time for requirement of first postoperative rescue analgesia in Group A was 380.61 ± 22.973 min, in Group B was 326.82 ± 17.131 min and in Group C was 244.09 ± 20.096 minutes. Total rescue analgesia requirement was less in Group A (1.394 ± 0.496 compared to Group B (1.758 ± 0.435 and Group C (2.546 ± 0.546. Group A had higher mean VAS score at 6 th and 24 th postoperative hours. No side effects found among the groups. Conclusion: Therefore, it suggests that intra-articular ropivacaine gives better postoperative pain relief, with increased time of first analgesic request and decreased need of total postoperative analgesia compared to fentanyl and dexmedetomidine.

  8. Pain relief in day care arthroscopic knee surgery: A comparison between intra-articular ropivacaine and levobupivacaine: A prospective, double-blinded, randomized controlled study

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    Anjan Das

    2014-01-01

    Full Text Available Background: Post-operative pain frequently hampers implementation of day care arthroscopic knee surgery in spite of so many analgesic, local anesthetic drugs and routes of administration. Aims: The aim of the present study was carried out to compare the efficacy of ropivacaine and levobupivacaine when administered through intra-articular route in controlling pain after day care arthroscopic knee surgery. Setting and Design: It was a prospective, double-blinded and randomized controlled study. Materials and Methods: April 2008-December 2008, 60 patients of both sex, of American Society of Anesthesiologists physical status I and II, undergoing day care arthroscopic knee surgery were randomly assigned into two groups (R, L. Group R received 10 ml of 0.75% ropivacaine, whereas group L received 10 ml of 0.50% levobupivacaine through intra-articular route at the end of the procedure. Pain assessed using visual analog scale (VAS and diclofenac sodium given as rescue analgesia when VAS >3. Time of first analgesic request and total rescue analgesic were calculated. Statistical Analysis and Results: based on comparable demographic profiles; time for the requirement of first post-operative rescue analgesia (242.16 ± 23.86 vs. 366.62 ± 24.42 min and total mean rescue analgesic requirement was (104.35 ± 18.96 vs. 76.82 ± 14.28 mg in group R and L respectively. Group R had higher mean VAS score throughout the study period. No side effects found among the groups. These two results were clinically and statistically significant (P < 0.05. Conclusion: Hence, it was evident that intra-articular levobupivacaine give better post-operative pain relief, with an increase in time of first analgesic request and decreased need of total post-operative analgesia compared with ropivacaine.

  9. Intra-articular changes precede extra-articular changes in the biceps tendon following rotator cuff tears in a rat model

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    Peltz, Cathryn D.; Hsu, Jason E.; Zgonis, Miltiadis H.; Trasolini, Nicholas A.; Glaser, David L.; Soslowsky, Louis J.

    2011-01-01

    Background Biceps tendon pathology is common with rotator cuff tears. The mechanisms for biceps changes, and therefore its optimal treatment, are unknown. Our objective was to determine the effect of rotator cuff tears on regional biceps tendon pathology. We hypothesized that histological and compositional changes would appear before organizational changes, both would appear before mechanical changes, and changes would begin at the tendon’s insertion site. Methods Sixty-five Sprague-Dawley rats received either detachment of supraspinatus and infraspinatus tendons or sham surgery. Rats were sacrificed at 1, 4 or 8 weeks for regional measurements of histological, compositional, organizational (1, 4 and 8 weeks) or mechanical properties (4 and 8 weeks only). Results One week following tendon detachments, decreased organization and more rounded cell shape were found in the intra-articular space of the biceps tendon. Aggrecan expression was increased along the entire length of the tendon while all other compositional changes were at the tendon’s proximal insertion into bone only. With time, this disorganization and more rounded cell shape extended the length of the tendon. Organizational and cell shape changes also preceded detrimental mechanical changes, as decreased modulus in the intra-articular space was found after 8 weeks. Conclusions Results support a degenerative component to pathology in the biceps tendon. Additionally, changes resembling a tendon exposed to compressive loading occurring first in the intra-articular space indicate that the biceps tendon plays an increased role as a load bearing structure against the humeral head in the presence of rotator cuff tears. PMID:21816629

  10. Clinical efficacy of intra-articular injections in knee osteoarthritis: a prospective randomized study comparing hyaluronic acid and betamethasone

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    Trueba Davalillo CA

    2015-01-01

    Full Text Available Cesáreo Ángel Trueba Davalillo,1,2 Cesáreo Trueba Vasavilbaso,2 José Mario Navarrete Álvarez,2 Pilar Coronel Granado,3 Ozcar Alejandro García Jiménez,2 Mercedes Gimeno del Sol,3 Félix Gil Orbezo2 1School of Medicine (UNAM, México DF, Mexico; 2Orthopedic Service, Hospital Español de México, México DF, Mexico; 3Scientific Department, TEDEC-MEIJI FARMA,SA, Alcalá de Henares, Spain Background: Osteoarthritis (OA is the most common joint disease and leading cause of disability. Intra-articular (IA administration of hyaluronic acid (HA or corticosteroids (CS have been previously studied, though using insufficient number of patients or short follow-up periods.Objective: We evaluate HA and CS in patients with knee OA in terms of clinical efficacy over 12 months.Methods: We used a prospective, randomized study with parallel groups. Randomized patients received IA injections of HA or betamethasone (BM. The primary outcomes were improvement in pain using Visual Analog Scale and function in the Western Ontario and McMaster University Osteoarthritis Index (Likert scale. Follow-up visits were scheduled at 3 months, 6 months, 9 months, and 12 months.Results: A total of 200 patients were included. Pain was significantly reduced in both groups at the first follow-ups. At 12 months, the mean pain reduction in the HA group was 33.6% (95% CI: 31.1–36.1 compared to 8.2% (95% CI: 5.2–11.1 in BM (P<0.0001. Function improvement was higher in HA through every visit, and mean improvement at 12 months was 47.5% (95% CI: 45.6–49.3 in HA patients vs 13.2% (95% CI: 11.4–14.9 in the BM group (P<0.0001. All patients from both groups achieved the Minimal Clinically Important Improvement (MCII for both pain and function up to 6 months. At 9 months and 12 months, the MCII figures were higher in HA group with ≥80% compared to ≤10% in BM group (P<0.0001. Adverse reactions were rare and related to the administration procedure.Conclusion: Both treatments

  11. Safety of intra-articular cell-therapy with culture-expanded stem cells in humans: a systematic literature review.

    Science.gov (United States)

    Peeters, C M M; Leijs, M J C; Reijman, M; van Osch, G J V M; Bos, P K

    2013-10-01

    An important goal of stem cell research in orthopaedics is to develop clinically relevant techniques that could be applied to heal cartilage or joint pathology. Stem cell treatment in orthopaedics for joint pathology is promising since these cells have the ability to modulate different processes in the various tissues of the joint simultaneously. The non life-threatening nature of musculoskeletal system disorders makes safety of stem cell therapy a necessary prerequisite. To systematically review the literature and provide an overview of reported adverse events (AEs) of intra-articular treatment with culture-expanded stem cells in humans. A systematic literature search was performed in Pubmed, EMBASE, Web of Science and CINAHL in February 2013. AEs were reported into three categories: local/systemic, serious adverse event or AE (SAE/AE), related/unrelated. 3039 Potentially eligible articles were identified of which eventually eight fulfilled our inclusion criteria. In total, 844 procedures with a mean follow-up of 21 months were analysed. Autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) were used for cartilage repair and osteoarthritis treatment in all included studies. Four SAEs were reported by the authors. One infection following bone marrow aspiration (BMA) was reported as probably related and resolved with antibiotics. One pulmonary embolism occurred 2 weeks after BMA and was reported as possibly related. Two tumours, both not at the site of injection, were reported as unrelated. Twenty-two other cases of possible procedure-related and seven of possible stem cell-product related adverse events (AEs) were documented. The main AEs related to the procedure were increased pain/swelling and dehydration after BMA. Increased pain and swelling was the only AE reported as related to the stem cell-product. Based on current literature review we conclude that application of cultured stem cells in joints appears to be safe. We believe that with continuous

  12. Displaced Intra-Articular Fractures of the Distal Radius: Open Reduction With Internal Fixation Versus Bridging External Fixation

    Directory of Open Access Journals (Sweden)

    Fakoor

    2015-08-01

    Full Text Available Background Distal radius fracture is common in all ages. Mobility and wrist function is important. The choice of treatment should aim for optimal function with minimal complications. Objectives In this study we compared two surgical approaches, open reduction and internal fixation (ORIF and closed reduction with external fixation (CR + EF, for treatment of intra-articular distal radius fractures. Patients and Methods Ninety-four patients with distal radius fracture (type 3, 4 and 5 Fernandez classification were treated with two surgical methods (ORIF and CR + EF; 55 were treated with CR + EF and 39 were treated with ORIF by different surgeons. All patients were assessed at the end of the first, third and sixth week; and then after the third, sixth and 12th month. At the end of the follow-up, all patients completed the Michigan hand outcome questionnaire (MHOQ. We compared radiological parameters of distal radius, range of motion (ROM of the wrist, duration of rehabilitation, complication and patient satisfaction of the methods. Results In our study, radiological findings for the ORIF group were radial inclination (RI: 19.35, radial length (RL: 10.35, radial tilt (RT: 8.92, and ulnar variance (UV: 1.64, while for the CR + EF group these were RI: 15.13, RL: 8, RT: 4.78, and UV: 0.27. The ROM for ORIF were flexion/extension (F/E: 137, Radial/Ulnar deviation (R/U: 52, and Supination/Pronation (S/P: 141, while for the CR + EF group these were F/E: 117, R/U: 40 and S/P: 116. Michigan hand outcome score for ORIF was 75% and for Ext. fix was 60%. The rate of complication with the ORIF method was 58% and in Ext. fix this was 69%. The patients in CR + EF had more than the ORIF course of physiotherapy and rehabilitation. Conclusions In comparison of ORIF and CR + EF, all results including functional score, clinical and radiologic criteria were in favor of the ORIF method while there were less complications with this method. We believe that ORIF is a better

  13. Intra-articular injection of Botulinum toxin A reduces neurogenic inflammation in CFA-induced arthritic rat model.

    Science.gov (United States)

    Wang, Lin; Wang, Kaile; Chu, Xiao; Li, Tieshan; Shen, Nana; Fan, Chenglei; Niu, Zhenyuan; Zhang, Xiaochen; Hu, Luoman

    2017-02-01

    Currently, administration of Botulinum toxin Type A (BoNT/A) to treat arthritic pain has promising efficacy in clinical research. However, the mechanisms underlying anti-neurogenic inflammation mediated by BoNT/A remains unclear. The aim of this study was to demonstrate the effectiveness in macro and micro levels and to explore the causal mechanism of BoNT/A. Wistar rats (n = 60) were injected with 50ul complete Freund's adjuvant (CFA) in the left ankle joint capsule to establish a model of chronic monoarthritis. Pain behaviour (Evoked pain assessment) and infrared thermal imaging testing were performed at the macroscopic level to assess the effectiveness of analgesia and anti-inflammation. Western blotting and immunofluorescence staining were used at the microscopic level in an attempt to determine the mechanisms of anti-nociceptive or anti-inflammatory effects of BoNT/A. Additionally, hematoxylin-eosin staining was also used to visualise the cartilage and the synovial degenerative conditions of arthritis. By comparing the outcome of the evoked pain test and immunofluorescence staining, there was a significant improvement in BoNT/A compared with the normal saline (NS) injected control group. In addition, thermal variations showed that the temperature of ipsilateral ankle joint increased between 1 and 2 weeks following injection of CFA, but decreased after 3 weeks (still above the contralateral side). However, the temperature showed no difference between the BoNT/A group and NS group after treatment. The expression of IL-1β or TNF-α in the ankle synovial tissue was significantly decreased in the BoNT/A group compared to the NS group (p < 0.05). Based on the HE assessment, cartilage degeneration and infiltration of inflammatory cells in the BoNT/A group was alleviated compared to the NS group after treatment. In conclusion, we proposed the hypothesis that intra-articular BoNT/A administration does play an important role in anti-neurogenic inflammation. The

  14. The effects of intra-articular glucocorticoids and exercise on pain and synovitis assessed on static and dynamic magnetic resonance imaging in knee osteoarthritis

    DEFF Research Database (Denmark)

    Riis, R G C; Henriksen, M; Klokker, L

    2017-01-01

    before exercise therapy in KOA-patients. PROMs were assessed using the KOOS (knee injury and osteoarthritis outcome score). Synovitis was assessed on conventional non-contrast-enhanced, conventional contrast-enhanced (CE) and dynamic contrast-enhanced (DCE) MRI. PROMs and MRIs were obtained prior......OBJECTIVE: The aims of the present knee osteoarthritis (KOA)-study were to: (1) describe and compare the changes in magnetic resonance imaging (MRI)-measures of synovitis following an exercise program preceded by an intra-articular injection of either corticosteroid or isotonic saline and (2...

  15. Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Ambrose J.; Torriani, Martin; Bredella, Miriam A.; Chang, Connie Y.; Simeone, Frank J.; Palmer, William E. [Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States); Balza, Rene [Centro Medico de Occidente, Department of Radiology, Maracaibo (Venezuela, Bolivarian Republic of)

    2016-03-15

    To compare the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections with respect to successful intra-articular needle placement, fluoroscopy time, radiation dose, and dose area product (DAP). This retrospective study was IRB-approved and HIPAA-compliant. 498 fluoroscopically guided tibiotalar joint injections were performed or supervised by one of nine staff radiologists from 11/1/2010-12/31/2013. The injection approach was determined by operator preference. Images were reviewed on a PACS workstation to determine the injection approach (lateral mortise versus anterior midline) and to confirm intra-articular needle placement. Fluoroscopy time (minutes), radiation dose (mGy), and DAP (μGy-m{sup 2}) were recorded and compared using the student's t-test (fluoroscopy time) or the Wilcoxon rank sum test (radiation dose and DAP). There were 246 lateral mortise injections and 252 anterior midline injections. Two lateral mortise injections were excluded from further analysis because no contrast was administered. Intra-articular location of the needle tip was documented in 242/244 lateral mortise injections and 252/252 anterior midline injections. Mean fluoroscopy time was shorter for the lateral mortise group than the anterior midline group (0.7 ± 0.5 min versus 1.2 ± 0.8 min, P < 0.0001). Mean radiation dose and DAP were less for the lateral mortise group than the anterior midline group (2.1 ± 3.7 mGy versus 2.5 ± 3.5 mGy, P = 0.04; 11.5 ± 15.3 μGy-m{sup 2} versus 13.5 ± 17.3 μGy-m{sup 2}, P = 0.006). Both injection approaches resulted in nearly 100 % rates of intra-articular needle placement, but the lateral mortise approach used approximately 40 % less fluoroscopy time and delivered 15 % lower radiation dose and DAP to the patient. (orig.)

  16. Prolonged naproxen joint residence time after intra-articular injection of lipophilic solutions comprising a naproxen glycolamide ester prodrug in the rat

    DEFF Research Database (Denmark)

    Thing, Mette; Lu, Yi; Agårdh, Li

    2013-01-01

    Intra-articular injection of oil solutions of lipophilic prodrugs that rapidly degrade to their parent compound in synovial fluid may constitute a feasible approach to increase the joint residence time of non-steroidal anti-inflammatory drugs. In this in vivo study, oil solutions of the N...... around 0.11 to 3.3h and a 30% reduction in the maximum serum concentration were observed compared to that of the parent naproxen. The similar serum profiles obtained using the two oils indicate that the release was not affected by the oil viscosity. A prolonged naproxen joint residence time in rats...

  17. Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults.

    LENUS (Irish Health Repository)

    Wakai, Abel

    2012-01-31

    BACKGROUND: There is conflicting evidence regarding the use of intra-articular lignocaine injection for the closed manual reduction of acute anterior shoulder dislocations. A systematic review may help cohere the conflicting evidence. OBJECTIVES: To compare the clinical efficacy and safety of intra-articular lignocaine and intravenous analgesia (with or without sedation) for reduction of acute anterior shoulder dislocation. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), and EMBASE (1980 to March 2010). We searched Current Controlled Trials metaRegister of Clinical Trials (compiled by Current Science) (March 2010). We imposed no language restriction. SELECTION CRITERIA: Randomized controlled trials comparing intra-articular lignocaine (IAL) with intravenous analgesia with or without sedation (IVAS) in adults aged 18 years and over for reduction of acute anterior shoulder dislocation. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Where possible, data were pooled and relative risks (RR) and mean differences (MD), each with 95% confidence intervals (CI), were computed using the Cochrane Review Manager statistical package (RevMan). MAIN RESULTS: Of 1041 publications obtained from the search strategy, we examined nine studies. Four studies were excluded, and five studies with 211 participants were eligible for inclusion. There was no difference in the immediate success rate of IAL when compared with IVAS in the closed manual reduction of acute anterior shoulder dislocation (RR 0.95; 95% CI 0.83 to 1.10). There were significantly fewer adverse effects associated with IAL compared with IVAS (RR 0.16; 95% CI 0.06 to 0.43). The mean time spent in the emergency department was significantly less with IAL compared with IVAS (MD 109.46 minutes; 95% CI 84.60 to 134.32). One trial reported significantly less time for

  18. Long-term sustained-released in situ gels of a water-insoluble drug amphotericin B for mycotic arthritis intra-articular administration: preparation, in vitro and in vivo evaluation.

    Science.gov (United States)

    Shan-Bin, Guo; Yue, Tian; Ling-Yan, Jian

    2015-04-01

    Amphotericin B (AMB) was often used in intra-articular injection administration for fungal arthritis, because it could often bring a satisfactory therapeutic efficacy and a minimum systemic toxic side effect. However, because of the multiple operations and the frequent injections, the compliance of the patients was bad. Therefore, to develop a long-term sustained-released preparation of AMB for mycotic arthritis intra-articular administration is of great significance. The purpose of present study was to develop a long-term sustained-released in situ gel of a water-insoluble drug AMB for mycotic arthritis intra-articular administration. Based on the evaluations of the in vitro properties of the formulations, the formulation containing 10% (w/w) ethanol, 15% (w/w) PG, 0.75% (w/w) HA, 5% (w/w) purified soybean oil, 0.03% (w/w) α-tocopherol, 15% (w/w) water and 55% (w/w) glyceryl monooleate was selected as a suitable intra-articular injectable in situ gel drug delivery system for water-insoluble drug AMB. Furthermore, the results of the in vivo study on rabbits showed that the selected formulation was a safe and effective long-term sustained-released intra-articular injectable AMB preparation. Therefore, the presented in situ AMB gel could reduce the frequency of the administration in the AMB treatment of fungal arthritis, and then would get a good patient compliance.

  19. Safety and efficacy of intra-articular anti-tumor necrosis factor α agents compared to corticosteroids in a treat-to-target strategy in patients with inflammatory arthritis and monoarthritis flare.

    Science.gov (United States)

    Carubbi, Francesco; Zugaro, Luigi; Cipriani, Paola; Conchiglia, Armando; Gregori, Lorenzo; Danniballe, Cristino; Letizia Pistoia, Maria; Liakouli, Vasiliki; Ruscitti, Piero; Ciccia, Francesco; Triolo, Giovanni; Masciocchi, Carlo; Giacomelli, Roberto

    2016-06-01

    The aim of this study was to assess safety and efficacy of ultrasonography (US)-guided intra-articular injections using tumor necrosis factor (TNF) blockers compared to corticosteroids in rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients, experiencing refractory monoarthritis despite the current systemic therapy. Eighty-two patients were randomized to receive three intra-articular injections monthly of either corticosteroid or TNF blockers. Primary endpoints were the safety and an improvement greater than 20% for visual analogic scales of involved joint pain in patients injected with anti-TNFα. Further clinical, US, and magnetic resonance imaging (MRI) evaluations were considered secondary endpoints. Intra-articular TNF blockers are a safe strategy, determining a significant reduction of patient and physician reported clinical outcomes and US/MRI scores, in RA and PsA patients, when compared to intra-articular injections of corticosteroids. US guidance excluded the possibility to inject the drug in the wrong site, maximizing local effects, reducing systemic effects, and increasing the safety of the procedure. Patients with inflammatory monoarthritis could be successfully treated with US-guided intra-articular TNF blockers that are a safe and well tolerated procedure, to achieve a longstanding clinical and radiological good clinical response and/or disease remission.

  20. [Effects of SL-1010 (sodium hyaluronate with high molecular weight) on experimental osteoarthritis induced by intra-articularly applied papain in guinea pigs].

    Science.gov (United States)

    Tanaka, H; Kitoh, Y; Katsuramaki, T; Tanaka, M; Kitabayashi, N; Fujimori, S; Umemoto, J; Namba, K

    1992-07-01

    Effects of SL-1010 on the experimental osteoarthritis (OA) produced by intra-articular injection of papain, proteolytic enzyme, in the knee joint of the guinea pigs were histologically and biochemically investigated. In addition, experimental conditions to produce OA in guinea pig knee joint were also examined, since papain-induced OA has been mainly studied in rabbits. Six weeks after intra-articular injection of papain (1%, 0.1 ml), there were inflammatory reactions of the synovial membrane, degenerative changes in chondrocytes and the matrix of the articular cartilage, a decrease in the Safranin-O staining intensity and lowering of sulfated glycosaminoglycan. Electronmicroscopic observations revealed that the amorphous layer had disappeared and large bundles of unit collagen fibers and larger collagen fibers had appeared in the cartilage matrix. In the OA model, SL-1010 reduced the inflammatory reactions of the synovial membrane, inhibited development of degenerative changes in chondrocytes and the matrix of the articular cartilage and recovered the Safranin-O staining intensity. The sulfated glycosaminoglycan contents in the cartilage was significantly increased in the SL-1010-treated group, compared with the control group. The electromicroscopically observed charges in the papain-injected knee joint of the control group were rarely detected in the SL-1010-treated group. These results suggest that SL-1010 inhibits degenerative changes in the chondrocytes and the matrix probably by reducing synovial inflammation and protection of the cartilage in the OA model of guinea pigs.

  1. A feasibility study of the effect of intra-articular corticosteroid injection on isokinetic muscle strength in children with juvenile idiopathic arthritis.

    Science.gov (United States)

    McKay, Damien; Ostring, Genevieve; Broderick, Carolyn; Chaitow, Jeffrey; Singh-Grewal, Davinder

    2013-05-01

    This study assessed the magnitude of changes in isokinetic muscle strength in children with juvenile idiopathic arthritis (JIA) before and after treatment with intra-articular corticosteroid injection and assessed the feasibility of a larger study of the same effect. Isokinetic dynamometry was used to measure peak knee extension and flexion torque in 12 children before and after treatment for unilateral knee arthritis. Extensor and flexor strength was reduced on the affected side before treatment (-0.56 Nm/kg, p = .004 and -0.24 Nm/kg, p = .02 respectively). Increases in extensor strength were observed at two weeks (p = .01) and twelve weeks postinjection (p = .03). Improvements at 6 weeks approached but did not reach statistical significance (p = .17). Improvements in flexor strength were not observed until 12 weeks postinjection (p = .03). Despite significant improvements in extensor strength, low peak knee extensor torque continued to be observed at 12 weeks (p = .01). Knee extensor and flexor strength is reduced in children with JIA with active arthritis and improves following intra-articular corticosteroid injection. Significant improvements in knee extensor and flexor strength were seen postinjection; however deficits in extensor strength were still evident at three months. Isokinetic dynamometry was safe and well tolerated in our sample of children with JIA with active arthritis.

  2. Comparative, double-blind, controlled study of intra-articular hyaluronic acid (Hyalubrix®) injections versus local anesthetic in osteoarthritis of the hip

    Science.gov (United States)

    2009-01-01

    Introduction Comparison of intra-articular bacterial-derived hyaluronic acid (Hyalubrix®) (HA) with local analgesia (mepivacaine) for osteoarthritis (OA) of the hip. Methods A pilot prospective, double-blind, 6-month randomized trial of 42 patients with hip OA. HA or mepivacaine was administered twice (once a month) under ultrasound guidance. Efficacy measurements included the Lequesne's algofunctional index, a visual analog scale for pain, concomitant use of analgesia, patient and physician global measurement, and safety. Results Patients in the HA group exhibited a significantly reduced Lequesne's algofunctional index 3 and 6 months after treatment (P < 0.001) and significantly reduced visual analog scale pain scores 3 and 6 months after treatment (P < 0.05) compared with the local anesthetic group. All primary and secondary measures were significantly improved versus baseline, but other than the above were not different from each other at 3 or 6 months. Adverse effects were minimal. Conclusions This comparative study suggests a beneficial effect and safety of intra-articular HA in the management of hip OA. Trial registration number ISRCTN39397064. PMID:20003205

  3. Cationic PLGA/Eudragit RL nanoparticles for increasing retention time in synovial cavity after intra-articular injection in knee joint.

    Science.gov (United States)

    Kim, Sung Rae; Ho, Myoung Jin; Lee, Eugene; Lee, Joon Woo; Choi, Young Wook; Kang, Myung Joo

    2015-01-01

    Positively surface-charged poly(lactide-co-glycolide) (PLGA)/Eudragit RL nanoparticles (NPs) were designed to increase retention time and sustain release profile in joints after intra-articular injection, by forming micrometer-sized electrostatic aggregates with hyaluronic acid, an endogenous anionic polysaccharide found in high amounts in synovial fluid. The cationic NPs consisting of PLGA, Eudragit RL, and polyvinyl alcohol were fabricated by solvent evaporation technique. The NPs were 170.1 nm in size, with a zeta potential of 21.3 mV in phosphate-buffered saline. Hyperspectral imaging (CytoViva(®)) revealed the formation of the micrometer-sized filamentous aggregates upon admixing, due to electrostatic interaction between NPs and the polysaccharides. NPs loaded with a fluorescent probe (1,1'-dioctadecyl-3,3,3',3' tetramethylindotricarbocyanine iodide, DiR) displayed a significantly improved retention time in the knee joint, with over 50% preservation of the fluorescent signal 28 days after injection. When DiR solution was injected intra-articularly, the fluorescence levels rapidly decreased to 30% of the initial concentration within 3 days in mice. From these findings, we suggest that PLGA-based cationic NPs could be a promising tool for prolonged delivery of therapeutic agents in joints selectively.

  4. Eficácia analgésica do uso da dextrocetamina intra-articular em pacientes submetidos a artroplastia total do joelho

    Directory of Open Access Journals (Sweden)

    Hireno Guará Sobrinho

    2012-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A artroplastia total do joelho (ATJ é associada a significativa dor pós-operatória. Muitos agentes de uso intra-articular (IA têm sido empregados para analgesia pós-operatória com resultados inconsistentes. O enantiômetro cetamina S(+, a dextrocetamina, foi recentemente lançado comercialmente, com maior potência analgésica e menos efeitos indesejáveis do que a forma racêmica. Estudo prospectivo, experimental, aleatório e duplamente encoberto foi conduzido com o objetivo de avaliar a eficácia analgésica do uso da dextrocetamina por via intra-articular em pacientes submetidos à ATJ primária. MÉTODO: Foram avaliados 56 pacientes, alocados em três grupos: Grupo A (n = 19, que recebeu 0,25 mg.kg-1 de peso de dextrocetamina, diluído em 20 mL de solução fisiológica a 0,9%; Grupo B (n = 17, 0,5 mg.kg-1 de peso diluído da mesma forma; e Grupo C (n = 20, somente 20 mL de solução fisiológica a 0,9%, intra-articular, logo após o fim do procedimento e a colocação do dreno. Todos os pacientes tiveram acesso à terapia analgésica de resgate, sendo usada somente morfina endovenosa. Foram feitas avaliações 2, 6, 12 e 24 horas de pós-operatório, com mensuração da intensidade da dor pela Escala Analógica Visual (EAV, o uso da medicação de resgate pela avaliação do tempo decorrido entre a injeção intra-articular da solução e a primeira dose de resgate, o seu consumo total nas 24 horas e os efeitos adversos. RESULTADOS: Os grupos dextrocetamina obtiveram menores escores de dor quando comparados com a solução salina. A menor dose de dextrocetamina intra-articular (Grupo A: 0,25 mg.kg-1 usada resultou em melhores escores de dor e menos analgésico de resgate, com tempo de espera maior para sua solicitação. Os efeitos adversos foram infrequentes. Os resultados com menores escores de dor nos grupos que usaram a dextrocetamina são uma tend&eci+rc;ncia, pois não houve significância estat

  5. Eficácia analgésica do uso de dose alta de morfina intra-articular em pacientes submetidos à artroplastia total de joelho Eficacia analgésica del uso de dosis alta de morfina intra-articular en pacientes sometidos a la artroplastia total de rodilla Analgesic efficacy of the intra-articular administration of high Doses of morphine in patients undergoing total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    João Batista Santos Garcia Garcia

    2010-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Apesar da eficácia da morfina intraarticular (IA permanecer controversa, tem-se mostrado que doses maiores promovem melhores resultados e, consequentemente, menor consumo pós-operatório de analgésico, caracterizando, assim, efeito dose-dependente na ação periférica. Foi conduzido estudo controlado, aleatório e duplamente encoberto para avaliar a eficácia de 10 mg de morfina por via intra-articular em pacientes submetidos à artroplastia total de joelho. MÉTODO: Foram avaliados 50 pacientes submetidos à artroplastia total de joelho, distribuídos aleatoriamente em dois grupos: o grupotratamento recebeu 10 mg (1 mL de morfina por via intra-articular diluído em 19 mL de solução fisiológica a 0,9% (SF, enquanto o grupo-controle recebeu injeção intra-articular contendo 20 mL de SF, ambos após o fechamento da cápsula articular, ao final da operação. Morfina subcutânea sob demanda esteve disponível para dor residual. As seguintes variáveis foram avaliadas: intensidade da dor graduada na Escala Numérica (EN às 2 h (M1, 6 h (M2, 12 h (M3 e 24 h (M4 após injeção IA; tempo para primeira solicitação de analgésico; consumo de analgésicos e efeitos adversos. CONCLUSÕES: O grupo-tratamento apresentou menores valores na EN que o grupo-controle em M1 e M2, enquanto que nos outros momentos não houve diferença significativa. O intervalo para primeira solicitação de analgésicos foi significativamente maior no grupo tratamento e o consumo de analgésicos nas primeiras 24 horas foi menor neste grupo. Não houve diferença entre incidência de efeitos adversos entre os grupos. Concluiu-se que 10 mg de morfina reduziram dor pós-operatória 2 e 6 horas após injeção IA, promoveram maior período sem analgésico de resgate e reduziram seu consumo nas primeiras 24 horas.JUSTIFICATIVA Y OBJETIVOS: A pesar de que la eficacia de la morfina intra-articular (IA, permanece como algo controvertido, ha quedado

  6. A treat-to-target strategy with methotrexate and intra-articular triamcinolone with or without adalimumab effectively reduces MRI synovitis, osteitis and tenosynovitis and halts structural damage progression in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Axelsen, Mette Bjørndal; Eshed, Iris; Hørslev-Petersen, Kim

    2014-01-01

    OBJECTIVES: To investigate whether a treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid injections suppresses MRI inflammation and halts structural damage progression in patients with early rheumatoid arthritis (ERA), and whether adalimumab provides an additional...... effect. METHODS: In a double-blind, placebo-controlled trial, 85 disease-modifying antirheumatic drug-naïve patients with ERA were randomised to receive methotrexate, intra-articular glucocorticosteroid injections and placebo/adalimumab (43/42). Contrast-enhanced MRI of the right hand was performed...

  7. The comparison effects of intra-articular injection of different opioids on postoperative pain relieve after arthroscopic anterior cruciate ligament reconstruction: A randomized clinical trial study*

    Science.gov (United States)

    Arti, Hamidreza; Mehdinasab, Seyed Abdoulhossein

    2011-01-01

    BACKGROUND: Pain after knee surgery, if not relieved, it would lead to a more severe and prolonged pain that can delay the patients recovery and rehabilitation. The effect of pain relief by some drugs after intra-articular injection has been shown. This study compared the effect of intra-articular injection of opioids (morphine, pethidine, methadone, and tramadol) on postoperative relieving pain after arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS: 150 candidate patients for knee arthroscopic ACL reconstruction were randomly enrolled into five groups. At the end of the procedure, all patients in each group received a joint injection solution including 9.5 millimeters bupivacaine with 1:200,000 epinephrine. The remaining 0.5 milliliters of syringe capacity was filled with one of the five solutions listed below: methadone group I: 5 mg methadone, morphine group II: 5 mg morphine, pethidine group III: 37.5 mg pethidine, tramadol group IV: 100 mg Tramadol, and control group V: 0.5 ml normal saline. Afterwards, any drug further administered to the patients based on need was recorded, and the morphine equivalent for all drugs was calculated. Patients need to narcotic drugs during the first twelve hours of hospitalization and pain scores were recorded. After data gathering, they were analyzed by SPSS 16 software with chi-Square, Kruskal-Wallis and ANOVA statistical tests. RESULTS: The highest and the lowest significant pain intensity were seen in placebo and morphine groups, respectively, in the first, second and third 4 hours after surgery. There were significant differences among the groups for need to analgesics. In other words, placebo group needed the highest dosage of analgesics and morphine and methadone groups needed the lowest dosage of analgesics. Morphine and methadone groups had maximum and minimum response to pain, respectively, in the first, second and third 4 hours after surgery. CONCLUSIONS: Administering 5 mg intra-articular

  8. The comparison effects of intra-articular injection of different opioids on postoperative pain relieve after arthroscopic anterior cruciate ligament reconstruction: A randomized clinical trial study.

    Science.gov (United States)

    Arti, Hamidreza; Mehdinasab, Seyed Abdoulhossein

    2011-09-01

    Pain after knee surgery, if not relieved, it would lead to a more severe and prolonged pain that can delay the patients recovery and rehabilitation. The effect of pain relief by some drugs after intra-articular injection has been shown. This study compared the effect of intra-articular injection of opioids (morphine, pethidine, methadone, and tramadol) on postoperative relieving pain after arthroscopic anterior cruciate ligament (ACL) reconstruction. 150 candidate patients for knee arthroscopic ACL reconstruction were randomly enrolled into five groups. At the end of the procedure, all patients in each group received a joint injection solution including 9.5 millimeters bupivacaine with 1:200,000 epinephrine. The remaining 0.5 milliliters of syringe capacity was filled with one of the five solutions listed below: methadone group I: 5 mg methadone, morphine group II: 5 mg morphine, pethidine group III: 37.5 mg pethidine, tramadol group IV: 100 mg Tramadol, and control group V: 0.5 ml normal saline. Afterwards, any drug further administered to the patients based on need was recorded, and the morphine equivalent for all drugs was calculated. Patients need to narcotic drugs during the first twelve hours of hospitalization and pain scores were recorded. After data gathering, they were analyzed by SPSS 16 software with chi-Square, Kruskal-Wallis and ANOVA statistical tests. The highest and the lowest significant pain intensity were seen in placebo and morphine groups, respectively, in the first, second and third 4 hours after surgery. There were significant differences among the groups for need to analgesics. In other words, placebo group needed the highest dosage of analgesics and morphine and methadone groups needed the lowest dosage of analgesics. Morphine and methadone groups had maximum and minimum response to pain, respectively, in the first, second and third 4 hours after surgery. Administering 5 mg intra-articular morphine after arthroscopic ACL reconstruction is

  9. Bohler's angle's role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study.

    Science.gov (United States)

    Su, Yanling; Chen, Wei; Zhang, Tao; Wu, Xingwang; Wu, Zhanpo; Zhang, Yingze

    2013-09-24

    Controversy exits over the role of Böhler's angle in assessing the injury severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following internal fixation. This study aims to investigate whether a correlation exists between Böhler's angle and the injury severity of displaced calcaneal fractures, and between surgical improvement of Böhler's angle and functional outcome. Patients treated operatively for unilateral closed displaced intra-articular calcaneal fractures from January 1, 2004 to March 31, 2008 were identified. The Böhler's angles of both calcaneus were measured, and the measurement of the uninjured foot was used as its normal control. The difference in the value of Böhler's angle measured preoperatively or postoperatively between the angle of the injured foot and that of the contralateral calcaneus were calculated, respectively. The change in Böhler's angle by ratio was calculated by dividing the difference value of Böhler's angle between bilateral calcaneus by its normal control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot & Ankle Society hindfoot scores. 274 patients were included into the study with a mean follow-up duration of 71 months. According to Sanders classification, the fracture pattern included 105 type II, 121 type III and 48 type IV fractures. According to American Orthopaedic Foot & Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 104, 132, 27, and 11 patients, respectively. The preoperative Böhler's angle, difference value of Böhler's angle between bilateral calcaneus, and change in Böhler's angle by ratio each has a significant correlation with Sanders classification (rs=-0.178, P=0.003; rs=-0.174, P=0.004; rs=-0.172, P=0.005, respectively), however, is not correlated with functional outcome individually. The three postoperative measurements

  10. Intra-articular (IA) ropivacaine microparticle suspensions reduce pain, inflammation, cytokine, and substance p levels significantly more than oral or IA celecoxib in a rat model of arthritis.

    Science.gov (United States)

    Rabinow, Barrett; Werling, Jane; Bendele, Alison; Gass, Jerome; Bogseth, Roy; Balla, Kelly; Valaitis, Paul; Hutchcraft, Audrey; Graham, Sabine

    2015-02-01

    Current therapeutic treatment options for osteoarthritis entail significant safety concerns. A novel ropivacaine crystalline microsuspension for bolus intra-articular (IA) delivery was thus developed and studied in a peptidoglycan polysaccharide (PGPS)-induced ankle swelling rat model. Compared with celecoxib controls, both oral and IA, ropivacaine IA treatment resulted in a significant reduction of pain upon successive PGPS reactivation, as demonstrated in two different pain models, gait analysis and incapacitance testing. The reduction in pain was attended by a significant reduction in histological inflammation, which in turn was accompanied by significant reductions in the cytokines IL-18 and IL-1β. This may have been due to inhibition of substance P, which was also significantly reduced. Pharmacokinetic analysis indicated that the analgesic effects outlasted measurable ropivacaine levels in either blood or tissue. The results are discussed in the context of pharmacologic mechanisms both of local anesthetics as well as inflammatory arthritis.

  11. Análise da sintomatologia em pacientes com disfunções intra-articulares da articulação temporomandibular

    OpenAIRE

    DONEGÁ,Sílvio Henrique de Paula; Cardoso, Renato [UNIFESP; Antonio Sílvio Fontão PROCÓPIO; Luz,João Gualberto de Cerqueira

    1997-01-01

    Foi realizado estudo analisando a sintomatologia em pacientes com disfunções intra-articulares da articulação temporomandibular. A queixa mais citada foi de dor na região pré-auricular (40,7%). Sintomatologia dolorosa articular (63,2%) e ruídos articulares (83,3%) foram os achados mais comuns ao exame clínico. Os ruídos articulares mais freqüentes foram os estalos (66,6%). Dor muscular ocorreu, em especial, nos músculos pterigóideo medial e lateral e na inserção do temporal. Houve decréscimo ...

  12. Intra-articular corticosteroids in the treatment of juvenile idiopathic arthritis: Safety, efficacy, and features affecting outcome. A comprehensive review of the literature

    Directory of Open Access Journals (Sweden)

    Alisa Carman Gotte

    2009-05-01

    Full Text Available Alisa Carman GotteUniversity of Texas Southwestern Medical Center, Department of Pediatrics, Dallas, TX, USAAbstract: Intra-articular corticosteroid injection (IACI has been used in the treatment of inflammatory arthritis in adults for over fifty years. Over the last two decades, IACI has become an important tool in the management of juvenile idiopathic arthritis (JIA, particularly in the oligoarthritis subset of JIA. Many factors may affect the efficacy of this treatment modality, although the majority of evidence on this topic is anecdotal, nonconvincing, or conflicting. The review examines the rationale, efficacy, safety, and application of the use of IACI in the treatment of JIA, focusing on factors that affect the outcome following IACI. Keywords: juvenile idiopathic arthritis, juvenile rheumatoid arthritis, glucocorticoids, treatment, children

  13. Does Kapandji wiring help in older patients? A retrospective comparative review of displaced intra-articular distal radial fractures in patients over 55 years.

    Science.gov (United States)

    Board, T; Kocialkowski, A; Andrew, G

    1999-12-01

    Forty-six patients aged 55-90 with intra-articular displaced fractures of the distal radius were reviewed retrospectively. All patients were treated with either manipulation and plaster of Paris or Kapandji wiring. Radiographic and functional review was performed by an independent observer a mean of 17 months after the fracture. The results showed superior anatomical and functional results in the group treated with Kapandji wiring. The mean dorsal angle was significantly better in the wired group, and the improvement in dorsal angle, radial angle and radial length from presentation to final result was also significantly better. Functional results were excellent or good in 19/23 of the wired group, compared with 12/23 of the plaster group. There was a strong correlation between functional outcome and both dorsal angle and radial length at union. These results support the use of this method of wire fixation in older patients, as the technique is simple and complications were few.

  14. Intra-articular hyaluronan is without clinical effect in knee osteoarthritis: a multicentre, randomised, placebo-controlled, double-blind study of 337 patients followed for 1 year

    DEFF Research Database (Denmark)

    Jørgensen, Anette; Stengaard-Pedersen, Kristian; Simonsen, Lars Ole;

    2010-01-01

    Objective To examine the long-term efficacy and safety of five intra-articular injections with hyaluronan in knee osteoarthritis. Methods A multicentre, randomised, placebo-controlled double-blind study of 337 patients fulfilling the American College of Rheumatology (ACR) criteria for knee...... efficacy parameter. LFI, pain on walking 50 m based on visual analogue scale (VAS pain 50 m), paracetamol consumption, patients' global assessment, Nottingham health profile, joint effusion and number of responders were secondary efficacy parameters. The efficacy parameters were analysed by intention...... to treat (ITT) and per protocol (PP). All adverse events (AE) were recorded as safety parameters. Results Time to recurrence showed no significant treatment effect (ITT analysis, p = 0.26). Change from baseline in LFI and VAS pain 50 m for the ITT population showed no treatment effect. Paracetamol...

  15. Concentraciones de aminoácidos maternos secundarias al uso de betametasona para la

    OpenAIRE

    Keibis Jiménez-Castillejo; Eduardo Reyna-Villasmil; Duly Torres- Cepeda; Joel Santos-Bolívar; Jorly Mejia-Montilla

    2016-01-01

    El objetivo de la investigación fue determinar las concentraciones plasmáticas de aminoácidos maternos secundarias al uso de betametasona para la maduración pulmonar fetal. Se realizó una investigación con un diseño tipo cuasi-experimental y una muestra no probabilística intencional de 106 pacientes que acudieron a la Consulta Pe-Natal de Alto Riesgo del Hospital Central “Dr. Urquinaona". A las pacientes seleccionadas se les administró betametasona intramuscular (12 mg) por dos dí...

  16. EFECTOS DE LA BETAMETASONA EN LA FORMACIÓN DE ADHERENCIAS PERITONEALES POSTOPERATORIAS EN RATAS

    OpenAIRE

    Luis Alfredo Hernández Villarroel; Carlos Alfredo Caraballo Guevara; Víctor Rodríguez Henríquez; Laura Cedeño Calvo; Luisa Cesín; Henry Fernández

    2014-01-01

    Objetivos: Evaluar los Efectos de la Betametasona, en la Formación de adherencias peritoneales postoperatorias en modelo animal de la ONU. Metodología: A 10 Ratas hembrasSprague-Dawley se les practico Cirugía formadora de adherencias peritoneales y were Distribuidas de forma aleatoria en 2 Grupos, Qué grupo ONU recibio dosisintraperitoneal Única de Betametasona, y El Otro Como grupo control. Resultados: Los animales sacrificados were y evaluados a los 15 Días, differences observandoestadístic...

  17. Concentraciones de aminoácidos maternos secundarias al uso de betametasona para la

    OpenAIRE

    Keibis Jiménez-Castillejo; Eduardo Reyna-Villasmil; Duly Torres- Cepeda; Joel Santos-Bolívar; Jorly Mejia-Montilla

    2016-01-01

    El objetivo de la investigación fue determinar las concentraciones plasmáticas de aminoácidos maternos secundarias al uso de betametasona para la maduración pulmonar fetal. Se realizó una investigación con un diseño tipo cuasi-experimental y una muestra no probabilística intencional de 106 pacientes que acudieron a la Consulta Pe-Natal de Alto Riesgo del Hospital Central “Dr. Urquinaona". A las pacientes seleccionadas se les administró betametasona intramuscular (12 mg) por dos dí...

  18. The promotion of osteochondral repair by combined intra-articular injection of parathyroid hormone-related protein and implantation of a bi-layer collagen-silk scaffold.

    Science.gov (United States)

    Zhang, Wei; Chen, Jialin; Tao, Jiadong; Hu, Changchang; Chen, Longkun; Zhao, Hongshi; Xu, Guowei; Heng, Boon C; Ouyang, Hong Wei

    2013-08-01

    The repair of osteochondral defects can be enhanced with scaffolds but is often accompanied with undesirable terminal differentiation of bone marrow-derived mesenchymal stem cells (BMSCs). Parathyroid hormone-related protein (PTHrP) has been shown to inhibit aberrant differentiation, but administration at inappropriate time points would have adverse effects on chondrogenesis. This study aims to develop an effective tissue engineering strategy by combining PTHrP and collagen-silk scaffold for osteochondral defect repair. The underlying mechanisms of the synergistic effect of combining PTHrP administration with collagen-silk scaffold implantation for rabbit knee joint osteochondral defect repair were investigated. In vitro studies showed that PTHrP treatment significantly reduced Alizarin Red staining and expression of terminal differentiation-related markers. This is achieved in part through blocking activation of the canonical Wnt/β-catenin signaling pathway. For the in vivo repair study, intra-articular injection of PTHrP was carried out at three different time windows (4-6, 7-9 and 10-12 weeks) together with implantation of a bi-layer collagen-silk scaffold. Defects treated with PTHrP at the 4-6 weeks time window exhibited better regeneration (reconstitution of cartilage and subchondral bone) with minimal terminal differentiation (hypertrophy, ossification and matrix degradation), as well as enhanced chondrogenesis (cell shape, Col2 and GAG accumulation) compared with treatment at other time windows. Furthermore, the timing of PTHrP administration also influenced PTHrP receptor expression, thus affecting the treatment outcome. Our results demonstrated that intra-articular injection of PTHrP at 4-6 weeks post-injury together with collagen-silk scaffold implantation is an effective strategy for inhibiting terminal differentiation and enhancing chondrogenesis, thus improving cartilage repair and regeneration in a rabbit model. Copyright © 2013 Elsevier Ltd. All

  19. Intra-articular administration of hyaluronic acid increases the volume of the hyaline cartilage regenerated in a large osteochondral defect by implantation of a double-network gel.

    Science.gov (United States)

    Fukui, Takaaki; Kitamura, Nobuto; Kurokawa, Takayuki; Yokota, Masashi; Kondo, Eiji; Gong, Jian Ping; Yasuda, Kazunori

    2014-04-01

    Implantation of PAMPS/PDMAAm double-network (DN) gel can induce hyaline cartilage regeneration in the osteochondral defect. However, it is a problem that the volume of the regenerated cartilage tissue is gradually reduced at 12 weeks. This study investigated whether intra-articular administration of hyaluronic acid (HA) increases the volume of the cartilage regenerated with the DN gel at 12 weeks. A total of 48 rabbits were used in this study. A cylindrical osteochondral defect created in the bilateral femoral trochlea was treated with DN gel (Group DN) or left without any implantation (Group C). In both Groups, we injected 1.0 mL of HA in the left knee, and 1.0 mL of saline solution in the right knee. Quantitative histological evaluations were performed at 2, 4, and 12 weeks, and PCR analysis was performed at 2 and 4 weeks after surgery. In Group DN, the proteoglycan-rich area was significantly greater in the HA-injected knees than in the saline-injected knees at 12 weeks (P = 0.0247), and expression of type 2 collagen, aggrecan, and Sox9 mRNAs was significantly greater in the HA-injected knees than in the saline-injected knees at 2 weeks (P = 0.0475, P = 0.0257, P = 0.0222, respectively). The intra-articular administration of HA significantly enhanced these gene expression at 2 weeks and significantly increased the volume of the hyaline cartilage regenerated by implantation of a DN gel at 12 weeks. This information is important to develop an additional method to increase the volume of the hyaline cartilage tissue in a potential cartilage regeneration strategy using the DN gel.

  20. Intra-articular use of a medical device composed of hyaluronic acid and chondroitin sulfate (Structovial CS: effects on clinical, ultrasonographic and biological parameters

    Directory of Open Access Journals (Sweden)

    Henrotin Yves

    2012-08-01

    Full Text Available Abstract Background This pilot open noncontrolled study was designed to assess the efficacy of intra-articular injections of a solution combining hyaluronic acid (HA and chondroitin sulphate (CS in the treatment of outpatients affected by knee osteoarthrosis. Findings Thirty patients with knee OA have been included. The primary objective was to assess clinical efficacy as measured by pain and Lequesne’s index. Secondary objectives were to assess potential effect of the treatment on ultrasound parameters, safety and biomarkers of cartilage metabolism and joint inflammation. After a selection visit (V1, the study treatment was administered 3 times on a weekly basis (V2, V3, V4. Follow-up was planned 6 (V5 and 12 weeks (V6 after the first intra-articular injection. Efficacy results showed a reduction in mean pain at V3 and V6 and in functional impairment, the most marked changes being measured at the two follow-up visits (V5 and V6. Although statistical significance was not achieved due to small sample size, a clear tendency towards improvement was detectable for ultrasound assessments as well as biomarkers. Except for a mild injection site hematoma for which the drug causal relationship could not be excluded, no adverse effect of clinical relevance was recorded during the study. Conclusion Although this pilot study was performed according to an open design only, the ultrasound as well as biomarkers changes strongly suggest a non-placebo effect. These preliminary results call now for a randomized controlled study to confirm the clinical relevance of the observed results. Trial registration #ISRCTN91883031

  1. Intra-articular administration of an antibody against CSF-1 receptor reduces pain-related behaviors and inflammation in CFA-induced knee arthritis.

    Science.gov (United States)

    Alvarado-Vazquez, P A; Morado-Urbina, C E; Castañeda-Corral, G; Acosta-Gonzalez, R I; Kitaura, H; Kimura, K; Takano-Yamamoto, T; Jiménez-Andrade, J M

    2015-01-01

    Several studies have shown that blockade of colony stimulating factor-1 (CSF-1) or its receptor (CSF-1R) inhibits disease progression in rodent models of rheumatoid arthritis (RA); however, the role of the CSF-1/CSF-1R pathway in RA-induced pain and functional deficits has not been studied. Thus, we examined the effect of chronic intra-articular administration of a monoclonal anti-CSF-1R antibody (AFS98) on spontaneous pain, knee edema and functional disabilities in mice with arthritis. Unilateral arthritis was produced by multiple injections of complete Freund's adjuvant (CFA) into the right knee joint of adult male ICR mice. CFA-injected mice were then treated twice weekly from day 10 until day 25 with anti-CSF-1R antibody (3 and 10 μg/5 μL per joint), isotype control (rat IgG 10 μg/5 μL per joint) or PBS (5 μl/joint). Knee edema, spontaneous flinching, vertical rearing and horizontal exploratory activity were assessed at different days. Additionally, counts of peripheral leukocytes and body weight were measured to evaluate general health status. Intra-articular treatment with anti-CSF-1R antibody significantly increased horizontal exploratory activity and vertical rearing as well as reduced spontaneous flinching behavior and knee edema as compared to CFA-induced arthritis mice treated with PBS. Treatment with this antibody neither significantly affect mouse body weight nor the number of peripheral leukocytes. These results suggest that blockade of CSF-1R at the initial injury site (joint) could represent a therapeutic alternative for improving the functional disabilities and attenuating pain and inflammation in patients with RA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Oral rosmarinic acid-enhanced Mentha spicata modulates synovial fluid biomarkers of inflammation in horses challenged with intra-articular LPS.

    Science.gov (United States)

    Pearson, W; Fletcher, R S; Kott, L S

    2012-10-01

    A biological extract of high-rosmarinic acid mint (HRAM) has previously demonstrated inhibitory effects on lipopolysaccharide (LPS)-induced prostaglandin E(2) (PGE(2)), nitric oxide (NO) and glycosaminoglycan (GAG) release in vitro. This study was undertaken to determine whether HRAM added to feed produces similar effects in horses challenged with intra-articular LPS. Eight horses received HRAM (0 or 28.1 ± 1.3 g/day; n = 4 per group) in their feed for 24 days in a blinded manner. On day 21, all horses received an intra-articular injection of LPS (0.3 ng) into their left or right intercarpal joint. Synovial fluid (SF) samples were taken on postinjection day (PID)-21 (i.e. prior to commencement of supplementation), PID0, PID0.25, PID0.5, PID1 and PID3 and analysed for PGE(2), GAG, NO, protein and total nucleated cells counts. Blood biochemistry and haematology screens were conducted at PID-21, PID0, PID1 and PID3. There was a significant reduction in LPS-induced PGE(2) and GAG in SF in horses supplemented with HRAM compared with controls and a tendency to increase complement recognition protein accumulation in synovial fluid of HRAM horses. Plasma from HRAM horses had reduced total white blood cells, segmented neutrophils (compared with baseline concentrations) and lymphocytes (compared with controls), and increased SF nucleated cell count (compared with baseline concentrations and controls). It is concluded that HRAM offered as part of the feed alter biomarkers of inflammation in SF of LPS-challenged horses. Larger studies that seek to clarify effects of HRAM on synovial fluid cell counts and possible role of HRAM-induced interference with complement signalling are warranted. © 2011 Blackwell Publishing Ltd.

  3. Anti-inflammatory and analgesic effects of intra-articular injection of triamcinolone acetonide, mepivacaine hydrochloride, or both on lipopolysaccharide-induced lameness in horses.

    Science.gov (United States)

    Kay, Alastair T; Bolt, David M; Ishihara, Akikazu; Rajala-Schultz, Paivi J; Bertone, Alicia L

    2008-12-01

    To assess analgesia, inflammation, potency, and duration of action associated with intra-articular injection of triamcinolone acetonide (TA), mepivacaine hydrochloride, or both in metacarpophalangeal (MCP) joints of horses with experimentally induced acute synovitis. 18 horses. Both forelimbs of each horse were injected with lipopolysaccharide (LPS) 3 times. After the first LPS injection, 1 forelimb of each horse was treated with intra-articular injection of mepivacaine (80 mg; n=6), TA (9 mg; 6), or mepivacaine with TA (same doses of each; 6) 12 hours after the initial LPS injection. Contralateral limbs served as control limbs. Joint pain was assessed via lameness score and measurements of vertical force peak and pain-free range of motion of the MCP joint. Periarticular edema was evaluated. Degree of synovial inflammation was determined via synovial fluid analysis for WBC count and total protein concentration. Samples of plasma and synovial fluid were analyzed for TA and mepivacaine concentrations. Each injection of LPS induced lameness and joint inflammation. Mepivacaine effectively eliminated lameness within 45 minutes after injection, regardless of whether TA was also administered, whereas TA reduced lameness, edema, and concentration of synovial fluid protein after the second LPS injection, regardless of whether mepivacaine was also injected. Treatment with TA also induced higher WBC counts and mepivacaine concentrations in synovial fluid, compared with results for mepivacaine alone. Results suggested TA is a potent analgesic and anti-inflammatory medication for acute synovitis in horses and that simultaneous administration of mepivacaine does not alter the potency or duration of action of TA.

  4. Adalimumab added to a treat-to-target strategy with methotrexate and intra-articular triamcinolone in early rheumatoid arthritis increased remission rates, function and quality of life. The OPERA Study

    DEFF Research Database (Denmark)

    Hørslev-Petersen, Kim; Hetland, Merete Lund; Junker, Peter

    2014-01-01

    OBJECTIVES: An investigator-initiated, double-blinded, placebo-controlled, treat-to-target protocol (Clinical Trials:NCT00660647) studied whether adalimumab added to methotrexate and intra-articular triamcinolone as first-line treatment in early rheumatoid arthritis (ERA) increased the frequency ...

  5. 跟骨距下关节内移位骨折的手术治疗与术后康复%Operative treatment and postoperative rehabilitation of displaced intra-articular fractures of calcaneus

    Institute of Scientific and Technical Information of China (English)

    金晨; 胡小鹏; 杨裕红; 张德常; 陈学桂; 吴揭地

    2002-01-01

    @@ Background:Fracture of calcaneus often leads to pain,deformity,function of foot is impaired and even permanent function impairments are left.Many divergence existed in treatment of severe intra articular fracture existed,but with the development of pedal surgery and deep study of biomechanics anatomy,especially building of BO theory,the therapeutic programs have become clearer.

  6. The effect of intra-articular injection of ultracain in the temporomandibular joint in patients with preauricular pain - A randomized prospective double-blind placebo-controlled crossover study

    NARCIS (Netherlands)

    Tjakkes, Geerten-Has E.; TenVergert, Elisabeth M.; de Bont, Lambert G. M.; Stegenga, Boudewijn

    2007-01-01

    Objectives: To evaluate the distinguishing ability of intraarticular anesthesia from placebo in orofacial pain patients with pain located in the temporomandibular joint (TMJ) region, aiming at a validation of intra-articular anesthesia injection as a diagnostic test of pain in the TMJ region. Materi

  7. Comparison of the Effectiveness of Suprascapular Nerve Block With Physical Therapy, Placebo, and Intra-Articular Injection in Management of Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Chang, Ke-Vin; Hung, Chen-Yu; Wu, Wei-Ting; Han, Der-Sheng; Yang, Rong-Sen; Lin, Chih-Peng

    2016-08-01

    To explore the effectiveness of suprascapular nerve block (SSNB) at different timing after administration compared with physical therapy, placebo, and intra-articular injections in patients with chronic shoulder pain. Two electronic data sources, PubMed and Scopus, were mainly searched from the earliest record to September 2015. Eleven randomized controlled trials that compared SSNB with physical therapy, placebo, and intra-articular injections were included, comprising 591 patients. Patient demographics, regimens for SSNB and intra-articular injections, use of fluoroscopy or ultrasound guidance, conjunction with physical therapy, methods of randomization, and measurements of functional change and pain improvement were retrieved. The standardized mean differences (SMDs) of pain relief and functional improvement were calculated 1, 4, and 12 weeks after intervention. Regarding pain relief, SSNB provided better pain relief for 12 weeks compared with physical therapy (SMD=.75; 95% confidence interval [CI], .35-1.14) and placebo injections (SMD=.70; 95% CI, .40-1.00), but was not superior to intra-articular injections. Differences in patient populations and use of pulsed radiofrequency did not cause a significant variation in therapeutic efficacy, but guidance using ultrasound showed consistently better effectiveness than guidance using surface landmarks and fluoroscopy. This meta-analysis demonstrated the superiority of SSNB to placebo and physical therapy and a similar efficacy of SSNB compared with intra-articular injection for treatment of chronic shoulder pain. Ultrasound was the most preferable guidance tool, and future studies are advised to integrate physical therapy in order to improve the long-term effectiveness of SSNB. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  8. EFECTOS DE LA BETAMETASONA EN LA FORMACIÓN DE ADHERENCIAS PERITONEALES POSTOPERATORIAS EN RATAS

    Directory of Open Access Journals (Sweden)

    Luis Alfredo Hernández Villarroel

    2014-01-01

    Full Text Available Objetivos: Evaluar los Efectos de la Betametasona, en la Formación de adherencias peritoneales postoperatorias en modelo animal de la ONU. Metodología: A 10 Ratas hembrasSprague-Dawley se les practico Cirugía formadora de adherencias peritoneales y were Distribuidas de forma aleatoria en 2 Grupos, Qué grupo ONU recibio dosisintraperitoneal Única de Betametasona, y El Otro Como grupo control. Resultados: Los animales sacrificados were y evaluados a los 15 Días, differences observandoestadísticamente significativas Entre los Grupos en Cuanto Al Numero (p = 0,013, severidad (p = 0,049, Grado de Inflamación (= 0027, de proliferaciones vasculares(p = 0,007 y fibrosis (p = 0,040 de las adherencias peritoneales. Conclusión: Este Estudio demostro la del que gestion de Betametasona Disminuye la Formaciónde adherencias peritoneales postoperatorias y, del tanto del por, la ONU Tiene efecto preventivo de las MismaPalabras Clave: adherencias tisulares, betametasona, Inflamación.

  9. Concentraciones de aminoácidos maternos secundarias al uso de betametasona para la

    National Research Council Canada - National Science Library

    Keibis Jiménez-Castillejo; Eduardo Reyna-Villasmil; Duly Torres- Cepeda; Joel Santos-Bolívar; Jorly Mejia-Montilla

    2016-01-01

    El objetivo de la investigación fue determinar las concentraciones plasmáticas de aminoácidos maternos secundarias al uso de betametasona para la maduración pulmonar fetal. Se realizó una investigación...

  10. Hyaluronic acid intra-articular injection and exercise therapy: effects on pain and disability in subjects affected by lower limb joints osteoarthritis. A systematic review by the Italian Society of Physical and Rehabilitation Medicine (SIMFER).

    Science.gov (United States)

    Monticone, Marco; Frizziero, Antonio; Rovere, Giancarlo; Vittadini, Filippo; Uliano, Domenico; LA Bruna, Silvano; Gatto, Renato; Nava, Claudia; Leggero, Vittorio; Masiero, Stefano

    2016-06-01

    It is debated whether intra-articular viscosupplementation with hyaluronic acid (HA) can lead to improvements in subjects with osteoarthritis (OA) undergoing physical and rehabilitative interventions. To assess the effects of intra-articular viscosupplementation on disability in subjects with OA undergoing physical and rehabilitative interventions. Information on pain and quality of life were also collected. The databases of PubMed, Medline, EMbase and CINAHL were searched for English language full-text randomized controlled trials comparing intra-articular viscosupplementation alone or associated with physical and rehabilitative interventions to viscosupplementation alone, shame treatment, waiting lists, and any type of rehabilitative interventions. Methodological quality of each study was assessed by using the Physiotherapy Evidence Database (PEDro) Scale. A total of 115 references were retrieved, and 8 studies were selected. Three trials compared HA injection and physical therapy in knee OA, with disability and pain improvements in all studies, and between-group differences in favor of physical therapy in two studies; two trials compared HA injection and home exercises in knee OA, with improvements in pain, disability and quality of life in all studies, without between-group differences; two trials compared HA injection plus physical therapy agents and exercises to exercises plus physical therapy agents in knee OA, with improvements in disability and pain in both studies, and between-group differences in favor of the inclusion HA in one study; one trial compared HA injection and home exercises in ankle OA, with improvements in disability and pain in both arms without between-group differences. Physical therapy agents seemed to have greater effects than intra-articular viscosupplementation on disability and pain. In the other cases both intra-articular viscosupplementation and physical and rehabilitative interventions seemed to be equally effective in improving

  11. Total hip replacement rate in a cohort of patients affected by symptomatic hip osteoarthritis following intra-articular sodium hyaluronate (MW 1,500-2,000 kDa) ORTOBRIX study.

    Science.gov (United States)

    Migliore, Alberto; Bella, Antonino; Bisignani, Massimariano; Calderaro, Michele; De Amicis, Daniele; Logroscino, Giandomenico; Mariottini, Fabio; Moreschini, Oreste; Massafra, Umberto; Bizzi, Emanuele; Laganà, Bruno; Piscitelli, Prisco; Tormenta, Sandro

    2012-08-01

    Hip osteoarthritis is very common and costly. The European League Against Rheumatology Committee agenda asks for research to investigate treatments able to slow down the progression of hip osteoarthritis (OA), to delay joint replacement, and to determine the comparative effectiveness and cost-effectiveness of non-surgical and surgical treatment modalities as well as criteria relating to the indications for and timing of total hip replacement (THR). After publishing the results of a randomized controlled trial and a cohort study on the efficacy of Intra-articular sodium hyaluronate (MW 1,500-2,000 kDa) on symptomatic hip OA, we performed this retrospective study in patients suffering from hip OA treated with ultrasound-guided intra-articular injections of HyalOne (Hyalubrix 60 Italian brand name) involving a group of THR expert orthopedic surgeons to appraise whether or not considered eligible for THR and the frequency and timing of THR. Six orthopedists, not routinely performing hip intra-articular injections, each independently assessed whether 176 patients suffering from hip OA and treated with ultrasound-guided intra-articular injections of sodium hyaluronate (MW 1,500-2,000 kDa) were candidates for THR according to the clinical data (age, body mass index, Pain Visual Analog Scale, Lequesne Algofunctional Index, global patient assessment, global physician assessment, nonsteroidal anti-inflammatory drug intake, and hip X-ray) collected at the first intra-articular sodium hyaluronate injection visit and provided as anonymous electronic data. At 24 months, 159 out of 76 (90 %) patients did not undergo to THR. At 48 months, 82 % (N = 144) of the study population treated with intra-articular hyaluronic acid avoided THR. In the group of 93 patients considered candidates for THR (that is, in which 4, 5, or 6 orthopedic surgeons agreed that the patient was a suitable candidate for THR), only 17 had undergone THR, with survival results of 82 % at 24 months. At 48 months

  12. Diagnostic performance of magnetic resonance imaging and pre-surgical evaluation in the assessment of traumatic intra-articular knee disorders in children and adolescents: what conditions still pose diagnostic challenges?

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    Gans, Itai; Ganley, Theodore J. [The Children' s Hospital of Philadelphia, Division of Orthopaedics, 34th and Civic Center Boulevard, Philadelphia, PA (United States); Bedoya, Maria A.; Ho-Fung, Victor [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2014-08-31

    Diagnosis of intra-articular lesions in children based on clinical examination and MRI is particularly challenging. To evaluate the diagnostic performance of MRI and pre-surgical evaluation of the knee in pediatric patients relative to arthroscopic evaluation as the gold standard. We report diagnoses frequently missed or inaccurately diagnosed pre-operatively. We conducted a retrospective review of MRI and pre-surgical evaluation in children and adolescents ages 1-17 years who were treated by knee arthroscopy during a 21/2-year period. All MRIs were reviewed by a pediatric radiologist blinded to clinical findings. Pediatric orthopedic clinic notes were reviewed for pre-surgical evaluation (based on physical exam, radiograph, MR images and radiologist's MRI report). Arthroscopic findings were used as the gold standard. We calculated the percentages of diagnoses at arthroscopy missed on both MRI and pre-surgical evaluation. Diagnostic accuracy between children and adolescents and in patients with one pathological lesion vs. those with >1 lesion was analyzed. We performed a second review of MR images of the missed or over-called MRI diagnoses with knowledge of arthroscopic findings. We included 178 children and adolescents. The most common diagnoses missed on MRI or pre-surgical evaluation but found at arthroscopy were: discoid meniscus (8/30, or 26.7% of cases); lateral meniscal tears (15/80, or 18.8% of cases); intra-articular loose bodies (5/36, or 13.9% of cases), and osteochondral injuries (9/73, or 12.3% of cases). Overall diagnostic accuracy of MRI and pre-surgical evaluation was 92.7% and 95.3%, respectively. No significant difference in diagnostic accuracy between children and adolescents was observed. When multiple intra-articular lesions were present, lateral meniscal tears were more likely to be inaccurately diagnosed (missed or over-called) on both MRI (P = 0.009) and pre-surgical evaluation (P < 0.001). Overall diagnostic accuracy of MRI and pre

  13. Pre-injection of hyaluronic acid does not affect the systemic effects of intra-articular depot betamethasone injection at the knee joint.

    Science.gov (United States)

    Habib, George; Khatib, Muhamad; Sakas, Fahed; Artul, Suheil; Jabaly-Habib, Haneen

    2017-01-01

    Intra-articular injection (IAI) of both hyaluronic acid (HA) and depot-steroid preparations had the advantage of quick and prolonged favorable effects on pain relief among patients with symptomatic osteoarthritis of the knee (OAK). The effect of IAI of HA on the systemic effects of the intra-articular steroids had not been investigated. Non-selected patients attending the rheumatology clinic with symptomatic OAK who failed NSAIDS and physical therapy were offered an IAI of HA at the knee joint followed 20 min later by an IAI of 1 ml of Celestone Chronodose at the same joint (group 1). Morning serum levels of cortisol were obtained just prior to the IAI and 1, 2 and 8 days later. Demographic, clinical, and laboratory parameters were obtained also from all the patients. Age- and sex-matched group of patients from the same clinic were recruited as a control group (group 2). Mean baseline serum cortisol levels in group 1 was 381 ± 154 mmol/l vs. 376 ± 119 in group 2 (p = 0.954). Morning serum cortisol levels at day 1 and day 2 were 24 ± 6 and 22 ± 6 mmol/l, respectively, in group 1 patients vs. 27 ± 5.8 (p = 0.214) and 25 ± 5.6 mmol/l (p = 0.200), respectively, in group 2. These levels were significantly lower than baseline levels in each group. Morning serum cortisol levels at day 8 in group 1 and group 2 were 349 ± 128 and 314 ± 99 mmol/l, respectively (p = 0.419). Pre-injection of HA at the knee joint did not affect the systemic effect on the hypothalamic-pituitary-adrenal axis of IAI of Celestone Chronodose.

  14. Intradiscal and intra-articular facet infiltrations with plasma rich in growth factors reduce pain in patients with chronic low back pain

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    Kirchner, Fernando; Anitua, Eduardo

    2016-01-01

    Context: Low back pain (LBP) is a complex and disabling condition, and its treatment becomes a challenge. Aims: The aim of our study was to assess the clinical outcome of plasma rich in growth factors (PRGF-Endoret) infiltrations (one intradiscal, one intra-articular facet, and one transforaminal epidural injection) under fluoroscopic guidance-control in patients with chronic LBP. PRGF-Endoret which has been shown to be an efficient treatment to reduce joint pain. Settings and Design: The study was designed as an observational retrospective pilot study. Eighty-six patients with a history of chronic LBP and degenerative disease of the lumbar spine who met inclusion and exclusion criteria were recruited between December 2010 and January 2012. Subjects and Methods: One intradiscal, one intra-articular facet, and one transforaminal epidural injection of PRGF-Endoret under fluoroscopic guidance-control were carried out in 86 patients with chronic LBP in the operating theater setting. Statistical Analysis Used: Descriptive statistics were performed using absolute and relative frequency distributions for qualitative variables and mean values and standard deviations for quantitative variables. The nonparametric Friedman statistical test was used to determine the possible differences between baseline and different follow-up time points on pain reduction after treatment. Results: Pain assessment was determined using a visual analog scale (VAS) at the first visit before (baseline) and after the procedure at 1, 3, and 6 months. The pain reduction after the PRGF-Endoret injections showed a statistically significant drop from 8.4 ± 1.1 before the treatment to 4 ± 2.6, 1.7 ± 2.3, and 0.8 ± 1.7 at 1, 3, and 6 months after the treatment, respectively, with respect to all the time evaluations (P < 0.0001) except for the pain reduction between the 3rd and 6th month whose signification was lower (P < 0.05). The analysis of the VAS over time showed that at the end point of the

  15. Open reduction and internal fixation of Ideberg IV and V glenoid intra-articular fractures through a Judet approach: a retrospective analysis of 11 cases.

    Science.gov (United States)

    Hu, Chuanzhen; Zhang, Weibin; Qin, Hui; Shen, Yuhui; Xue, Zichao; Ding, Haoliang; An, Zhiquan

    2015-02-01

    To evaluate the methods and the outcomes of complex intra-articular glenoid fractures, treated by open reduction and internal fixations. The outcomes of 11 cases of complex intra-articular glenoid scapular fractures were retrospectively analyzed. The fractures were classified as type IV in five cases, type Va in two and Vb in four cases, according to Ideberg classification system. The mean step or gap between the main articular fragments was 6.3 ± 6.2 (4-25) mm. The fractures were openly reduced through a Judet approach and fixed with reconstructive plates or bands placed on the lateral and medial side of affected scapula, respectively. The main articular fragments were strengthened with a 4.0-mm cannulated screw in five cases. The bone union, the anterior flexion, the external and internal rotation of the shoulders were checked and recorded. The functional outcomes were evaluated using DASH questionnaire, Constant and UCLA shoulder score systems, respectively. 11 patients were followed up with an average of 28.2 ± 12.6 (12-50) months. All the fractures were united smoothly without second intervention. At the latest visiting, the mean anterior flexion of affected shoulder was 157.3 ± 7.37° (range 150°-170°), the mean external rotation of the affected shoulder was 58.2 ± 7.5° (range 50°-70°). When the shoulder in the internal rotation, the extended thumb reached to L4 or L1 or T10 or T7 in one case, to T12 in two cases and to T8 in four cases, respectively, the mean Constant score was 91.7 ± 2.8 (86-96) points. The mean UCLA score was 32.7 ± 1.7 (30-35) points, leading to four cases of excellent and seven cases of good results. The mean DASH score was 7.4 ± 3.3 (3.4-13) points. Good outcomes could be obtained when Ideberg IV and V glenoid fractures were treated by open reduction and internal fixation through a Judet approach.

  16. Long-term clinical benefit and cost-effectiveness of an 8-week multimodal knee osteoarthritis management program incorporating intra-articular sodium hyaluronate (Hyalgan® injections

    Directory of Open Access Journals (Sweden)

    Miller LE

    2017-05-01

    Full Text Available Larry E Miller,1 Michael J Sloniewsky,2 Thomas E Gibbons,3 Janice G Johnston,4 Kent D Vosler,4 Saad Nasir5 1Miller Scientific Consulting, Inc., Asheville, NC, 2RMG Holding, Inc., Florence, 3Doctors Care, PA, Columbia, SC, 4Arrowhead Health Centers, Glendale, AZ, 5Fidia Pharma USA Inc., Parsippany, NJ, USA Background: Given the poor long-term effectiveness of focused nonsurgical knee osteoarthritis (OA treatments, alternative therapies are needed for patients who have unsuccessfully exhausted nonsurgical options.Methods: A telephone interview was conducted in patients who participated in a single 8-week multimodal knee OA treatment program (mean follow-up: 3.7 years, range: 2.7–4.9 years. The program consisted of five intra-articular knee injections of sodium hyaluronate (Hyalgan®, with each injection given 1 week apart, structured physical therapy, knee bracing, and patient education. Clinical outcomes included knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC subscores, current medication use, and history of total knee arthroplasty. Base-case, subgroup, and sensitivity analyses were conducted to determine the incremental cost-effectiveness ratio (ICER of the treatment program with comparisons made to historical literature controls undergoing usual care. Results: A total of 218 patients (54% provided long-term follow-up data. Knee pain severity decreased 60% and WOMAC subscores decreased 33%–42% compared to baseline (all p<0.001. Total knee arthroplasty was performed in 22.8% (81/356 of knees during follow-up. The treatment program was highly cost-effective compared to usual care with a base-case ICER of $6,000 per quality-adjusted life year (QALY. Results of subgroup analyses, one-way deterministic sensitivity analyses, and second-order probabilistic sensitivity analyses resulted in ICERs ranging from $3,996 to $10,493 per QALY. The percentage of simulations with an ICER below willingness

  17. The safety and efficacy of intra-articular dual molecular weighted hyaluronic acid in the treatment of knee osteoarthritis: the I.D.E.H.A. study

    Directory of Open Access Journals (Sweden)

    Xuming Shen

    2013-12-01

    Full Text Available In clinical practice viscosupplementation with hyaluronic acid (HA is common for the treatment of degenerative osteoarthritis (OA. Both molecular weight and concentration of HA have significant impact on its rheological properties, which in turn affects its therapeutic effects. The objective of this study is to evaluate the effectiveness of a double HA preparation for the treatment of knee osteoarthritis with respect to pain reduction, joint function improvement and concomitant medication consumption reduction. One thousand and fourteen patients (521 males and 693 females with a mean age of 62.4 years old, suffering from OA of the knee, were enrolled into this study. All patients received two intra-articular injections one week apart and a third injection one month after the second one. Concomitant medication was recorded and evaluated at follow up visits. Evaluation was performed at baseline, day 30 and day 180, on several parameters: knee pain by visual analog scale (VAS 0-10 cm, Lequesne Index, and consumption of concomitant medications including non-steroidal anti-inflammatory drugs, analgesics and chondoprotective supplementations. A statistically significant reduction in pain VAS score was recorded at D30 (38.01±17.68; P<0.01 before the third injection, and D180 (25.91±15.33; P<0.01 check-points comparing to baseline (67.12±15.99. Similarly, remarkable reduction in Lequesne Index was shown at D30 (5.91±4.01; P<0.01 in 1214 patients before the third injection, and D180 (3.59±3.45; P<0.01 (with 938 patients when compared to the baseline (11.60±5.13. Patients also consumed less concomitant medications after the treatment course. The beneficial effects were maintained for up to six months. Intra-articular injection of a double HA preparation of low molecular weight and high molecular weight of different concentrations was well tolerated, and generated satisfactory results in terms of pain control, joint function improvement and

  18. COMPARATIVE EFFICACY AND TOLERABILITY OF AVOCADO / SOYBEAN UNSAPONIFIABLES AND THEIR COMBINATION WITH INTRA-ARTICULAR HYALURONIC ACID IN PATIENTS WITH KNEE AND HIP OSTEOARTHROSIS

    Directory of Open Access Journals (Sweden)

    Ye. I. Shmidt

    2014-11-01

    Full Text Available Objective: to evaluate the comparative efficacy and tolerability of avocado / soybean unsaponifiables (ASU and their combination with intra-articular hyaluronic acid in patients with knee and hip osteoarthrosis (OA.Subjects and methods. A randomized observational non-interventional non-placebo controlled trial was conducted. It included 18 patients who were randomized to 2 groups with 9 in each. One patient group took only ASU along with nonsteroidal anti-nflammatory drugs (NSAIDs; the other received ASU in combination with intra-articular hyaluronic acid. Their treatment was performed for 6 months, followed by a 6-month follow-up. The results were assessed by the WOMAC index. Account was taken of the opinions of a patient and his / her physician on therapeutic effectiveness, as well as altered needs for NSAIDs during treatment and after the follow-up.Results. There was a gradual reduction in joint pain, stiffness, and dysfunction (as shown by the visual analog scale in both groups just one month posttherapy. This trend remained for 3 months. After 6 months of therapy, there were slight increases in the values of joint pain, stiffness, and dysfunction in the combined therapy group whereas the values continued to decrease in the monotherapy group. Six months after termination of treatment, the examined values doubled in the ASU monotherapy group and remained at posttreatment visit levels in the combined therapy group. Just the same, six months after termination of 6-month therapy, both groups displayed the significantly lower values of pain, stiffness, and dysfunction than those prior to treatment. ASU used both alone and in combination with hyaluronic acid was noted to be well tolerated. The considerable reduction in the needs for NSAIDs in both groups and, in a number of cases, the possibility of reducing their intake proved the efficiency of ASU used alone and in combination with hyaluronic acid. The important result of this trial

  19. COMPARATIVE EFFICACY AND TOLERABILITY OF AVOCADO / SOYBEAN UNSAPONIFIABLES AND THEIR COMBINATION WITH INTRA-ARTICULAR HYALURONIC ACID IN PATIENTS WITH KNEE AND HIP OSTEOARTHROSIS

    Directory of Open Access Journals (Sweden)

    Ye. I. Shmidt

    2014-01-01

    Full Text Available Objective: to evaluate the comparative efficacy and tolerability of avocado / soybean unsaponifiables (ASU and their combination with intra-articular hyaluronic acid in patients with knee and hip osteoarthrosis (OA.Subjects and methods. A randomized observational non-interventional non-placebo controlled trial was conducted. It included 18 patients who were randomized to 2 groups with 9 in each. One patient group took only ASU along with nonsteroidal anti-nflammatory drugs (NSAIDs; the other received ASU in combination with intra-articular hyaluronic acid. Their treatment was performed for 6 months, followed by a 6-month follow-up. The results were assessed by the WOMAC index. Account was taken of the opinions of a patient and his / her physician on therapeutic effectiveness, as well as altered needs for NSAIDs during treatment and after the follow-up.Results. There was a gradual reduction in joint pain, stiffness, and dysfunction (as shown by the visual analog scale in both groups just one month posttherapy. This trend remained for 3 months. After 6 months of therapy, there were slight increases in the values of joint pain, stiffness, and dysfunction in the combined therapy group whereas the values continued to decrease in the monotherapy group. Six months after termination of treatment, the examined values doubled in the ASU monotherapy group and remained at posttreatment visit levels in the combined therapy group. Just the same, six months after termination of 6-month therapy, both groups displayed the significantly lower values of pain, stiffness, and dysfunction than those prior to treatment. ASU used both alone and in combination with hyaluronic acid was noted to be well tolerated. The considerable reduction in the needs for NSAIDs in both groups and, in a number of cases, the possibility of reducing their intake proved the efficiency of ASU used alone and in combination with hyaluronic acid. The important result of this trial

  20. Effect of a treat-to-target strategy based on methotrexate and intra-articular betamethasone with or without additional cyclosporin on MRI-assessed synovitis, osteitis, tenosynovitis, bone erosion, and joint space narrowing in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Møller-Bisgaard, S; Ejbjerg, B J; Eshed, I

    2016-01-01

    OBJECTIVES: To investigate whether a treat-to-target strategy based on methotrexate (MTX) and intra-articular (IA) betamethasone suppresses magnetic resonance imaging (MRI)-determined measures of disease activity and reduces joint destruction in early rheumatoid arthritis (eRA) patients, and to i......OBJECTIVES: To investigate whether a treat-to-target strategy based on methotrexate (MTX) and intra-articular (IA) betamethasone suppresses magnetic resonance imaging (MRI)-determined measures of disease activity and reduces joint destruction in early rheumatoid arthritis (eRA) patients...... participated in the MRI substudy, and had contrast-enhanced MR images of the non-dominant hand at months 0, 6, 12, and 24. MR images were evaluated for osteitis, synovitis, tenosynovitis, bone erosion, and joint space narrowing (JSN), using validated scoring methods. RESULTS: Significant reductions were seen...

  1. Aggressive combination therapy with intra-articular glucocorticoid injections and conventional disease-modifying anti-rheumatic drugs in early rheumatoid arthritis: second-year clinical and radiographic results from the CIMESTRA study

    DEFF Research Database (Denmark)

    Hetland, M.L.; Stengaard-Pedersen, K.; Junker, P.;

    2008-01-01

    OBJECTIVE: To investigate whether clinical and radiographic disease control can be achieved and maintained in patients with early, active rheumatoid arthritis (RA) during the second year of aggressive treatment with conventional disease-modifying antirheumatic drugs (DMARDs) and intra-articular c......OBJECTIVE: To investigate whether clinical and radiographic disease control can be achieved and maintained in patients with early, active rheumatoid arthritis (RA) during the second year of aggressive treatment with conventional disease-modifying antirheumatic drugs (DMARDs) and intra......% in monotherapy), but hypertension was not more prevalent. CONCLUSION: Continuous methotrexate and intra-articular corticosteroid treatment resulted in excellent clinical response and disease control at 2 years, and the radiographic erosive progression was minimal. Addition of ciclosporine during the first 76...

  2. Effectiveness of MIS technique as a treatment modality for open intra-articular calcaneal fractures: A prospective evaluation with matched closed fractures treated by conventional technique.

    Science.gov (United States)

    Dhillon, Mandeep Singh; Gahlot, Nitesh; Satyaprakash, Sambit; Kanojia, Rajendra Kumar

    2015-09-01

    Twenty-five displaced intra-articular calcaneal fractures in 21 patients, aged 15-55 years were included in this study. Sanders' type I fractures, severe crushing or partial amputation, were excluded from the study. Patients were divided into group 1 (open fractures treated by MIS), and group 2 (closed fractures treated by ORIF). Group 1 had 16 and group 2 had 9 cases. Seven of 25 fractures (28%) developed wound related issues postoperatively. One patient (11.1%) in group 2 had wound margin necrosis, while 6 patients (37.5%) in group 1 developed pin tract and/or wound infection. At 1-year follow-up, the mean MFS for group 1 was 79 and mean MFS for group 2 was 84.4 (66.67% were good). The AOFAS score for group 1 was 77.37 and for group 2 was 86.1. The Bohlers' angle was restored in 81.16% cases in group 1 and 88.8% in group 2, while Gissane angle was restored in 68.75% of group 1 cases and 77.79% of group 2 cases. This study shows that acceptable fracture reduction can be obtained and maintained by MIS technique and it can be used as the primary definitive treatment option in open calcaneal fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Current management options for displaced intra-articular calcaneal fractures: Non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review.

    Science.gov (United States)

    Sharr, P J; Mangupli, M M; Winson, I G; Buckley, R E

    2016-03-01

    Management of Displaced Intra-articular Calcaneal Fractures (DIACFs) continues to be technically demanding. The literature has not been definitive in its guidance for surgeons dealing with these injuries. Recent publications have further added to the lack of clarity. This review is intended to summarise the present state of knowledge, and provide some genuine guidance for clinicians. To review previous research, focussing on articles published within the last fifteen years, and summarise the findings to aid surgeons in managing DIACFs with choosing best management for patients. We reviewed the best evidence and literature, focussing on articles published within the last fifteen years, and summarised findings into workable recommendations. Variables of (1) patient, (2) the associated soft tissue injury and (3) the fracture characteristics were used to aid surgeons in choosing the best of the available options for each patient that presents with a DIACF. Management of DIACFs can best be divided into four broad categories: (i) non-operative management, (ii) open reduction and internal fixation, (iii) minimally invasive reduction and fixation, and (iv) primary subtalar arthrodesis. The evolution of the literature would suggest orthopaedic surgeons managing calcaneus fractures should have an expert's knowledge, surgical expertise and the latest techniques to cover these four options, to tailor the treatment of DIACFs to the individual patient. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  4. An In Vivo Study of Low-Dose Intra-Articular Tranexamic Acid Application with Prolonged Clamping Drain Method in Total Knee Replacement: Clinical Efficacy and Safety

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    Paphon Sa-ngasoongsong

    2015-01-01

    Full Text Available Background. Recently, combined intra-articular tranexamic acid (IA-TXA injection with clamping drain method showed efficacy for blood loss and transfusion reduction in total knee replacement (TKR. However, until now, none of previous studies revealed the effect of this technique on pharmacokinetics, coagulation, and fibrinolysis. Materials and Methods. An experimental study was conducted, during 2011-2012, in 30 patients undergoing unilateral TKR. Patients received IA-TXA application and then were allocated into six groups regarding clamping drain duration (2-, 4-, 6-, 8-, 10-, and 12-hours. Blood and drainage fluid were collected to measure tranexamic acid (TXA level and related coagulation and fibrinolytic markers. Postoperative complication was followed for one year. Results. There was no significant difference of serum TXA level at 2 hour and 24 hour among groups (p<0.05. Serum TXA level at time of clamp release was significantly different among groups with the highest level at 2 hour (p<0.0001. There was no significant difference of TXA level in drainage fluid, postoperative blood loss, blood transfusion, and postoperative complications (p<0.05.  Conclusions. Low-dose IA-TXA application in TKR with prolonged clamping drain method is a safe and effective blood conservative technique with only minimal systemic absorption and without significant increase in systemic absorption over time.

  5. Disposition of human recombinant lubricin in naive rats and in a rat model of post-traumatic arthritis after intra-articular or intravenous administration.

    Science.gov (United States)

    Vugmeyster, Yulia; Wang, Qin; Xu, Xin; Harrold, John; Daugusta, Daren; Li, Jian; Zollner, Richard; Flannery, Carl R; Rivera-Bermúdez, Moisés A

    2012-03-01

    We have recently demonstrated that intra-articular (IA) administration of human recombinant lubricin, LUB:1, significantly inhibited cartilage degeneration and pain in the rat meniscal tear model of post-traumatic arthritis. In this report, we show that after a single IA injection to naïve rats and rats that underwent unilateral meniscal tear, [(125)I]LUB:1 had a tri-phasic disposition profile, with the alpha, beta, and gamma half-life estimates of 4.5 h, 1.5 days, and 2.1 weeks, respectively. We hypothesize that the terminal phase kinetics was related to [(125)I]LUB:1 binding to its ligands. [(125)I]LUB:1 was detected on articular cartilage surfaces as long as 28 days after single IA injection. Micro-autoradiography analysis suggested that [(125)I]LUB:1 tended to localize to damaged joint surfaces in rats with meniscal tear. After a single intravenous (IV) dose to rats, [(125)I]LUB:1 was eliminated rapidly from the systemic circulation, with a mean total body clearance of 154 mL/h/kg and a mean elimination half-life (t (1/2)) of 6.7 h. Overall, LUB:1 has met a desired disposition profile of a potential therapeutic intended for an IA administration: target tissue (knee) retention and fast elimination from the systemic circulation after a single IA or IV dose.

  6. Intra-articular delivery of sinomenium encapsulated by chitosan microspheres and photo-crosslinked GelMA hydrogel ameliorates osteoarthritis by effectively regulating autophagy.

    Science.gov (United States)

    Chen, Pengfei; Xia, Chen; Mei, Sheng; Wang, Jiying; Shan, Zhi; Lin, Xianfeng; Fan, Shunwu

    2016-03-01

    Reduced expression of autophagy regulators has been observed in pathological cartilage in humans and mice. The present study aimed to investigate the synergistic therapeutic effect of promotion of chondrocyte autophagy via exposure to sinomenium (SIN) encapsulated by chitosan microspheres (CM-SIN) and photo-crosslinked gelatin methacrylate (GelMA) hydrogel, with the goal of evaluating CM-SIN as a treatment for patients with osteoarthritis. First, we fabricated and characterized GelMA hydrogels and chitosan microspheres. Next, we measured the effect of SIN on cartilage matrix degradation induced by IL1-β in chondrocytes and an ex vivo model. SIN ameliorated the pathological changes induced by IL1-β at least partially through activation of autophagy. Moreover, we surgically induced osteoarthritis in mice, which were injected intra-articularly with CM-SIN and GelMA. Cartilage matrix degradation and chondrocyte autophagy were evaluated 4 and 8 weeks after surgery. Treatment with the combination of CM-SIN and GelMA retarded the progression of surgically induced OA. SIN ameliorated cartilage matrix degradation at least partially by inducing autophagy in vivo. Our results demonstrate that injection of the combination of GelMA hydrogel and CM-SIN could be a promising strategy for treating patients with osteoarthritis.

  7. Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography

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    Klempka, A.; Wagner, M.; Fodor, S.; Schmitt, R. [Cardiovascular Center Bad Neustadt an der Saale, Department of Diagnostic and Interventional Radiology, Bad Neustadt an der Saale (Germany); Prommersberger, K.J. [Clinic for Hand Surgery, Bad Neustadt an der Saale (Germany); Uder, M. [Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Department of Diagnostic Radiology, Erlangen (Germany)

    2016-03-15

    To evaluate the prevalence of injuries of the scapholunate and lunotriquetral interosseous ligaments (SLIL, LTIL) as well as the triangular fibrocartilage complex (TFCC) in intra-articular distal radius fractures (iaDRF). Two hundred and thirty-three patients with acute iaDRF underwent MDCT arthrography. The SLIL and LTIL were described as normal, partially or completely ruptured. Major injuries of the SLIL were defined as completely ruptured dorsal segments, those of the LTIL as completely ruptured palmar segments. The TFCC was judged as normal or injured. Interobserver variability was calculated. Injury findings were correlated with the types of iaDRF (AO classification). In 159 patients (68.2 %), no SLIL injuries were seen. Minor SLIL injuries were detected in 54 patients (23.2 %), major injuries in 20 patients (8.6 %). No correlation was found between the presence of SLIL lesions and the types of iaDRF. Minor LTIL injuries were seen in 23 patients (9.9 %), major injuries in only 5 patients (2.2 %). The TFCC was altered in 141 patients (60.5 %). Interobserver variability was high for MDCT arthrography in assessing SLIL and TFC lesions, and fair for LTIL lesions. In iaDRF, prevalence of major injuries of the most relevant SLIL is about 9 % as evaluated with CT arthrography. (orig.)

  8. An evaluation of the delayed effect of intra-articular injections of lidocaine (2%) on articular cartilage: an experimental study in rabbits.

    Science.gov (United States)

    Yazdi, Hamidreza; Nimavard, Bahahreh Tabatabaeian; Shokrgozar, Mohammadali; Dehghan, Mohammadmehdi; Moayedi, Reza Jamei; Majidi, Mohammad; Mokhtari, Tahmineh

    2014-12-01

    Lidocaine is commonly injected into the joints as an analgesic. The aim of the present study was to evaluate the delayed effect of intra-articular injections of lidocaine (2%) on articular cartilage in rabbit knees. Ten rabbits were divided into two groups, each group containing five animals. Two milliliters of normal saline solution was injected into both knee joints of animals in group one (control group), and 2 ml of lidocaine was injected into both knee joints of animals in group two (case group). After 8 weeks, the articular cartilage of the distal femur was harvested and analyzed through confocal microscopy and real-time polymerase chain reaction to evaluate the viability and function of chondrocytes, respectively. Confocal microscopy showed a significant decrease in the number of live cells caused by lidocaine (P ≤ 0.001). The changes in gene expression of collagen types II (COL II) and aggrecan were significant in group two (P = 0.008 and P = 0.002, respectively). According to the results, the delayed in vivo effect of lidocaine on chondrocyte is to reduce live chondrocytes and change in the gene expression of COL II and aggrecan.

  9. 关节镜诊治关节内桡骨远端粉碎性骨折的软组织损伤%Arthroscopic assessment of soft tissue injuries in comminuted intra-articular fractures of the distal radius

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To diagnose and evaluate soft tissue injuries in intra-articular fractures of the distal radius using arthroscopy. Methods Twenty young patients with displaced intra-articular fractures of distal radius were recruited in this prospective study. Three AO C2 and 17 C3 fractures were included. After arthroscopic examination fractures of distal radius were treated by external fixation with limited internal fixation or open plate fixation.Results Triangular fibrocartilage complex (TFCC) injury was found in 18 patients (90%) . Most were isolated Palmer type 1D injuries (67 %). Scapho-lunate ligament injury was found in two patients: one partial tear (grade Ⅱ) and one complete tear (grade Ⅲ). Follow-ups ranged from 6 to 18 months. At the last follow-up, wrist function was excellent in one patient (6%), good in eight(44%) and fair in 11 (50%). Conclusion TFCC injuries are common in intra-articular fractures of the distal radius while injuries to scapho-luuate ligament are uncommon.

  10. Analgesia intra-articular com morfina, bupivacaína ou fentanil após operação de joelho por videoartroscopia Analgesia intra-articular con morfina, bupivacaína o fentanil después de operación de rodilla por videoartroscopia Intra-articular analgesia with morphine, bupivacaine or fentanyl after knee video-arthroscopy surgery

    Directory of Open Access Journals (Sweden)

    Rogério Helcias de Souza

    2002-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O uso de métodos que promovam analgesia para dor do joelho sem prejudicar a função motora tem sido bastante pesquisado. O objetivo do presente estudo foi comparar o efeito analgésico da morfina, da bupivacaína e do fentanil, com a solução fisiológica, injetada por via intra-articular após operação de joelho por videoartroscopia. MÉTODO: Sessenta pacientes foram divididos de forma aleatória, em quatro grupos: GI (n=15 - 10 ml de solução fisiológica; GII (n = 15 - 2 mg de morfina diluídos para 10 ml de solução fisiológica; GIII (n = 15 - 10 ml de bupivacaína a 0,25%; GIV (n = 15 - 100 µg de fentanil diluídos para 10 ml de solução fisiológica, injetados ao término da operação. Todos os pacientes foram submetidos à anestesia subaracnóidea com 15 mg de bupivacaína hiperbárica. A intensidade da dor foi avaliada pela escala analógica visual (imediatamente após o término da operação e após 6, 12, 18 e 24 horas, bem como a necessidade de complementação analgésica (dipirona 1 g por via venosa. Foram anotados os possíveis efeitos colaterais. RESULTADOS: Não houve diferença significativa na intensidade da dor entre os grupos, na quase totalidade dos tempos estudados. Houve diferença estatística até seis horas, quando o grupo fentanil apresentou intensidade da dor significativamente menor. O grupo morfina necessitou de maior número de complementações com dipirona. Os efeitos colaterais foram mínimos, sem significância estatística. CONCLUSÕES: Não houve diferença significativa entre a analgesia promovida pelas soluções estudadas na maioria dos tempos investigados.JUSTIFICATIVA Y OBJETIVOS: El uso de métodos que promuevan analgesia para el dolor de rodilla sin perjudicar la función motora ha sido bastante pesquisado. El objetivo del presente estudio fue comparar el efecto analgésico de la morfina, de la bupivacaína y del fentanil, con la solución fisiológica, inyectada

  11. Avaliação biomecânica das fraturas intra-articulares do calcâneo e sua correlação clínica radiográfica Biomechanical evaluation of intra articular calcaneal fracture and clinical radiographic correlation

    Directory of Open Access Journals (Sweden)

    Marcos Emilio Kuschnaroff Contreras

    2004-06-01

    's classification of calcaneal fractures. The plantar pressure distribution was analyzed with F-scanning system. The results of the intra-articular calcaneal fractures were clinically satisfactory, showed average punctuation with 75,5 in AOFAS criterion. The surgical reduction in a better angle of Böchler and Gissane. The study showed statistical differences between the forefoot and rearfoot concerning the the contact area, average preassure and strength in the injured foot. The figures found to this parameter were bigger in the rearfoot than the forefoot. The trajectory of pressure (COP was shorter in the fractured foot than in the normal foot. The correlation between the angle of Gissane after the reduction and the second peak of force was found, showing as better as the reduction of this angle, the better is the impulsion. It was also found the correlation between the punctuation between AOFAS and the first peak of force, showing as better is the clinical result the better is the foot supporter.

  12. 参麦针关节腔内注射治疗膝骨性关节炎的临床研究%Clinical research of intra-articular injection of shenmai needle in treating knee osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    张龙; 陈健; 姚子升; 卓秋华

    2015-01-01

    Objective: To observe the clinical curative effect of intra-articular injection of shenmai needle in treating knee osteoarthritis. Methods:86 case of patients with knee osteoarthritis were divided into two groups: the intra-articular injection of shenmai needle group(45 cases)(treatment group)and the intra-articular injection of sodium hyaluronate group(41 cases)(control group).The treatment group are given shenmai needle and lidocaine by intra-articular injection twice a week,the control group are given sodium hyaluronate by intra-articular injection once a week.Before and after the treatment ,the two groups are given TCM symptom scores and ISOA scores. Result: The total effective rate of the treatment group was 90.7%, and 68.0% of the control group , the difference between the two groups was statistically significant (x2=8.331, P< 0.05). After treatment,the ISOA of the treatment group was (7.76±1.64) , the ISOC of the control group was (8.52±1.87),the difference between the two groups was statistically significant (t =-2.215,P<0.05). Conclusion:The intra-articular injection of shenmai needle in treating knee osteoarthritis had exact curative effect, and the recurrence rate was lower when compared with simple intra-articular injections of sodium hyaluronate .%目的:观察参麦针关节腔内注射治疗膝骨性关节炎的临床疗效.方法:86 例膝骨性关节炎患者,分为参麦针关节腔内注射组(治疗组45例),玻璃酸钠关节腔内注射组(对照组41例).治疗组予每周2次参麦针+利多卡因膝关节腔内注射,对照组予玻璃酸钠每周 1 次膝关节腔内注射.在治疗前后两组进行中医症状评分、ISOA 评分,并根据评分结果进行疗效比较.结果:治疗组中医症状改善总有效率达90.7%,对照组为68.0%,两组差异有统计学意义(x2=8.331,P<0.05).治疗后治疗组ISOA积分(7.76±1.64),对照组ISOA积分(8.52±1.87),两组差异有统计学意义(t=-2.215,P<0.05);治疗组治疗前

  13. Intra-articular Injected synovial stem cells differentiate into meniscal cells directly and promote meniscal regeneration without mobilization to distant organs in rat massive meniscal defect.

    Science.gov (United States)

    Horie, Masafumi; Sekiya, Ichiro; Muneta, Takeshi; Ichinose, Shizuko; Matsumoto, Kenji; Saito, Hirohisa; Murakami, Takashi; Kobayashi, Eiji

    2009-04-01

    Osteoarthritis in the knees, which can be caused by meniscal defect, constitutes an increasingly common medical problem. Repair for massive meniscal defect remains a challenge owing to a lack of cell kinetics for the menisci precursors in knee joint. The synovium plays pivotal roles during the natural course of meniscal healing and contains mesenchymal stem cells (MSCs) with high chondrogenic potential. Here, we investigated whether intra-articular injected synovium-MSCs enhanced meniscal regeneration in rat massive meniscal defect. To track the injected cells, we developed transgenic rats expressing dual luciferase (Luc) and LacZ. The cells derived from synovium of the rats demonstrated colony-forming ability and multipotentiality, both characteristics of MSCs. Hierarchical clustering analysis revealed that gene expression of meniscal cells was closer to that of synovium-MSCs than to that of bone marrow-MSCs. Two to 8 weeks after five million Luc/LacZ+ synovium-MSCs were injected into massive meniscectomized knee of wild-type rat, macroscopically, the menisci regenerated much better than it did in the control group. After 12 weeks, the regenerated menisci were LacZ positive, produced type 2 collagen, and showed meniscal features by transmission electron microscopy. In in-vivo luminescence analysis, photons increased in the meniscus-resected knee over a 3-day period, then decreased without detection in all other organs. LacZ gene derived from MSCs could not be detected in other organs except in synovium by real-time PCR. Synovium-MSCs injected into the massive meniscectomized knee adhered to the lesion, differentiated into meniscal cells directly, and promoted meniscal regeneration without mobilization to distant organs.

  14. Duration of symptom relief after intra-articular injection of hyaluronic acid combined with sorbitol (anti-ox-vs) in symptomatic hip osteoarthritis.

    Science.gov (United States)

    Migliore, A; Massafra, U; Bizzi, E; Tormenta, S; Cassol, M; Granata, M

    2014-01-01

    The intra-articular administration of hyaluronic acid (HA) in hip osteoarthritis (OA) has been recently increased following the use of ultrasound guidance to perform an accurate delivery of the injected product. Viscosupplementation in hip OA seems to show similar results to those obtained by viscosupplementation in knee OA. However, an unmet need is the duration of symptomatic relief, therefore several new products are proposed to prolong and increase symptomatic effects. Among these, an innovative viscosupplement has been produced from high a concentration of HA combined with a high concentration of sorbitol as a free radical scavenger. The aim of this study is to evaluate the mid-term pain-relief effect of an ultrasound-guided injection of SynolisV-A (ANTI-OX-VS) in patients suffering from symptomatic hip osteoarthritis. Lequesne index, Health Assessment Questionnaire (HAQ), pain reduction, Global Patient Assessment (GPA), Global Medical Assessment (GMA) and reduction in monthly analgesic consumption were assessed during the 12-month follow-up after the injection. A total of 20 patients were enrolled in the study and received one IA US-guided injection of two syringes of ANTI-OX-VS into the target hip. Eleven drop-out patients were registered, of whom 2 were for loss of efficacy at 6 months, 1 for loss of efficacy at 9 months and 8 patients for severe comorbilities. Mean scores of all clinical parameters evaluated at each control visit were significantly different when compared with baseline mean value. No systemic adverse events were observed. Even though the sample size of this study is limited, the results suggest a durable good efficacy of a 4-ml single injection of ANTI-OX-VS in hip OA, at least for the patients who completed the study. A larger number of patients and an RCT are needed to confirm these data, investigating also the predictive factors of clinical response to ANTI-OX-VS.

  15. Delayed Gadolinium-Enhanced Magnetic Resonance Imaging (dGEMRIC) of Hip Joint Cartilage: Better Cartilage Delineation after Intra-Articular than Intravenous Gadolinium Injection

    Energy Technology Data Exchange (ETDEWEB)

    Boesen, M.; Jensen, K. E.; Qvistgaard, E.; Danneskiold-Samsoe, B.; Thomsen, C.; Oestergaard, M.; Bliddal, H. [Frederiksberg Hospital, Copenhagen (Denmark). Parker Inst.

    2006-07-15

    Purpose: To investigate and compare delayed gadolinium (Gd-DTPA)-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) in the hip joint using intravenous (i.v.) or ultrasound-guided intra-articular (i.a.) Gd-DTPA injection. Material and Methods: In 10 patients (50% males, mean age 58 years) with clinical and radiographic hip osteoarthritis (OA; Kellgren score II-III), MRI of the hip was performed twice on a clinical 1.5T MR scanner: On day 1, before and 90-180 min after 0.3 mmol/kg body weight i.v. Gd-DTPA and, on day 8, 90-180 min after ultrasound-guided i.a. injection of a 4 mmol/l Gd-DTPA solution. Coronal STIR, coronal T1 fat-saturated spin-echo, and a cartilage-sensitive gradient-echo sequence (3D T1 SPGR) in the sagittal plane were applied. Results: Both the post-i.v. and post-i.a. Gd-DTPA images showed significantly higher signal-to-noise (SNR) and contrast-to-noise (CNR) in the joint cartilage compared to the non-enhanced images ( P <0.002). I.a. Gd-DTPA provided significantly higher SNR and CNR compared to i.v. Gd-DTPA ( P <0.01). Furthermore, a better delineation of the cartilage in the synovial/cartilage zone and of the chondral/subchondral border was observed. Conclusion: The dGEMRIC MRI method markedly improved delineation of hip joint cartilage compared to non-enhanced MRI. The i.a. Gd-DTPA provided the best cartilage delineation. dGEMRIC is a clinically applicable MRI method that may improve identification of early subtle cartilage damage and the accuracy of volume measurements of hip joint cartilage.

  16. Efficacy of radial styloid targeting screws in volar plate fixation of intra-articular distal radial fractures: a biomechanical study in a cadaver fracture model

    Directory of Open Access Journals (Sweden)

    Yamashita Toshihiko

    2010-12-01

    Full Text Available Abstract Background The locking screws target the radial styloid, theoretically provide greater stability against radial styloid fragment. However, it is unknown whether the radial styloid locking screws increased the stability of the volar plating system fixation along the entire distal radius or not. In this study, we evaluated the stability of the volar plating system fixation with or without the radial styloid screws using a biomechanical study in a cadaver fracture model. Methods Six matched pairs of fresh-frozen human cadaver wrists complete from the proximal forearm to the metacarpal bones were prepared to simulate standardized 3-part intra-articular and severe comminuted fractures. Specimens were fixed using the volar plating system with or without 2 radial styloid screws. Each specimen was loaded at a constant rate of 20 mm/min to failure. Load data was recorded and, ultimate strength and change in gap between distal and proximal fragments were measured. Data for ultimate strength and screw failure after failure loading were compared between the 2 groups. Results The average ultimate strength at failure of the volar plate fixation with radial styloid screws (913.5 ± 157.1 N was significantly higher than that without them (682.2 ± 118.6 N. After failure loading, the average change in gap between the ulnar and proximal fragment was greater than that between the radial and proximal fragment. The number of bent or broken screws in ulnar fragment was higher than that in radial fragment. The number of specimens with bent or broken screws in cases with radial styloid screws was fewer than that in the fixation without radial styloid screws group. Conclusion The ulnar fragment is more intensively stressed than the radial fragment under axial loading of distal radius at full wrist extension. The radial styloid screws were effective in stable volar plate fixation of distal radial fractures.

  17. Therapeutic effect of intra-articular injection of ribbon-type decoy oligonucleotides for hypoxia inducible factor-1 on joint contracture in an immobilized knee animal model.

    Science.gov (United States)

    Sotobayashi, Daisuke; Kawahata, Hirohisa; Anada, Natsuki; Ogihara, Toshio; Morishita, Ryuichi; Aoki, Motokuni

    2016-08-01

    Limited range of motion (ROM) as a result of joint contracture in treatment associated with joint immobilization or motor paralysis is a critical issue. However, its molecular mechanism has not been fully clarified and a therapeutic approach is not yet established. In the present study, we investigated its molecular mechanism, focusing on the role of a transcription factor, hypoxia inducible factor-1 (HIF-1), which regulates the expression of connective tissue growth factor (CTGF) and vascular endothelial growth factor (VEGF), and evaluated the possibility of molecular therapy to inhibit HIF-1 activation by ribbon-type decoy oligonucleotides (ODNs) for HIF-1 using immobilized knee animal models. In a mouse model, ROM of the immobilized knee significantly decreased in a time-dependent manner, accompanied by synovial hypertrophy. Immunohistochemical studies suggested that CTGF and VEGF are implicated in synovial hypertrophy with fibrosis. CTGF and VEGF were up-regulated at both the mRNA and protein levels at 1 and 2 weeks after immobilization, subsequent to up-regulation of HIF-1 mRNA and transcriptional activation of HIF-1. Of importance, intra-articular transfection of decoy ODNs for HIF-1 in a rat model successfully inhibited transcriptional activation of HIF-1, followed by suppression of expression of CTGF and VEGF, resulting in attenuation of restricted ROM, whereas transfection of scrambled decoy ODNs did not. The present study demonstrates the important role of HIF-1 in the initial progression of immobilization-induced joint contracture, and indicates the possibility of molecular treatment to prevent the progression of joint contracture prior to intervention with physical therapy. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  18. Age-related effects on markers of inflammation and cartilage metabolism in response to an intra-articular lipopolysaccharide challenge in horses.

    Science.gov (United States)

    Kahn, M K; Coverdale, J A; Leatherwood, J L; Arnold, C E; Dabareiner, R A; Bradbery, A N; Millican, A A; Welsh, T H

    2017-02-01

    Eighteen Quarter Horses were used in a randomized complete design for a 28-d experiment to evaluate age-related effects on inflammation and cartilage turnover after induction of a single inflammatory insult using lipopolysaccharide (LPS). Horses were grouped by age as yearlings (3 males and 3 females), 2 to 3 yr olds (2/3 yr old; 2 males and 4 females), and skeletally mature 5 to 8 yr olds (mature; 2 males and 4 females). On d 0, all horses were individually housed and fed diets that met or exceeded requirements. On d 14, horses were challenged with an intra-articular injection of LPS. Radial carpal joints were randomly assigned to receive 0.5 ng LPS solution obtained from O55:B5 or 0.8 mL sterile lactated Ringer's solution as a contralateral control. Synovial fluid was collected prior to LPS injection at h 0 before injection and at 6, 12, 24, 168, and 336 h after injection. Samples were analyzed using commercial ELISA kits for PGE, collagenase cleavage neoepitope (C2C), and carboxypropeptide of type II collagen (CPII). Heart rate (HR), respiratory rate (RR), and rectal temperature (RT) were monitored over the initial 24 h and carpal circumference and surface temperature were also recorded, with additional measurements at 168 and 336 h. Data were analyzed using PROC MIXED of SAS. Values for RT, HR, and RR were within the normal range for each age group. Heart rate and RT were influenced by age ( horse ( = 0.84), but circumference and surface temperature increased ( horses. Concentrations of synovial C2C were affected by age of horse, with yearlings and 2/3 yr olds having lower ( horses. Similarly, synovial CPII was influenced by age, with yearlings and 2/3 yr olds having lower ( ≤ 0.02) concentrations than mature horses. Ratios of anabolic CPII to catabolic C2C varied by age, with mature and 2/3-yr-old horses having greater ( < 0.01) values compared with yearlings. These results indicate that inflammation and the corresponding cartilage turnover in response to

  19. Intra-articular corticosteroid injections to the temporomandibular joints are safe and appear to be effective therapy in children with juvenile idiopathic arthritis.

    Science.gov (United States)

    Stoll, Matthew L; Good, Jennifer; Sharpe, Tyler; Beukelman, Timothy; Young, Daniel; Waite, Peter D; Cron, Randy Q

    2012-08-01

    The purpose of this study was to evaluate the safety and efficacy of intra-articular corticosteroid injections (IACIs) of the temporomandibular joint (TMJ) in children with juvenile idiopathic arthritis (JIA) when administered by an oral and maxillofacial surgeon without imaging guidance. This was a retrospective study of children with JIA, seen at a single center, who were selected based on having received IACIs of the TMJ. All subjects received the intervention, which consisted of referral to a single oral and maxillofacial surgeon for TMJ IACI with 5 to 10 mg triamcinolone hexacetonide, under general anesthesia. Primary outcomes assessed in all subjects were the safety of the procedure and efficacy as determined by the change in maximal incisal opening (MIO). In addition, a subset of 31 subjects underwent repeat magnetic resonance imaging of the TMJ, permitting analysis of the change in the acute and chronic findings of arthritis in those patients. Sixty-three patients (68% female) received 137 IACIs. The mean age for diagnosis of JIA was 8.5 years, and the mean age at presentation for TMJ injections was 10 years. The injections were well tolerated: only 1 patient developed the steroid complication of hypopigmentation, and none developed degeneration or ankylosis. In terms of efficacy, the mean MIO increased from 40.8 ± 0.93 to 43.5 ± 0.90 mm (P = .001); in addition, changing the unit of analysis to individual joints, in patients who underwent repeat magnetic resonance imaging examination, 51% of TMJs showed magnetic resonance imaging evidence of improvement of arthritic changes, of whom 18% had complete resolution of TMJ arthritis. The results indicate that IACI of the TMJ can be safely performed by experienced oral and maxillofacial surgeons without a requirement for computed tomographic guidance. In addition, these results show that IACI may be effective in the management of TMJ arthritis, although further studies are required. Copyright © 2012 American

  20. The impact of intra-articular methylprednisolone acetate injection on fructosamine levels in diabetic patients with osteoarthritis of the knee, a case-control study.

    Science.gov (United States)

    Habib, George; Sakas, Fahed; Artul, Suheil; Khazin, Fadi; Hakim, Geries; Jabbour, Adel; Jabaly-Habib, Haneen

    2016-06-01

    Fructosamine is a glycated protein that reflects blood glucose control over the last 2-3 weeks. There are no studies that address the impact of intra-articular injection (IAI) of methylprednisolone acetate (MPA) on fructosamine levels among patients with type-2 diabetes and osteoarthritis of the knee (OAK). Non-selected patients attending the rheumatology or orthopedic clinic with type-2 diabetes and painful OAK, who failed non-steroidal anti-inflammatory drugs (NSAIDS) and physical therapy, were asked to participate in our study. After consent blood tests were drown for fructosamine, hemoglobin A1c (HbA1c) level, complete blood count, lipid profile, serum albumin, serum protein, c-reactive protein, and erythrocyte sedimentation rate. Demographic and different clinical parameters were also documented. Immediately after that, patients had IAI of 80 mg of MPA at the knee joint (group 1). Two to three weeks later, the same blood tests were repeated (except for HbA1c). Age- and sex-matched group of patients with type-2 diabetes and painful OAK attending the same clinics, but who were managed by NSAIDS were asked to participate as a control group (group 2) and had the same evaluation at enrollment and 2-3 weeks later, after consent. Eighteen patients from either group completed the study. Mean fructosamine level in group 1 patients was 263.7 ± 31.8 mg% prior to the IAI vs. 274.6 ± 39.3 mg% (p = 0.035), 2-3 weeks later, while mean fructosamine level in the control group (group 2) at enrollments was 274.2 ± 31.2 mg% vs. 269 ± 30.2 mg%, p = 0.509, 2-3 weeks later. There was no significant change in any other parameter tested at enrollment in either group, compared to those obtained 2-3 weeks afterwards. Body mass index was on the edge of significance as a predictor for a significant change in fructosamine level in group 1 patients. IAI of 80 mg of MPA in patients with type-2 diabetes and OAK had resulted in a significant, though mild

  1. Incorporating Novel Mobile Health Technologies Into Management of Knee Osteoarthritis in Patients Treated With Intra-Articular Hyaluronic Acid: Rationale and Protocol of a Randomized Controlled Trial

    Science.gov (United States)

    Skrepnik, Nebojsa; Toselli, Richard M; Leroy, Bruno

    2016-01-01

    Background Osteoarthritis (OA) of the knee is one of the leading causes of disability in the United States. One relatively new strategy that could be helpful in the management of OA is the use of mHealth technologies, as they can be used to increase physical activity and promote exercise, which are key components of knee OA management. Objective Currently, no published data on the use of a mHealth approach to comprehensively monitor physical activity in patients with OA are available, and similarly, no data on whether mHealth technologies can impact outcomes are available. Our objective is to evaluate the effectiveness of mHealth technology as part of a tailored, comprehensive management strategy for patients with knee OA. Methods The study will assess the impact of a smartphone app that integrates data from a wearable activity monitor (thereby both encouraging changes in mobility as well as tracking them) combined with education about the benefits of walking on patient mobility. The results from the intervention group will be compared with data from a control group of individuals who are given the same Arthritis Foundation literature regarding the benefits of walking and wearable activity monitors but who do not have access to the data from those monitors. Activity monitors will capture step count estimates and will compare those with patients’ step goals, calories burned, and distance walked. Patients using the novel smartphone app will be able to enter information on their daily pain, mood, and sleep quality. The relationships among activity and pain, activity and mood, and sleep will be assessed, as will patient satisfaction with and adherence to the mobile app. Results We present information on an upcoming trial that will prospectively assess the ability of a mobile app to improve mobility for knee OA patients who are treated with intra-articular hyaluronic acid. Conclusions We anticipate the results of this study will support the concept that m

  2. Intra-articular vs. systemic administration of etanercept in antigen-induced arthritis in the temporomandibular point. Part I: histological effects

    Directory of Open Access Journals (Sweden)

    Nyengaard Jens R

    2009-02-01

    Full Text Available Abstract Background Temporomandibular joint (TMJ arthritis in children causes alterations in craniomandibular growth. This abnormal growth may be prevented by an early anti-inflammatory intervention. We have previously shown that intra-articular (IA corticosteroid reduces TMJ inflammation, but causes concurrent mandibular growth inhibition in young rabbits. Blockage of TNF-α has already proven its efficacy in children with juvenile idiopathic arthritis not responding to standard therapy. In this paper we evaluate the effect of IA etanercept compared to subcutaneous etanercept in antigen-induced TMJ-arthritis in rabbits on histological changes using histomorphometry and stereology. This article presents the data and discussion on the anti-inflammatory effects of systemic and IA etanercept. In Part II the data on the effects of systemic and IA etanercept on facial growth are presented. Methods Forty-two rabbits (10 weeks old pre-sensitized with ovalbumin and locally induced inflammation in the temporomandibular joints were divided into three groups: a placebo group receiving IA saline injections in both joints one week after arthritis induction (n = 14, an IA etanercept group receiving 0.1 mg/kg etanercept per joint one week after arthritis induction (n = 14 and a systemic etanercept group receiving 0.8 mg/kg etanercept weekly throughout the 12-week study (n = 14. Arthritis was maintained by giving four inductions three weeks apart. Additional IA saline or etanercept injections were also given one week after the re-inductions. Histomorphometric and unbiased stereological methods (optical fractionator were used to assess and estimate the inflammation in the joints. Results The histomorphometry showed synovial proliferation in all groups. The plasma cell count obtained by the optical fractionator was significantly reduced when treating with systemic etanercept but not with IA etanercept. Semi-quantitative assessments of synovial proliferation and

  3. Quantitative assessment of synovial inflammation by dynamic gadolinium-enhanced magnetic resonance imaging. A study of the effect of intra-articular methylprednisolone on the rate of early synovial enhancement

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Stoltenberg, M; Henriksen, O;

    1996-01-01

    The effect of temporary inflammatory suppression on synovial membrane enhancement, as determined by dynamic and static gadolinium-DTPA enhanced magnetic resonance imaging (MRI), was studied. MRI of 18 arthritic knees was performed before and 1, 7, 30 and 180 days after intra-articular methylpredn......The effect of temporary inflammatory suppression on synovial membrane enhancement, as determined by dynamic and static gadolinium-DTPA enhanced magnetic resonance imaging (MRI), was studied. MRI of 18 arthritic knees was performed before and 1, 7, 30 and 180 days after intra...

  4. In vitro assessment of lidocaine release from aqueous and oil solutions and from preformed and in situ formed aqueos and oil suspensions. Parenteral depots for intra-articular administration

    DEFF Research Database (Denmark)

    Pedersen, Brian Thoning; Larsen, Susan Weng; Østergaard, Jesper;

    2008-01-01

    In vitro drug release rates from aqueous and oil solutions as well as preformed and in situ formed aqueous and oil suspensions intended for intra-articular delivery have been investigated using the rotating dialysis cell model. Using lidocaine as a model drug substance the release kinetics from...... compartment applied to zero-order kinetics as long sufficient amounts of solid lidocaine remained in the donor cell. The obtained data indicate that oil solutions and oil suspensions of lidocaine possess prolonged release properties equal to or better than those of aqueous counterparts. Also the release...

  5. Dynamic Contrast Enhanced MRI Can Monitor the Very Early Inflammatory Treatment Response upon Intra-Articular Steroid Injection in the Knee Joint: A Case Report with Review of the Literature

    DEFF Research Database (Denmark)

    Boesen, Mikael; Kubassova, Olga; Cimmino, Marco A;

    2011-01-01

    Dynamic contrast-enhanced MRI in inflammatory arthritis, especially in conjunction with computer-aided analysis using appropriate dedicated software, seems to be a highly sensitive tool for monitoring the early inflammatory treatment response in patients with rheumatoid arthritis. This paper gives...... a review of the current knowledge of the emerging technique. The potential of the technique is demonstrated and discussed in the context of a case report following the early effect of an intra-articular steroid injection in a patient with rheumatoid arthritis flare in the knee....

  6. La asociación gentamicina-valerato de betametasona en piodermitis superficiales

    OpenAIRE

    Gutiérrez Aldana, Guillermo; Henao Agudelo, Mario; Rocha Posada, Hernando

    2011-01-01

    Se estudió el efecto antibacteriano tópico de un nuevo antibiótico de amplio espectro, la gentamicina, asociada al valerato de betametasona, en el tratamiento de 35 casos de piodermitis superficiales. En 34 de los 35 enfermos se hizo estudio bacteriológico, y en todos los que se pudieron controlar hasta el final, se llevó a cabo estudio fotográfico para la apreciación objetiva de los resultados terapéuticos.

  7. Efficacy of intra-articular bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac on postoperative pain relief after ambulatory arthroscopic knee surgery: a randomized double-blind study.

    Science.gov (United States)

    Ng, Huey-Ping; Nordström, Ulf; Axelsson, Kjell; Perniola, Andrea Davide; Gustav, Ekbäck; Ryttberg, Lars; Gupta, Anil

    2006-01-01

    Effective pain relief is important after diagnostic and therapeutic arthroscopic knee surgery to permit early discharge and improve comfort and mobility at home. The aim of this study was to assess the efficacy of bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac injected intra-articularly for postoperative pain relief after arthroscopic knee surgery. Sixty-three healthy patients undergoing knee arthroscopy under local anesthesia (LA) were randomized to receive 1 of the following substances intra-articularly postoperatively: group B: 30 mL of bupivacaine (150 mg); group R: 30 mL of ropivacaine (150 mg); and group RMK: ropivacaine 150 mg, morphine 4 mg, and ketorolac 30 mg in normal saline (total volume 30 mL). Oral paracetamol 1g and tramadol 50 mg were used as rescue drugs. Postoperatively, pain was assessed at rest and movement, and side effects were recorded. The patients were asked to self-assess pain for 7 days and record analgesic consumption as well as activities of daily living (ADLs). Plasma concentration of LA was measured in another 8 patients. All groups had excellent analgesia at 0 and 4 hours postoperatively. Group RMK had significantly lower visual analog pain score at rest at 8 hours and during movement at 8 and 24 hours compared with the other groups (Ptramadol on day 1 (Pintra-articularly enhances analgesic efficacy of LA, reduces postdischarge analgesic consumption, and improves ADLs without increasing side effects after ambulatory arthroscopic knee surgery.

  8. MR evaluation of radiation synovectomy of the knee by means of intra-articular injection of holmium-166-chitosan complex in patients with rheumatoid arthritis: results at 4-month follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hoon; Suh, Jin Suck; Kim, Ho Seok; Lee, Jong Doo; Song, Jung Sik; Lee, Soo Kon [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2003-09-01

    To determine whether MRI is able to demonstrate the effect of radiation synovectomy after the intra-articular injection of holmium-166-chitosan complex for the treatment of rheumatoid arthritis of the knee. Fourteen patients aged 36-59 years were treated with 10-20 mCi of holmium-166-chitosan complex. A criterion for inclusion in this study was the absence of observable improvement after 3- or more months of treatment of the knee with disease-modifying anti-rheumatic drugs. MR images were acquired both prior to and 4-months after treatment. Clinical evaluation included the use of visual analog scales to assess pain, and the circumference of the knee and its range of motion were also determined. MR evaluation included measurement of the volume of synovial enhancement and wall thickness, the amount of joint effusion, and quantifiable scoring of bone erosion, bone edema and lymph nodes. Visual analog scale readings decreased significantly after radiation synovectomy (p<0.05). MRI showed that joint effusion decreased significantly (p<0.05), and that the volume of synovial enhancement tended to decrease, but to an insignificant extent (p=0.107). The decreased joint effusion noted at 4-month follow-up resulted from radiation synovectomy of the rheumatoid knee by means of intra-articular injection of holmium-166-chitosan complex.

  9. 外固定架或石膏固定对桡骨远端不稳定性关节内骨折康复的影响%Rehabilitative effect on external fixator or cast immobilization for unstable intra-articular fracture of distal radius

    Institute of Scientific and Technical Information of China (English)

    蔡靖宇; 郭涛; 朱庆生

    2002-01-01

    Objective To investigate the advantage of external fixator in treatment of unstable intra-articular fracture of distal radius and important of rehabilitation treatment. Methods Fifty-two consecutive patients with unstable intra-articular fractures of distal radius (Frykman type VII, VIII) were randomly divided into 2 groups.A group treated by external fixator and B group treated by closed reduction and cast immobilization. Using the scoring system of Stewart and Dinest assessed all patients. Wrist joint rang motion (ROM) was measured by using gonimeter pre and post rehabilitation treatment.Results Both the anatomical and functional results were significantly better in the external fixator group than in the cast immobilization group (P< 0.05), there was significantly difference of wrist joint ROM between pre and post rehabilitation treatment. Conclusion It is recommended the use of external fixator for unstable intra-articular fractures of distal radius and rehabilitation treatment have an important role.

  10. Efficacy of intra-articular hyaluronan (Synvisc® for the treatment of osteoarthritis affecting the first metatarsophalangeal joint of the foot (hallux limitus: study protocol for a randomised placebo controlled trial

    Directory of Open Access Journals (Sweden)

    Landorf Karl B

    2009-01-01

    Full Text Available Abstract Background Osteoarthritis of the first metatarsophalangeal joint (MPJ of the foot, termed hallux limitus, is common and painful. Numerous non-surgical interventions have been proposed for this disorder, however there is limited evidence for their efficacy. Intra-articular injections of hyaluronan have shown beneficial effects in case-series and clinical trials for the treatment of osteoarthritis of the first metatarsophalangeal joint. However, no study has evaluated the efficacy of this form of treatment using a randomised placebo controlled trial. This article describes the design of a randomised placebo controlled trial to evaluate the efficacy of intra-articular hyaluronan (Synvisc® to reduce pain and improve function in people with hallux limitus. Methods One hundred and fifty community-dwelling men and women aged 18 years and over with hallux limitus (who satisfy inclusion and exclusion criteria will be recruited. Participants will be randomised, using a computer-generated random number sequence, to receive a single intra-articular injection of up to 1 ml hyaluronan (Synvisc® or sterile saline (placebo into the first MPJ. The injections will be performed by an interventional radiologist using fluoroscopy to ensure accurate deposition of the hyaluronan in the joint. Participants will be given the option of a second and final intra-articular injection (of Synvisc® or sterile saline according to the treatment group they are in either 1 or 3 months post-treatment if there is no improvement in pain and the participant has not experienced severe adverse effects after the first injection. The primary outcome measures will be the pain and function subscales of the Foot Health Status Questionnaire. The secondary outcome measures will be pain at the first MPJ (during walking and at rest, stiffness at the first MPJ, passive non-weightbearing dorsiflexion of the first MPJ, plantar flexion strength of the toe-flexors of the hallux, global

  11. Correlation of the SLAP lesion with lesions of the medial sheath of the biceps tendon and intra-articular subscapularis tendon

    Directory of Open Access Journals (Sweden)

    Bennett William

    2009-01-01

    Full Text Available Background: Superior labral anterior to posterior (SLAP lesions have been well described in the literature and are thought to be secondary to traction injuries to the biceps anchor and/or falls on the outstretched arm. The pulley has recently been described as a structure that aids in the prevention of biceps instability. The intra-articular subscapularis insertion (IASS has been noted to contribute to the robust nature of the medial sheath. The purpose of the study was to determine a potential correlation of SLAP lesions and pulley lesions with/without IASS lesions, (hereafter referred to as medial sheath as forces that can disrupt the biceps anchor and may also disrupt structures of the medial sheath or vice-versa. Materials and Methods: Three hundred and sixteen consecutive shoulder arthroscopies performed by one surgeon were reviewed retrospectively. Operative reports and arthroscopic pictures were carefully reviewed with particular attention paid to the labral and pulley pathology. Selection bias was noted as the author had never operated primarily for a Type 1 SLAP lesion. Following, however, and as such, the exclusion criteria, was a Type 1 SLAP. Results: There were a total of 30 SLAP lesions and a total of 126 medial sheath lesions. There were 13 patients who had both SLAP and medial sheath lesions. There were 17 patients who had a SLAP lesion without a medial sheath lesion. There were 96 medial sheath lesions without a SLAP. A comparison of rates between patients who had a medial sheath lesion with a SLAP and those who had a medial sheath lesion without a SLAP, for the 316 patients, and when tested with a Fisher exact test revealed that there was no statistical significance, P = 0.673. The prevalence of SLAP lesions in this population of 316 patients was 9.4%, Buford 1%, medial sheath lesions 39%, and SLAP and medial sheath lesions 4%. Interestingly, there were three Buford complexes, all associated with a SLAP and one Buford complex

  12. Efeitos da ciclosporina A e betametasona na toxocaríase murina experimental

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    Lescano Susana A. Zevallos

    2004-01-01

    Full Text Available Estudou-se o efeito de ciclosporina A ou betametasona em camundongos experimentalmente infectados por larvas de Toxocara canis administrados 15 dias antes ou 45 dias após infecção por esse ascarídeo. Nos animais infectados determinou-se a cinética da resposta humoral por IgG 60 e 90 dias após infecção por meio de pesquisa de anticorpos anti-Toxocara, utilizando teste imunoenzimático, em amostras de sangue obtidas por punção do plexo orbitário. No 90º dia após a infecção todos os animais sobreviventes foram sacrificados e submetidos a digestão ácida da carcaça, pulmões, fígado e cérebro para recuperação de larvas de Toxocara canis encistadas nesses órgãos. Observou-se retardo na produção de anticorpos IgG anti-Toxocara nos animais tratados com ciclosporina A ou betametasona 15 dias antes da infecção, além de aumento significativo na quantidade de larvas de Toxocara canis recuperadas no grupo de animais que foi tratado com ciclosporina A 15 dias antes da infecção pelo ascarídeo.

  13. Intra-articular hyaluronate sodium and oral glucosamine sulfate for the treatment of ankle osteoarthritis%联合治疗老年踝关节骨性关节炎的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    万国帅

    2013-01-01

    目的观察联合应用玻璃酸钠和硫酸氨基葡萄糖胶囊治疗老年踝关节骨性关节炎的临床疗效。方法对60例诊断为踝关节骨性关节炎的老年患者常规关节腔内注射玻璃酸钠(SH),每周一次,5周一疗程。联合应用硫酸氨基葡萄糖胶囊,连续服用6周为一疗程。采用t检验比较治疗前后踝关节疼痛、功能及活动度改善的差异性。结果治疗后,踝关节疼痛、肿胀及功能障碍均较治疗前明显改善,总有效率为93%。结论联合应用酸钠和硫酸氨基葡萄糖胶囊对踝关节骨性关节炎具有良好的临床疗效。%Objecitive:To observe the therapeutic effect of hyaluronate sodium intra-articular injection and glucosamine sulfate on the treatment of ankle osteoarthritis.Methods:In our study, 60 patients(70 ankles) with osteoarthritis were treated with intra-articular hyaluronate sodium and oral glucosamine sulfate, the ankle pain, range of motion and function were evaluated after treatment with Mazur system. Results: Compared with pre-treatment, the pain, range of motion and function were improved significantly (P<0.05).All the patients were satisfactory with the clinical effect. Conclusion: Intra-articular hyaluronate sodium and oral glucosamine sulfate can alleviate the pain and improve the function of ankle having a good clinical effect for osteoarthritis.

  14. A treat-to-target strategy with methotrexate and intra-articular triamcinolone with or without adalimumab effectively reduces MRI synovitis, osteitis and tenosynovitis and halts structural damage progression in early rheumatoid arthritis: results from the OPERA randomised controlled trial.

    Science.gov (United States)

    Axelsen, Mette Bjørndal; Eshed, Iris; Hørslev-Petersen, Kim; Stengaard-Pedersen, Kristian; Hetland, Merete Lund; Møller, Jakob; Junker, Peter; Pødenphant, Jan; Schlemmer, Annette; Ellingsen, Torkell; Ahlquist, Palle; Lindegaard, Hanne; Linauskas, Asta; Dam, Mette Yde; Hansen, Ib; Horn, Hans Christian; Ammitzbøll, Christian Gytz; Jørgensen, Anette; Krintel, Sophine B; Raun, Johnny; Krogh, Niels S; Johansen, Julia Sidenius; Østergaard, Mikkel

    2015-05-01

    To investigate whether a treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid injections suppresses MRI inflammation and halts structural damage progression in patients with early rheumatoid arthritis (ERA), and whether adalimumab provides an additional effect. In a double-blind, placebo-controlled trial, 85 disease-modifying antirheumatic drug-naïve patients with ERA were randomised to receive methotrexate, intra-articular glucocorticosteroid injections and placebo/adalimumab (43/42). Contrast-enhanced MRI of the right hand was performed at months 0, 6 and 12. Synovitis, osteitis, tenosynovitis, MRI bone erosion and joint space narrowing (JSN) were scored with validated methods. Dynamic contrast-enhanced MRI (DCE-MRI) was carried out in 14 patients. Synovitis, osteitis and tenosynovitis scores decreased highly significantly (p<0.0001) during the 12-months' follow-up, with mean change scores of -3.7 (median -3.0), -2.2 (-1) and -5.3 (-4.0), respectively. No overall change in MRI bone erosion and JSN scores was seen, with change scores of 0.1 (0) and 0.2 (0). The tenosynovitis score at month 6 was significantly lower in the adalimumab group, 1.3 (0), than in the placebo group, 3.9 (2), Mann-Whitney: p<0.035. Furthermore, the osteitis score decreased significantly during the 12-months' follow-up in the adalimumab group, but not in the placebo group, Wilcoxon: p=0.001-0.002 and p=0.062-0.146. DCE-MRI parameters correlated closely with conventional MRI inflammatory parameters. Clinical measures decreased highly significantly during follow-up. A treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid in patients with ERA effectively decreased synovitis, osteitis and tenosynovitis and halted structural damage progression as judged by MRI. The findings suggest that addition of adalimumab is associated with further suppression of osteitis and tenosynovitis. Published by the BMJ Publishing Group Limited. For

  15. 玻璃酸钠对老年膝关节炎患者本体感觉的影响%Effect of intra-articular injection of hyaluronan on proprioception of the knee joint in gerontal patients with osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    潘哲尔; 张挺; 刘扬波; 张纯武; 李驰; 朱雄白

    2011-01-01

    Objective To investigate the short-term effects of intra-articular injection of hyaluronan on proprioception of the knee in gerontal patients with osteoarthritis (OA). Methods The 53 gerontal patients were included in this study. The study included treatment group (n=35) and the placebo group (n=18). Hyaluronan was intra-articularly injected into both knees of the subjects in treatment group, whereas physiological saline was intra-articularly injected in the placebo group. Proprioception test was performed, and Western Ontario and McMaster Universities(WOMAC) scales were used to evaluate pain and physical function. Results Statistical analysis was performed on 100 knees of 50 patients who completed the trial. Compared with the placebo group,the average absolute angular error (AAAE) value in the treatment group was detected to be statistically lower one week after the 4th injection (1.8±0.9 vs.2.9±1.1,t=2.42,P=0.02),and WOMAC was lower in the treatment group after one week (8.7±3.1 vs.11.5±4.0, t=0.73,P<0.05). Conclusions Intra-articular injection of hyaluronan in gerontal patients with knee OA leads to a short-term increase in proprioception, and significant improvement in the functional conditions of patients.%目的 研究关节内注射玻璃酸钠后对老年膝骨关节炎患者膝关节本体感觉的影响.方法 共53例老年患者入选该研究.受试者被随机分为治疗组(35例)和安慰剂组(18例).治疗组患者行双侧膝关节玻璃酸钠(阿尔治)关节内注射,安慰剂组则予双侧膝关节注射生理盐水.测量膝关节本体感觉,西方安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分表用于评估膝关节疼痛和功能改善情况.结果 共50例患者100个膝关节进行了评估,平均绝对角误差值在第4次注射后1周,治疗组明显低于安慰剂组,分别为(1.8±0.9)分和(2.9±1.1)分(t=2.42,P=0.02);治疗组WOMAC积分在注射玻璃酸钠1周后开始明显下降,治疗组和

  16. Treatment of Knee Osteochondral Lesions Using a Novel Clot of Autologous Plasma Rich in Growth Factors Mixed with Healthy Hyaline Cartilage Chips and Intra-Articular Injection of PRGF.

    Science.gov (United States)

    Cugat, Ramón; Alentorn-Geli, Eduard; Steinbacher, Gilbert; Álvarez-Díaz, Pedro; Cuscó, Xavier; Seijas, Roberto; Barastegui, David; Navarro, Jordi; Laiz, Patricia; García-Balletbó, Montserrat

    2017-01-01

    Knee cartilage or osteochondral lesions are common and challenging injuries. To date, most symptomatic lesions warrant surgical treatment. We present two cases of patients with knee osteochondral defects treated with a one-step surgical procedure consisting of an autologous-based matrix composed of healthy hyaline cartilage chips, mixed plasma poor-rich in platelets clot, and plasma rich in growth factors (PRGF). Both patients returned to playing soccer at the preinjury activity level and demonstrated excellent defect filling in both magnetic resonance imaging and second-look arthroscopy (in one of them). The use of a clot of autologous plasma poor in platelets with healthy hyaline cartilage chips and intra-articular injection of plasma rich in platelets is an effective, easy, and cheap option to treat knee cartilage injuries in young and athletic patients.

  17. 关节腔注射皮质类固醇激素治疗幼年特发性关节炎%Intra-articular corticosteroid injections in the management of juvenile idiopathic arthritis

    Institute of Scientific and Technical Information of China (English)

    杨昌融; 唐雪梅

    2010-01-01

    @@ 幼年特发性关节炎(juvenile idiopathic arthritis,JIA)是儿科常见的风湿性疾病,也是儿童致残的重要原因之一.在欧美国家,关节腔注射皮质类固醇激素(intra-articular corticosteroid injections,IACIs)治疗JIA被证实是安全而有效的,通过类固醇激素在关节腔局部抑制滑膜炎症,达到迅速缓解关节症状,恢复关节功能的目的,目前已经成为治疗JIA的重要手段之一.

  18. Fração total de células mononucleares intra-articular em cães submetidos à reconstrução do ligamento cruzado

    Directory of Open Access Journals (Sweden)

    D.C.M. Müller

    2013-04-01

    Full Text Available Avaliou-sea ação da fração total de células mononucleares autógenas da medula óssea (FCMO por aplicação intra-articular, após a correção cirúrgica do ligamento cruzado rompido. Foram utilizados 20 cães, os quais sofreram desmotomia do ligamento cruzado cranial e caudal unilaterais, 21 dias antes do reparo cirúrgico. Dez animais receberam as células autógenas no momento da correção. As avaliações se deram por estudo radiográfico, exames clínicos e biópsias aos 50 e 90 dias pós-operatórios. O grupo que recebeu a FCMO apresentou crescimento ósseo intra-articular ao estudo radiográfico, contudo os 20 animais apresentaram célulasCD34 positivas em suas amostras biopsiadas, indicando haver presença de células-tronco em ambos os grupos. Conclui-se que,para o modelo experimental proposto, não se recomenda o uso da fração total de células mononucleares e que trabalhos experimentais com o uso de células-tronco nas articulações devem evitar modelos cujo foco de lesão mantenha contato direto com a medula óssea.

  19. Efficacy of medical ozone intra-articular injection for the treatment of patients with knee joint meniscus injury%医用三氧膝关节腔内注射治疗半月板损伤的疗效

    Institute of Scientific and Technical Information of China (English)

    董俊球; 黎小雅

    2015-01-01

    目的 探讨膝关节腔内注射医用三氧治疗半月板损伤的疗效.方法 半月板损伤患者64例,以随机法分为三氧组和理疗组,每组32例.三氧组采用膝关节腔内医用三氧注射治疗;理疗组采用中西结合物理治疗,两组均配合股四头肌功能训练.于治疗后1个月时行AKS评分及临床疗效评定.结果 治疗后三氧组患者AKS各分项及总评分均高于理疗组,优良率三氧组94%(30/32例)高于理疗组56%(18/32例),差异均有统计学意义(P<0.05).结论 膝关节腔内医用三氧注射治疗半月板损伤疗效良好.%Objective To observe the efficacy of medical ozone intra-articular injection in the treatment of patients with knee joint meniscus injury.Methods Sixty-four patients with knee joint meniscus injury were randomly divided into two groups,32 cases in each group.Patients in ozone group were received intraarticular injection of ozone,while physiotherapy group were received combination of traditional Chinese and Western physical therapy.All of the patients were combined with functional training of quadratus femoris muscle.AKS and clinical effects were evaluated at 1 month after the treatment.Results The total score of AKS and its each item were significantly higher in ozone group than those in physiotherapy group (P < 0.05).The excellent and good rate in ozone group (94%,30/32 cases) was significantly higher than that in physiotherapy group (56%,18/32 cases) (P < 0.05).Conclusion Medical ozone intra-articular injection is effective in the treatment of knee joint meniscus injury.

  20. Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures.

    Science.gov (United States)

    Vitale, Mark A; Brogan, David M; Shin, Alexander Y; Berger, Richard A

    2016-03-01

    Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre- and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p notch step-off, diastasis or DRUJ

  1. Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the Context of the Spanish National Health Care System

    Directory of Open Access Journals (Sweden)

    Elvira Montañez-Heredia

    2016-07-01

    Full Text Available Intra-articular injection of platelet-rich plasma (PRP has been established as a suitable treatment for knee osteoarthritis. Here, we present a double-blind randomized controlled clinical trial, conducted in a public Hospital of the Spanish National Health Care System, to evaluate the efficacy of injecting autologous PRP versus hyaluronic acid (HA in knee osteoarthritis. PRP was manufactured in Malaga’s Regional Blood Center (Spain. Patients that met the eligibility criteria were randomized into a PRP group or a HA group. Pain and functional improvements were assessed pre- and post-treatment (three and six months follow-up using the Visual Analogue Scale (VAS; the Knee and Osteoarthritis Outcome System (KOOS scale and the European Quality of Life scale (EUROQOL. Both groups presented pain reduction at six months. The VAS scores for the PRP group improved by at least 50% from their initial value, particularly at three months following the final infiltration, with results resembling those of the HA group at six months. PRP was more effective in patients with lower osteoarthritis grades. Both treatments improved pain in knee osteoarthritis patients without statistically significant differences between them. However, PRP injection was proved to improve pain three months after the final infiltration and to be more effective in lower osteoarthritis grades.

  2. Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the Context of the Spanish National Health Care System

    Science.gov (United States)

    Montañez-Heredia, Elvira; Irízar, Sofia; Huertas, Pedro J.; Otero, Esperanza; del Valle, Marta; Prat, Isidro; Díaz-Gallardo, Macarena S.; Perán, Macarena; Marchal, Juan A.; Hernandez-Lamas, María del Carmen

    2016-01-01

    Intra-articular injection of platelet-rich plasma (PRP) has been established as a suitable treatment for knee osteoarthritis. Here, we present a double-blind randomized controlled clinical trial, conducted in a public Hospital of the Spanish National Health Care System, to evaluate the efficacy of injecting autologous PRP versus hyaluronic acid (HA) in knee osteoarthritis. PRP was manufactured in Malaga’s Regional Blood Center (Spain). Patients that met the eligibility criteria were randomized into a PRP group or a HA group. Pain and functional improvements were assessed pre- and post-treatment (three and six months follow-up) using the Visual Analogue Scale (VAS); the Knee and Osteoarthritis Outcome System (KOOS) scale and the European Quality of Life scale (EUROQOL). Both groups presented pain reduction at six months. The VAS scores for the PRP group improved by at least 50% from their initial value, particularly at three months following the final infiltration, with results resembling those of the HA group at six months. PRP was more effective in patients with lower osteoarthritis grades. Both treatments improved pain in knee osteoarthritis patients without statistically significant differences between them. However, PRP injection was proved to improve pain three months after the final infiltration and to be more effective in lower osteoarthritis grades. PMID:27384560

  3. Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the Context of the Spanish National Health Care System.

    Science.gov (United States)

    Montañez-Heredia, Elvira; Irízar, Sofia; Huertas, Pedro J; Otero, Esperanza; Del Valle, Marta; Prat, Isidro; Díaz-Gallardo, Macarena S; Perán, Macarena; Marchal, Juan A; Hernandez-Lamas, María Del Carmen

    2016-07-02

    Intra-articular injection of platelet-rich plasma (PRP) has been established as a suitable treatment for knee osteoarthritis. Here, we present a double-blind randomized controlled clinical trial, conducted in a public Hospital of the Spanish National Health Care System, to evaluate the efficacy of injecting autologous PRP versus hyaluronic acid (HA) in knee osteoarthritis. PRP was manufactured in Malaga's Regional Blood Center (Spain). Patients that met the eligibility criteria were randomized into a PRP group or a HA group. Pain and functional improvements were assessed pre- and post-treatment (three and six months follow-up) using the Visual Analogue Scale (VAS); the Knee and Osteoarthritis Outcome System (KOOS) scale and the European Quality of Life scale (EUROQOL). Both groups presented pain reduction at six months. The VAS scores for the PRP group improved by at least 50% from their initial value, particularly at three months following the final infiltration, with results resembling those of the HA group at six months. PRP was more effective in patients with lower osteoarthritis grades. Both treatments improved pain in knee osteoarthritis patients without statistically significant differences between them. However, PRP injection was proved to improve pain three months after the final infiltration and to be more effective in lower osteoarthritis grades.

  4. Clinical and radiographic outcome of a treat-to-target strategy using methotrexate and intra-articular glucocorticoids with or without adalimumab induction: a 2-year investigator-initiated, double-blinded, randomised, controlled trial (OPERA).

    Science.gov (United States)

    Hørslev-Petersen, K; Hetland, M L; Ørnbjerg, L M; Junker, P; Pødenphant, J; Ellingsen, T; Ahlquist, P; Lindegaard, H; Linauskas, A; Schlemmer, A; Dam, M Y; Hansen, I; Lottenburger, T; Ammitzbøll, C G; Jørgensen, A; Krintel, S B; Raun, J; Johansen, J S; Østergaard, M; Stengaard-Pedersen, K

    2016-09-01

    To study clinical and radiographic outcomes after withdrawing 1 year's adalimumab induction therapy for early rheumatoid arthritis (eRA) added to a methotrexate and intra-articular triamcinolone hexacetonide treat-to-target strategy (NCT00660647). Disease-modifying antirheumatic drug (DMARD)-naive patients with eRA started methotrexate (20 mg/week) and intra-articular triamcinolone (20 mg/ml) for 2 years. In addition, they were randomised to receive placebo adalimumab (DMARD group, n=91) or adalimumab (40 mg/every other week) (DMARD+adalimumab group, n=89) during the first year. Sulfasalazine and hydroxychloroquine were added if disease activity persisted after 3 months. During year 2, synthetic DMARDs continued. Adalimumab was (re)initiated if active disease reoccurred. Clinical response, remission, disability, quality of life and radiographic changes were assessed. One year after adalimumab withdrawal, treatment profiles and clinical responses did not differ between groups. In the DMARD/DMARD+adalimumab groups, the median 2-year methotrexate dose was 20/20 mg/week (p=0.45), triple DMARD therapy had been initiated in 33/27 patients (p=0.49), adalimumab was (re)initiated in 12/12 patients and cumulative triamcinolone dose was 160/120 mg (p=0.15). The treatment target (disease activity score, 4 variables, C-reactive protein (DAS28CRP) ≤3.2 or DAS28>3.2 without swollen joints) was achieved at all visits in ≥85% of patients in year 2; remission rates were DAS28CRP<2.6:69%/66%; Clinical Disease Activity Index ≤2.8:55%/57%; Simplified Disease Activity Index <3.3:54%/49%; American College of Rheumatology/European League against Rheumatism (28 joints):44%/45% (p=0.66-1.00). Radiographic progression (Δtotal Sharp score/year) was similar 1.31/0.53 (p=0.12). Erosive progression (Δerosion score (ES)/year) was year 1:0.57/0.06 (p=0.02); year 2:0.38/0.05 (p=0.005). Proportion of patients without erosive progression (ΔES≤0) was year 1: 59%/76% (p=0.03); year

  5. Safety and efficacy findings from a non-interventional study of a new hyaluronic acid/sorbitol formulation (GO-ON® matrix) for intra-articular injection to relieve pain and disability in osteoarthritis patients.

    Science.gov (United States)

    Heisel, J; Kipshoven, C

    2013-09-01

    This non-interventional study was intended to examine the efficacy and tolerability of intra-articular injections with the GO-ON® matrix, a new viscosupplement product made of non-animal sodium hyaluronate combined with the oxygen free radical scavenger sorbitol, when used in routine clinical practice. A total of 1 147 patients (43.5% male, 53,5% female, 3% missing) aged on average 63.3 years with osteoarthritis were enrolled in 398 centers and treated with the product. The most commonly treated joint was the knee (92.9%) with a Kellgren-Lawrence classification of Grade I (6.7%), Grade II (31.4%), Grade III (48.0%), and Grade IV (13.9%).Most patients (58-66%, imputing for missing data) received 1 injection, 29-40% received 3 injections. Using a Likert scale to asses pain, the mean change in pain due to osteoarthritis was a reduction of 56.5% from baseline (2.61±0.80) to 6 months (1.07±0.86). At baseline, 56.2% of patients reported severe/very severe pain versus 5.9% after 6 months. Accordingly, 6.8% of patients reported no pain/mild pain at baseline vs. 67.1% after 6 months. At baseline, 28.9% reported no pain/mild pain vs. to 66.4% after 6 months. At baseline, 29.1% of patients reported severe/very severe functional impairment vs. 3.9% 6 months after the first injection. The 3 and 6 month results were comparable.Adverse reactions were rare and confined to musculoskeletal and connective tissue disorders. No infections were reported in any treated joints. The results confirm that the GO-ON matrix® treatment is effective and well tolerated in the treatment of symptoms due to osteoarthritis.

  6. Safety and biodistribution assessment of sc-rAAV2.5IL-1Ra administered via intra-articular injection in a mono-iodoacetate-induced osteoarthritis rat model

    Directory of Open Access Journals (Sweden)

    Gensheng Wang

    2016-01-01

    Full Text Available Interleukin-1 (IL-1 plays an important role in the pathophysiology of osteoarthritis (OA, and gene transfer of IL-1 receptor antagonist (IL-1Ra holds promise for OA treatment. A preclinical safety and biodistribution study evaluated a self-complementary adeno-associated viral vector carrying rat IL-1Ra transgene (sc-rAAV2.5rIL-1Ra at 5 × 108, 5 × 109, or 5 × 1010 vg/knee, or human IL-1Ra transgene (sc-rAAV2.5hIL-1Ra at 5 × 1010 vg/knee, in Wistar rats with mono-iodoacetate (MIA–induced OA at days 7, 26, 91, 180, and 364 following intra-articular injection. The MIA-induced OA lesions were consistent with the published data on this model. The vector genomes persisted in the injected knees for up to a year with only limited vector leakage to systemic circulation and uptake in tissues outside the knee. Low levels of IL-1Ra expression and mitigation of OA lesions were observed in the vector-injected knees, albeit inconsistently. Neutralizing antibodies against the vector capsid developed in a dose-dependent manner, but only the human vector induced a small splenic T-cell immune response to the vector capsid. No local or systemic toxicity attributable to vector administration was identified in the rats as indicated by clinical signs, body weight, feed consumption, clinical pathology, and gross and microscopic pathology through day 364. Taken together, the gene therapy vector demonstrated a favorable safety profile.

  7. Efficacy of intra-articular injection with sodium hyaluronate for knee joint osteoarthritis%玻璃酸钠关节腔内注射治疗膝关节骨关节炎的疗效

    Institute of Scientific and Technical Information of China (English)

    黄越

    2012-01-01

    Objective To observe the therapeutic effect of intra-articular injection with sodium hyaluronate for knee joint osteoarthritis. Methods 123 cases of knee joint osteoarthritis patients, total 159 gonitis were treated with sodium hyaluronate,once a week,5 times a course. The patients were evaluated with HSS' Scale before and after treatment, following up for 6 months. Results The joint function of 146 knee improved. The total effective rate was 91. 9% ,the signs and symptoms of most patients were improved obviously. Conclusion Sodium hyaluronate can alleviate the symptom effectively,and improve the joint's function for knee joint osteoarthritis.%目的 观察玻璃酸钠关节腔内注射治疗膝关节骨关节炎的临床疗效.方法 对123例膝关节骨关节炎患者(159个膝关节)腔内注射玻璃酸钠,每周注射1次,连续5次为1个疗程,采用HSS膝关节评分标准,分别于治疗前、治疗后进行评分,随访半年.结果 146个膝关节功能改善,症状减轻,总有效率达91.9%,半年随访,大部分患者膝关节症状、体征明显改善.结论 玻璃酸钠关节腔内注射治疗膝关节骨关节炎,能有效缓解疼痛,改善关节功能.

  8. 改良外侧“L”形切口治疗跟骨关节内移位骨折%The effect of surgical treatment of displaced intra-articular calcaneal fracture via modified lateral Lshaped incision

    Institute of Scientific and Technical Information of China (English)

    梁军; 辛景义; 曹红彬

    2012-01-01

    目的 探讨改良外侧“L”形切口治疗跟骨关节内移位骨折的临床疗效.方法 自2005年1月至2011年10月收治跟骨关节内移位骨折患者133例143足,男125例,女8例;年龄19~65岁,平均43.2岁.左侧56例,右侧67例,双侧10例,均为闭合骨折.其中3例合并脊柱损伤.根据Sanders分型:Ⅱ型15足、Ⅲ型107足、Ⅳ型21足.均采用外侧改良“L”型切口,切开复位异型钢板内固定.术后均未给予石膏外固定,早期行踝关节功能练习,术后6周部分负重,12周完全负重.采用美国足与踝关节外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分系统评价术后足踝功能.结果 125例135足获得随访(8例8足术后12周后失访),随访时间12~28个月,平均18.5个月.骨折均愈合,愈合时间8~16周,平均13周.无神经损伤,骨髓炎.4足切口裂开,骨折愈合内固定钢板取出后皮肤愈合.17足发生距下关节创伤性关节炎,行走时疼痛.5足负重后关节面出现塌陷.根据AOFAS踝与后足功能评分系统,优94例、良29例、可14例、差6例,优良率为92.9%.结论 应用改良外侧切口切开复位异型钢板内固定治疗跟骨关节内移位骨折可以获得满意疗效,但在临床应用中需要掌握熟练手术技术.%Objective To explore clinical effect of surgical treatment of displaced intra-articular calcaneal fractures via modified lateral L-shaped incision.Methods From January 2005 to October 2011,133patients (143 feet) with displaced intra-articular calcaneal fractures,including 125 males and 8 females,aged from 19 years to 65 years (average,43.2 years),underwent open reduction and internal fixation via modified lateral L-shaped incision.There were 56 cases of left calcaneal fractures,67 cases of right calcaneal fractures,and 10 cases of bilateral calcaneal fractures,and all of them were closed fracture.According to Sanders classification,15 feet were classified as type Ⅱ,107 type

  9. 切开复位内固定治疗移位的跟骨关节内骨折的疗效分析%Open reduction and internal fixation for displaced intra-articular calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    李喜功; 孙俊英; 殷浩; 宋兵华; 朱若夫; 唐祖林

    2008-01-01

    Objective To evaluate open reduction and internal fixation for displaced intra-articular calcaneal fractures and analyze factors affecting its clinical results. Methods From March 2004 to July 2006,46 displaced intra-arficular calcaneal fractures in 40 patients were surgically treated by open reduction and internal fixation.According to Sanders classification,there were 16 cases of type Ⅱ,19 cases of type Ⅲ and 11 cases of type Ⅳ. Results All the patients were followed up for anaverage of 18(13 to 28)months.The effects of treatment were evaluated according to Maryland Foot Score:excellent in 21 feet,good in 16 feet,fair in 6 feet,poor in 3 feet. The total good to excellent ratewas 82.6%.The respective good to excellent rates were 93.8%for type Ⅱ fractures,84.2%for type Ⅲ,and 54.5%for type Ⅳ;87.2%for the group with time interval from injury to surgery ≤14d,and 42.9%for the group with time interval>14d;37.5%for thegroup with B(o)hler angle<15°,and 89.5% for the group with B(o)hler angle≥15 °.91.2%for the group with reduction of intra-articular calcaneal fractures ≤2 mm,and 45.5% for the group with the reduction>2mm.The differences within each factor group were statistically significant(P<0.05). Conclusions Open reduction and internal fixation fordisplaced intra-articularcalcaneal fractures is a good method.Fracture type,time interval from injury to surgery,B(o)hler angle reduction,reduction of intra-articular calcaneal fractures are important factors affecting outcome of operation.%目的 评定切开复位内固定治疗移位的跟骨关节内骨折的疗效,并分析其影响因素.方法 回顾性分析2004年3月至2006年7月收治的采用切开复位内固定治疗的移位跟骨关节内骨折40例(46足).按照Sanders分型:Ⅱ型16足,Ⅲ型19足,Ⅳ型11足,总结评定其临床疗效并分析影响疗效的相关因素. 结果 所有患者均得到随访,平均随访18个月(13~28个月).根据Maryland足部评

  10. Fasceíte Necrosante após Mobilização e Infiltração Intrarticular do Ombro com Betametasona

    OpenAIRE

    Bento-Rodrigues, J; Judas, F; Pedrosa-Rodrigues, J; Oliveira, J; Simões, P.; Lucas, F.; Pais-Lopes, A

    2013-01-01

    Necrotizing Fasciitis is a rapidly progressive, potentially fatal infection of superficial fasciae and subcutaneous tissue, usually resulting from an inciting trauma to the skin. Medical literature refers few cases of necrotizing fasciitis related to intra-articular infiltrations, that often lead to patients death. This report describes the clinical events on a 55 year-old diabetic patient who developed upper extremity Necrotizing Fasciitis, 18 days after shoulder mobilization and intra-artic...

  11. Concentraciones plasmáticas de cortisol materno secundarias al uso de betametasona para la maduración pulmonar fetal

    Directory of Open Access Journals (Sweden)

    Keibis Jiménez Castillejo

    2014-09-01

    Full Text Available Resumen (español El objetivo de la investigación fue determinar las concentraciones plasmáticas de cortisol materno secundarias al uso de betametasona para la maduración pulmonar fetal. Se realizó una investigación con un diseño tipo cuasi-experimental y una muestra no probabilística intencional de 106 pacientes que acudieron a la consulta pre-natal de alto riesgo del Hospital Central “Dr. Urquinaona". Una vez seleccionadas las pacientes se le administró inyecciones intramusculares de betametasona (12 mg por dos días consecutivos. Las mediciones se realizaron en tres ocasiones: La primera medición, antes de la administración de la primera dosis de betametasona; la segunda medición, 24 horas después de la segunda y última inyección; y la tercera medición, siete días luego de la administración de la última dosis de betametasona. Se observó que las inyecciones con betametasona producían disminuciones de las concentraciones plasmáticas de cortisol materno, ya que el valor de la primera medición fue de 30,1 +/- 9,4 picogramos/dL, las concentraciones disminuyeron a 5,6 +/- 1,9 picogramos/dL durante la segunda medición y luego aumentaron a 23,2 +/- 4,2 picogramos/dL a la tercera medición. Las variaciones de las concentraciones de cortisol de la segunda y tercera medición se consideraron estadísticamente significativas al compararlas con las concentraciones iniciales (p = 0,001. Se concluye que el uso de betametasona para inducir la maduración pulmonar fetal produce disminución significativa en las concentraciones plasmáticas de cortisol materno

  12. Resposta adrenocortical em caninos tratados com betametasona e fludrocortisona por via auricular Canine adrenocortical response to otic betamethasone and fludrocortisone

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Jantzen Gaspar

    1999-12-01

    Full Text Available Vinte e quatro caninos adultos hígidos, sem raça definida, machos e fêmeas, com peso e idade variados, foram divididos igualmente em grupo controle, betametasona, fludrocortisona, e receberam, por via auricular, 2ml diários das seguintes soluções: salina a 0,9%, fosfato dissódico de betametasona a 0,1% e acetato de fludrocortisona a 0,1%, respectivamente. Os animais foram submetidos a duas aplicações diárias de 0,5ml da solução correspondente em cada conduto auditivo, durante um período de 14 dias. Foram realizadas colheitas de sangue da jugular no 7º e 14º dias de tratamento e no 7º dia após o término dos tratamentos. Realizou-se a determinação dos níveis séricos de cortisol pré e pós-estímulo com ACTH. Os grupos betametasona e fludrocortisona apresentaram um decréscimo significativo (PTwenty four mature mixed-breed dogs, healthy, male and female, of several weights and ages were divided into control, betamethasone and fludrocortisone groups and received 2ml daily of these solutions: 0.9% saline solution, 0.1% betamethasone disodic phosphate and 0.1% fludrocortisone acetate, respectively. The dogs received, twice in day, 0.5ml of corresponding solution into each external ear canal for 14 days. During the treatments were realized collections of data on 7th and 14th day and in post-treatment (seven days later the end of treatments. In these times were obtained blood samples by jugular venopunction, for serologic determination of level serum cortisol pre- and post-ACTH. The pre- and post-ACTH cortisol concentrations of fludrocortisone and betamethasone groups reduced significantly (P<0.05 compared with control, during the experiment. Betamethasone and fludrocortisone by otic administration produce considerable effects in the adrenocortical function.

  13. Intra-articular morphine in horses

    DEFF Research Database (Denmark)

    Lindegaard, Casper

    Regardless of species, optimal pain management of animals subjected to various painful procedures is of outmost importance for several reasons, including animal welfare considerations, improved convalescence and improved final outcome. One way of improving pain management in horses is through...... and laboratory animals. Recent discovery of opioid receptors in the synovial membrane of horses has made it reasonable to expect IA morphine to be analgesic in horses too. Treatment with IA morphine after arthroscopic surgery, or for other painful joint diseases, might therefore be an important contribution...... to a multimodal analgesia protocol. Despite that no research has investigated this issue in horses so far, IA injection of morphine after arthroscopic surgery has become common practice in several veterinary university teaching hospitals in Europe and USA. The aims of this thesis were to investigate the analgesic...

  14. Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures: a prospective randomized controlled trial.

    Science.gov (United States)

    Feng, Yongzeng; Shui, Xiaolong; Wang, Jianshun; Cai, Leyi; Yu, Yang; Ying, Xiaozhou; Kong, Jianzhong; Hong, Jianjun

    2016-07-15

    The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial. A prospective randomized controlled trial was conducted to compare percutaneous reduction, cannulated screw fixation and calcium sulfate cement (PR+CSC) grafting with minimally invasive sinus tarsi approach and plate fixation (MISTA) for treatment of DIACFs. Ultimately, 80 patients with a DIACFs were randomly allocated to receive either PR+CSC (N = 42) or MISTA (N = 38). Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores. Radiological results were assessed using plain radiographs and computed tomography (CT) scans, and postoperative wound-related complications were also recorded. The average time from initial injury to operation and the average operation time in the PR+CSC group were both significantly shorter than those in the MISTA group (p < 0.05). There were significantly fewer complications in the PR+CSC group than those in the MISTA group (7.1 % vs 28.9 %, p < 0.001). The calcaneal width immediate postoperatively and at the final follow-up in the MISTA group were obviously improved compared to those in the PR+CSC group (p < 0.001). The variables of sagittal motion and hindfoot motion of the AOFAS scoring system in the PR+CSC group were significantly higher than those in the MISTA group (p < 0.05). The good and excellent results in the two groups were comparable for Sanders Type-II calcaneal fractures, but the good to excellent rate in the MISTA group was significantly higher for Sanders Type-III fractures (p < 0.05). The clinical outcomes are comparable between the two minimally invasive techniques in the treatment of Sanders Type-II DIACFs. The PR+CSC grafting is superior to the MISTA in terms of the average time between initial injury and operation, operation time, wound-related complications and subtalar joint activity. However, the MISTA has its own

  15. [Intra-articular reinforcement of a partially torn anterior cruciate ligament (ACL) using newly developed UHMWPE biomaterial in combination with Hexalon ACL/PCL screws: ex-vivo mechanical testing of an animal knee model].

    Science.gov (United States)

    Fedorová, P; Srnec, R; Pěnčík, J; Dvořák, M; Krbec, M; Nečas, A

    2015-01-01

    PURPOSE OF THE STUDY Recent trends in the experimental surgical management of a partial anterior cruciate ligament (ACL) rupture in animals show repair of an ACL lesion using novel biomaterials both for biomechanical reinforcement of a partially unstable knee and as suitable scaffolds for bone marrow stem cell therapy in a partial ACL tear. The study deals with mechanical testing of the newly developed ultra-high-molecular-weight polyethylene (UHMWPE) biomaterial anchored to bone with Hexalon biodegradable ACL/PCL screws, as a new possibility of intra-articular reinforcement of a partial ACL tear. MATERIAL AND METHODS Two groups of ex vivo pig knee models were prepared and tested as follows: the model of an ACL tear stabilised with UHMWPE biomaterial using a Hexalon ACL/PCL screw (group 1; n = 10) and the model of an ACL tear stabilised with the traditional, and in veterinary medicine used, extracapsular technique involving a monofilament nylon fibre, a clamp and a Securos bone anchor (group 2; n = 11). The models were loaded at a standing angle of 100° and the maximum load (N) and shift (mm) values were recorded. RESULTS In group 1 the average maximal peak force was 167.6 ± 21.7 N and the shift was on average 19.0 ± 4.0 mm. In all 10 specimens, the maximum load made the UHMWPE implant break close to its fixation to the femur but the construct/fixation never failed at the site where the material was anchored to the bone. In group 2, the average maximal peak force was 207.3 ± 49.2 N and the shift was on average 24.1 ± 9.5 mm. The Securos stabilisation failed by pullout of the anchor from the femoral bone in nine out of 11 cases; the monofilament fibre ruptured in two cases. CONCLUSIONS It can be concluded that a UHMWPE substitute used in ex-vivo pig knee models has mechanical properties comparable with clinically used extracapsular Securos stabilisation and, because of its potential to carry stem cells and bioactive substances, it can meet the requirements for

  16. Radiosynovectomy of Painful Synovitis of Knee Joints Due to Rheumatoid Arthritis by Intra-Articular Administration of (177)Lu-Labeled Hydroxyapatite Particulates: First Human Study and Initial Indian Experience.

    Science.gov (United States)

    Shinto, Ajit S; Kamaleshwaran, K K; Chakraborty, Sudipta; Vyshakh, K; Thirumalaisamy, S G; Karthik, S; Nagaprabhu, V N; Vimalnath, K V; Das, Tapas; Banerjee, Sharmila

    2015-01-01

    The aim of this study is to assess the effectiveness of Radiosynovectomy (RSV) using (177)Lu-labeled hydroxyapatite ((177)Lu-HA) in the treatment of painful synovitis and recurrent joint effusion of knee joints in rheumatoid arthritis (RA). Ten patients, diagnosed with RA and suffering from chronic painful resistant synovitis of the knee joints were referred for RSV. The joints were treated with 333 ± 46 MBq of (177)Lu-HA particles administered intra-articularly. Monitoring of activity distribution was performed by static imaging of knee joint and whole-body gamma imaging. The patients were evaluated clinically before RSV and at 6 months after the treatment by considering the pain improvement from baseline values in terms of a 100-point visual analog scale (VAS), the improvement of knee flexibility and the pain remission during the night. RSV response was classified as poor (VAS good (VAS ≥ 50-75) and excellent (VAS ≥ 75), with excellent and good results considered to be success, while fair and poor as failure and also by range of motion. Three phase bone scan (BS) was repeated after 6 months and changes in the second phase of BS3 were assessed visually, using a four-degree scale and in the third phase, semiquantitatively with J/B ratio to see the response. Biochemical analysis of C-reactive protein (CRP) and fibrinogen was repeated after 48 h, 4 and 24 weeks. In all 10 patients, no leakage of administered activity to nontarget organs was visible in the whole-body scan. Static scans of the joint at 1 month revealed complete retention of (177)Lu-HA in the joints. All patients showed decreased joint swelling and pains, resulting in increased joint motion after 6 months. The percentage of VAS improvement from baseline values was 79.5 ± 20.0% 6 months after RS and found to be significantly related to patients' age (P = 0.01) and duration of the disease (P = 0.03). Knees with Steinbrocker's Grades 0 and I responded better than those with more advanced changes

  17. Factors influencing the operative results of displaced intra-articular calcaneal fracture%影响移位关节内跟骨骨折手术疗效的因素

    Institute of Scientific and Technical Information of China (English)

    宋兵华; 孙俊英; 倪增良; 何斌; 成文; 童舜谊

    2015-01-01

    Objective To determine the factors influencing the results of open reduction and internal fixation for displaced intra-articular calcaneal fracture (DIACF).Methods From May 2009 to June 2013, 80 patients with DIACF involving in 91 feet were treated by open reduction and internal fixation.Mean age was 38.7 years (range, 18-72 years).Patients were grouped according to the possible factors related to the operative results, including the Sanders classification of fracture, quality of fracture reduction, postoperative B(o)hler angle, width of postoperative calcaneus, and time to surgery after injury.Clinical result was evaluated and compared within each group.Results Mean duration of follow-up was 18.3 months (range, 14-26 months).The clinical results were excellent for 67 feet (74%), good for 12 feet (13%), fair for 7 feet (8%) and poor for 5 feet (5%), which yielded 87% good to excellent results.Good to excellent results in Sanders Ⅱ , Ⅲ and Ⅳ groups reached 94%, 85% and 53% respectively, in quality of fracture reduction ≤ 2 mm and > 2 mm groups reached 93% and 30% respectively, in postoperative B(o)hler angle < 15° and ≥15° groups reached 33% and 90% respectively;in broadening of postoperative calcaneus < 1 cm and ≥ 1 cm groups reached 92% and 17% respectively, in time to surgery after injury ≤14 days and > 14 days groups reached 91% and 43% respectively, in age ≤60 years old and > 60 years old groups reached 85% and 88% respectively.Except for the age group, the clinical result differed significantly within group (P < 0.05).Conclusions Fracture type, reduction quality, postoperative B(o)hler angle, width of postoperative calcaneus, time to surgery after injury are the factors influencing on the operative results of patients with displaced intra-articular calcaneal fracture.Thereupon the unfavorable influences should be avoided to improve the operative results.%目的 探讨影响移位关节内跟

  18. Sacroiliitis in children with spondyloarthropathy: therapeutic effect of CT-guided intra-articular corticosteroid injection; Sakroiliitis bei Kinder mit Spondylarthropathie: Therapeutischer Effekt der CT-gestuetzten intraartikulaeren Kortikosteroid-Injektionen

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, T.; Hermann, K.G.A.; Diekmann, F.; Hamm, B. [Humboldt-Universitaet, Berlin (Germany). Universitaetsklinikum Charite, Inst. fuer Radiologie; Biedermann, T. [HELIOS Klinikum Berlin (Germany). II. Klinik fuer Kinderheilkunde und Jugendmedizin, Abt. Kinderrheumatologie; Braun, J. [Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus (Germany); Bollow, M. [Augusta-Krankenhaus, Bochum (Germany). Inst. fuer Radiologie

    2003-06-01

    Purpose: The prospective investigation of the therapeutic effect of CT-guided intra-articular corticosteroid injection into inflammatory sacroiliac (SI) joints compared to conventional treatment with nonsteroidal anti-inflammatory drugs (NSAIDS) in children with juvenile spondyloarthropathy (jSpA) and the determination of the role of dynamic magnetic resonance imaging (MRI) in establishing the indication and monitoring the therapy. Materials and Methods: The study comprises 89 children with known jSpA who were diagnosed by MRI to have a unilateral or bilateral sacroiliitis. Therapy with NSAIDS was initiated or continued in all 89 patients. Four weeks after the diagnostic MRI, two groups were distinguished according to the clinical response of NSAIDS, with group 1 consisting of 22 responders and group 2 of 56 non-responders. The patients of group 2 were treated with CT-guided intra-articular corticosteroid injection (low-dose injection) while the therapy with NSAIDS was continued. A total of 83 SI joints were punctured without complications, 27 bilaterally and 29 unilaterally. The indication for the intervention was based on inflammatory activity as determined by MRI. The therapy was monitored by clinical follow-up every 8 to 12 weeks over a period of 20 months. Follow-up by dynamic MRI was performed in all 56 children of group 2 and 15 of the 33 children of group 1 within 8{+-}4 months of the initial examination. Results: A total of 87.5% of the children in group 2 showed a statistically signficant decrease in their subjective complaints from 6.9{+-}3.4 to 1.8{+-}1.7 (p<0.05) as measured on a visual analog scale (VAS from 0 to 10). Improvement was seen as early as 1.5{+-}1.0 weeks after the intervention and lasted for a mean of 12{+-}6 months. The children in group 1 already showed similar improvement of the VAS from 6.8{+-}3.2 to 1.5{+-}1.4 (p<0.05) during the initial four weeks of NSAIDS therapy, with the improvement lasting for the 20-month observation period

  19. Ultrasound-Guided Intra-articular Injection of the Radio-ulnar and Radio-humeral Joints and Ultrasound-Guided Dry Needling of the Affected Limb Muscles to Relieve Fixed Pronation Deformity and Myofascial Issues around the Shoulder, in a Case of Complex Regional Pain Syndrome Type 1.

    Science.gov (United States)

    Pai, Renuka S; Vas, Lakshmi

    2017-04-23

    Complex regional pain syndrome (CRPS) occurs due to different pathophysiological mechanisms. Presently there is no description of definitive treatment that can resolve the especially recalcitrant motor issues of disability in CRPS type 1 (CRPS-1). We have herein described the successful management of motor disability with a multimodal approach in a patient with CRPS-1 that occurred as a result of a fracture sustained in the lower end of the radius. Sensory/sudomotor/vasomotor symptoms were relieved completely by medications and stellate ganglion block in 2 weeks. Ultrasound-guided dry needling secured near-complete improvement of shoulder and hand movements in 45 days. Ultrasound guided intra-articular (radio-ulnar and radio-humeral joint) injections with steroid reduced residual pain and improved forearm movements by 50% initially. The patient continued to receive regular sessions of dry needling, physiotherapy, and cognitive behavioral therapy. By the end of 1 year, the functions of the limb improved remarkably, as did the functional outcome scores. In this patient with CRPS-1, intra-articular injections with steroid reduced nociception in the affected local structures and sensitization in the nervous system; dry needling resolved the myofascial issues; sustained physiotherapy maintained the motor recovery; and behavioral therapy techniques addressed the cognitive and life stress issues. It was concluded that the presenting symptoms in this case were a consequence of interactions between humoral, nervous, and myofascial systems. © 2017 World Institute of Pain.

  20. Fraturas intra-articulares do calcâneo: análise clínica e biomecânica Intraarticular calcaneal fracture: a clinical and biomechanical analysis

    Directory of Open Access Journals (Sweden)

    Marcos Emilio Kuschnaroff Contreras

    2009-01-01

    Full Text Available OBJETIVO: Verificar as variáveis de distribuição da pressão plantar de pacientes submetidos a tratamento cirúrgico de fratura de calcâneo e correlacioná-las com duas diferentes vias de acesso cirúrgico. Métodos: Os autores estudaram 15 pacientes com idade entre 20 e 53 anos (média de 40,06 anos que apresentaram fraturas intra-articulares do calcâneo, submetidos ao tratamento cirúrgico por duas vias de acesso cirúrgico, a via lateral e a via do seio do tarso. Avaliaram a distribuição da pressão plantar, correlacionando essas variáveis com as duas vias de acesso. A avaliação da distribuição da pressão plantar foi rea-lizada através do sistema Pedar (Novel, GmbH, Munique, Alemanha, verificando o pico máximo de pressão do retropé e do antepé do lado fraturado e do lado normal. RESULTADOS: A média das pressões máximas dos plantigramas do retropé dos pés operados pela via de acesso lateral e pela via curta não apresentou diferença estatística entre as duas vias de acesso (t = 0,11; p = 0,91, bem como a média das pressões máximas dos plantigramas do antepé também não mostrou diferença estatística significativa (t = -0,48; p = 0,64. CONCLUSÃO: Os autores concluíram que não houve diferença estatística entre as médias dos picos máximos de pressão do retropé e do antepé do lado operado, comparados com o lado normal, bem como não houve diferença estatística dessas variáveis comparadas com a via de acesso cirúrgico utilizada.OBJECTIVE: Verify the variables of plantar pressure distribution of patients submitted to surgical procedure for calcaneal fracture, and correlate them with two different surgical approaches. Method: The authors studied 15 patients between 20 and 53 years of age (average 40.06 yrs. who had intra-joint calcaneal fractures, submitted to surgical treatment by means of two different approaches: the lateral and the sinus tarsi. The authors checked the plantar pressure distribution by

  1. Doppler obstétrico posterior al uso de Betametasona para la maduración pulmonar fetal

    Directory of Open Access Journals (Sweden)

    Keibis Jiménez Castillejo

    2014-04-01

    Full Text Available El objetivo de la investigación fue determinar las modificaciones del Doppler obstétrico posterior al uso de betametasona para la maduración pulmonar fetal. Se realizó una investigación de tipo explicativa, prospectiva y longitudinal con un diseño cuasi-experimental y una muestra no probabilística intencional de 106 pacientes que acudieron a la consulta Pre-natal de Alto Riesgo del Hospital Central “Dr. Urquinaona". Una vez seleccionadas las pacientes se les administró inyecciones intramusculares de betametasona (12 mg/día por dos días consecutivos. Se realizaron las mediciones de índice de pulsatilidad e índice de resistencia en las arterias uterinas, umbilical y cerebral media fetal. No se encontraron diferencias estadísticamente significativas entre las determinaciones del índice de pulsatilidad y de resistencia de las arterias uterinas (p = ns. Se observaron disminuciones significativas en el índice de pulsatilidad y de resistencia de la arteria umbilical en la segunda y tercera medición al compararla con la medición inicial (p < 0,05. Se encontraron disminuciones en el índice de pulsatilidad de la arteria cerebral media fetal en ambos periodos de estudio comparado con los valores iniciales y solo se observó una disminución significativa del índice de resistencia en la segunda medición (p < 0,05. Se concluye que el uso de betametasona para la maduración pulmonar fetal produce modificaciones en la evaluación Doppler de las arterias umbilical y cerebral media fetal. Obstetric doppler after use of Betamethasone for fetal lung maturation Abstract The objective of research was to determine modifications of obstetric Doppler after to fetal lung maturation. An explicative, prospective and longitudinal research was done with a quasi-experimental design and an intentional non probabilistic sample of 106 patients who assisted to High Risk Antenatal Consult at Hospital Central “Dr. Urquinaona". Once patients were selected

  2. Frecuencia cardiaca y movimientos fetales posterior a la administracion de betametasona para maduración pulmonar fetal

    Directory of Open Access Journals (Sweden)

    Yolima Ruiz Lopez

    2013-05-01

    Full Text Available El objetivo de la investigación fue demostrar las modificaciones de la frecuencia cardiaca y los movimientos fetales producidas por la administración de betametasona para maduración pulmonar fetal. Se realizó una investigación de tipo explicativa, prospectiva y longitudinal con un diseño cuasi-experimental y una muestra no probabilística de 106 gestantes entre 24 y 34 semanas, con diagnóstico de amenaza de parto pretérmino tratadas con betametasona (12 mg intramuscular cada 24 horas por dos dosis que acudieron al Hospital Central “Dr. Urquinaona”. Se evaluaron los movimientos fetales y frecuencia cardiaca materna y fetal. No se encontraron diferencias significativas en la frecuencia cardiaca materna comparado con los valores iniciales (p = ns. Se observó que el valor inicial de la frecuencia cardiaca fetal fue de 135,1±9,7 latidos por minuto para aumentar luego a 137,2±8,9 latidos por minuto (p = ns para presentar un nuevo aumento hasta (142,9±9,9 latidos por minuto que fue significativo comparado con los valores iniciales (p < 0,05. Se observó una disminución significativa de movimientos fetales medidos en 30 minutos después de la primera inyección (23,1±6,0 movimientos comparado con 14,8±7,0 movimientos, para aumentar después de la segunda inyección pero aun presentando valores significativamente más bajos comparado con los valores iniciales (20,0 ±6,7 movimientos; p < 0,05. Se concluye que la administración de betametasona para maduración pulmonar fetal produce incremento significativo en la frecuencia cardiaca y reducción marcada de los movimientos fetales. Abstract Fetal heart rate and movements after betamethasone administration for fetal lung maturity The objective of research was to demonstrate fetal heart rate and movements modifications by the use of betamethasone for fetal lung maturity. An explicative, prospective and longitudinal research was done with a quasi-experimental design and a non

  3. Observation on Efficacy of Sodium Hyaluronate in Intra-articular Injection Treatment of Osteoarthrosis%玻璃酸钠膝关节腔内注射治疗骨关节病的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王荣

    2016-01-01

    OBJECTIVE:To investigate the efficacy of sodium hyaluronate in treatment of rheumatoid arthritis ,and the nursing method in the treatment .METHODS:120 cases of patients with rheumatoid arthritis admitted into Hubei Shiyan Xunyang District Traditional Chinese Medicine Hospital from Feb .2013 to Mar.2015 were collected to be divided into control group and observation group via the random number table ,with 60 cases in each.The control group were given conventional treatment and care ,namely ,oral Meloxicam tablets ,ultrashort wave and joint function exercise . The observation group additionally received give sodium hyaluronate injection treatment and nursing measures based on the control group .By contrast ,the recovery of two groups were compared .RESULTS:After treatment of five weeks ,the curative effects of two group of patients showed obvious differences .The total effective rate of observation group was 91.67%( 55/60 ) , significantly higher than that of control group 80.00%( 48/60 ) , with statistically significant difference(P<0.05).As for the extent of osteoarthrosis score in observation group ,patients of zero increased 7 cases, patients of more than 11 points decreased 6 cases;while in control group ,patients of zero increased 1 case ,patients of more than 11 points decreased 3 cases.The control effects of observation group was significantly better than that of control group , with statistically significant difference ( P<0.05 ) .CONCLUSIONS:The efficacy of sodium hyaluronate in intra-articular injection treatment of osteoarthrosis in clinic is significant .It is worthy of clinical promotion and application .%目的:探讨应用玻璃酸钠治疗类风湿性关节炎的疗效及治疗中的护理方法。方法:选择湖北省十堰市郧阳区中医医院从2013年2月—2015年3月的类风湿性关节炎患者120例作为研究对象,按随机数字表法分为对照组和观察组,每组各60例。对照组患者给予常规综合治疗和护

  4. 关节腔注射医用三氧和透明质酸钠治疗膝关节骨性关节炎的疗效%Efficacy of medical ozone combined with sodium hyaluronate intra-articular injection in the treatment of patients with knee osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    姚发利; 佘淑华; 李海涛; 高华

    2015-01-01

    目的 探讨医用三氧结合透明质酸钠治疗膝关节骨性关节炎的临床疗效.方法 膝关节骨性关节炎患者84例,随机分为注射组和传统组,各组42例.注射组使用医用三氧结合透明质酸钠关节腔内注射方法治疗,传统组使用针灸、特定电磁波谱(TDP)、中频、微波、中药敷贴等传统治疗方法治疗,于治疗前及治疗后5周记录VAS评分及Lysholm膝关节评分,并于治疗后5周评定治疗效果,观察治疗后的临床疗效.结果 与治疗前比较,两组患者治疗后VAS评分均下降,且注射组较传统组下降更明显,差异均有统计学意义(P<0.05);与治疗前比较,治疗后两组患者Lysholm评分均升高,且注射组升高更明显,差异均有统计学意义(P<0.05).注射组的有效率(92.8%,39/42例)高于传统组(81.0%,34/42例),差异有统计学意义(P<0.05).结论 医用三氧结合透明质酸钠治疗膝关节骨性关节炎疗效较传统方法好.%Objective To explore the clinical efficacy of medical ozone combined with sodium hyaluronate intra-articular injection in the treatment of patients with knee osteoarthritis.Methods Eighty-four patients with knee osteoarthritis were divided into medical ozone combined with intra-articular sodium hyaluronate injection group (injection group) and traditional group, 42 cases in each group.Patients in the injection group were received medical ozone combined with sodium hyaluronate intra-articular injection, while the others in the traditional group were received acupuncture, TDP, midfrequency, microwave, traditional Chinese medicine.VAS and Lysholm score were recorded before and after the treatment, and the effective rates were evaluated after the treatment.Results Compared with pre-treatment, VAS was decreased significantly after the treatment in both two groups, and that in injection group was better than that in traditional group (P< 0.05).Lysholm score was significantly increased after the treatment

  5. Clinical Observation on Intra-articular Injection of Sodium Hyaluronate Combined with External Application of Traditional Chinese Medicine in Treatment of Knee Osteoarthritis%玻璃酸钠关节腔内注射联合中药外敷治疗膝骨性关节炎临床观察

    Institute of Scientific and Technical Information of China (English)

    杨忠良

    2015-01-01

    目的:观察膝骨性关节炎应用玻璃酸钠关节腔内注射与中药外敷联合治疗的临床效果。方法选取我院2013年2月~2014年2月间收治的膝骨性关节炎患者37例,对照组单纯应用玻璃酸钠关节腔内注射治疗,观察组应用玻璃酸钠关节腔内注射与中药外敷联合治疗,比较两组ROM变化、膝关节功能Lysholm评分与治疗效果。结果观察组ROM变化与膝关节功能Lysholm评分改善显著,总有效率(94.44%)与对照组(78.95%)比较相对较高,两组治疗效果差异显著,有统计学意义(P<0.05)。结论膝骨性关节炎应用玻璃酸钠关节腔内注射与中药外敷联合治疗效果满意,安全性高,切实可行,值得推广。%Objective Clinical efficacy of intra-articular injection of sodium hyaluronate combined with external application of traditional Chinese medicine in treatment of knee osteoarthritis is to be observed. Methods Choose 37 patients suffering from knee osteoarthritis who are treated in hospital from February 2013 to February 2014 to study; patients in control group are given intra-articular injection of sodium hyaluronate treatment only; while patients in study group are given intra-articular injection of sodium hyaluronate combined with external application of traditional Chinese medicine treatment;and then observe and compare ROM changes,Lysholm score of keen function and treatment efficacy in these two groups . Results Patients’ ROM changes and Lysholm score of knee function in study group have a better improvement than those in control group;and in addition,treatment efficacy in study group(94.44%)is much higher than that in control group(78.95%);there is a treatment differential between two groups,and such a differential has statistic value(P<0.05). Conclusions Intra-articular injection of sodium hyaluronate combined with external application of traditional Chinese medicine is of efficacy and medical safety in

  6. The clinical observation on intra - articular injection of sodium hyaluronate combined with ozone under shoulder peak in the treatment for scapulohumeral periarthritis.%肩峰下关节腔注射玻璃酸钠复合臭氧治疗肩周炎的临床观察

    Institute of Scientific and Technical Information of China (English)

    王振涛; 韩玉龙; 李彦平; 王强

    2015-01-01

    Objective To observe the therapeutic effect of the intra - articular injection of sodium hyaluronate combined with ozone under shoulder peak in the treatment for scapulohumeral periarthritis. Methods A hundred and twenty patients with scapulohumeral periarthritis were randomly assigned to the group A(n = 30)in which an intra - articular injection of the analgesic solution(2% lidocaine 40 mg and triamcinolone acetonide 20 mg diluted in 0. 9% sodium chloride to 6 ml)under shoulder peak was performed and group B in which an intra - articular injection of the same analgesic solution and sodium hyaluronate(2. 5 ml)combined with ozone(180 μg in 6 ml)under shoulder peak was performed. Ad-ditional injections of the same analgesic solution were performed in circumscribed pain points such as the area of subcoracoid or low back of shoul-der peak in all patients. The therapeutic result and the activity of shoulder joint were observed between two groups. Results Patients in group B needed fewer number of treatment and had better therapeutic effect significantly than those in group A(all P ﹤ 0. 05). Conclusion The intra -articular injection of sodium hyaluronate combined with ozone under shoulder peak in the treatment for scapulohumeral periarthritis will shorten the therapeutic duration and have better therapeutic result.%目的:观察肩峰下关节腔注射玻璃酸钠复合臭氧治疗肩周炎的临床疗效。方法120例肩周炎患者随机分为两组。A 组:肩峰下关节腔注射止痛液(2%利多卡因2 ml +曲安奈德20 mg +生理盐水)共6 ml;B 组:A 组液+玻璃酸钠注射液2.5 ml +30μg/ ml 臭氧6 ml;其余在肩周较为局限的痛点如喙突下、肩峰背侧下方处等各注入止痛液5 ml,治疗一次/周。对比观察两组治疗次数和临床疗效。结果 B 组在治疗次数明显少于 A 组,治疗有效率明显高于 A组。差异均有统计学意义( P ﹤0.05)。结论肩峰下关节腔注射玻璃酸钠复

  7. Results of fixation of dorsally displaced intra-articular distal radius fractures with non angular stable implants%非角度稳定性钢板固定治疗桡骨远端关节内背侧移位骨折的结果

    Institute of Scientific and Technical Information of China (English)

    Wong Merng Koon

    2006-01-01

    Objective Intra-articular fractures of the distal radius in young adults comprise a distinct fracture pattern that is difficult to manage and associated with a high frequency of post-traumatic arthritis. Restoration of articular congruency and alignment should improve the outcome. Methods In this study we prospectively reviewed the results of 21 consecutive cases of dorsally displaced intra-articular distal radius fractures which were treated with internal fixation after failing to achieve articular congruency with closed reduction. Results 3 patients were lost to follow-up. For the rest of 18 patients, follow-up time ranges from 18 to 75 weeks the fractures had healed with highly satisfactory radiographic and functional results. The final volar tilt averaged 4.9°; radial inclination 23.9°; radial length 14mm; and articular incongruity, 0. 1 mm. Wrist motion at final follow-up examination averaged flexion 62°, extension 60°, radial deviation 16°, ulnar deviation 27°, pronation 77°and supination 74°. Grip strength averaged 83% of the uninjured side. The overall outcome of 18 patients (94.4%) had a good or excellent result according to the system of Gartland and Werley and 18 patients (72. 2% ) had a good result according to the modified system of Green and O'Brien at the most recent evaluation. The only complication in this series was a superficial pin tract infection, which was rapidly resolved with removal of pins at 5th week of external fixation.Conclusion Thus restoration of articular congruency and alignment is possible with minimal complication using modern non-angular stable methods of internal fixation.

  8. Modificaciones hemodinámicas y metabólicas maternas secundarias al uso de betametasona para la maduración pulmonar fetal

    Directory of Open Access Journals (Sweden)

    Keibis Jiménez-Castillejo

    2013-09-01

    Full Text Available El objetivo de la investigación fue determinar las modificaciones hemodinámicas y metabólicas maternas secundarias al uso de betametasona para la maduración pulmonar fetal. Se realizó una investigación de tipo explicativa, prospectiva y longitudinal con un diseño cuasi-experimental y una muestra no probabilística intencional de 106 pacientes que acudieron a la consulta pre-natal de alto riesgo del Hospital Central “Dr. Urquinaona". Una vez seleccionadas las pacientes se le administró inyecciones intramusculares de betametasona (12 mg por dos días consecutivos. El valor de presión arterial sistólica presentó un leve aumento luego de la segunda medición y la tercera medición (p = ns. La presión arterial diastólica presentó aumento significativo durante la segunda medición y un nuevo aumento significativo en la tercera medición (p < 0,05. Se observaron aumentos significativos en el valor promedio de la frecuencia cardiaca luego de la segunda y tercera medición de betametasona (p < 0,05. No se encontraron modificaciones significativas en las concentraciones de glicemia, sodio y potasio entre las tres mediciones (p = ns. Se concluye que el uso de betametasona para inducir la maduración pulmonar fetal produce modificaciones hemodinámicas maternas acompañados de cambios metabólicos transitorios. Hemodynamical and metabolic modifications secondary to betamethasone use for fetal lung maturity Abstract The objective of research was to determine maternal hemodynamic and metabolic modifications secondary to the use of betamethasone for fetal lung maturation. An explicative, prospective and longitudinal research was done with a quasi-experimental design and intentional non probabilistic sample of 106 patients who assisted to High Risk Antenatal Consult at Hospital Central “Dr. Urquinaona". Once patients were selected, two intramuscular injections of betamethasone (12 mg were administered for two consecutive days. Systolic blood

  9. Concentraciones plasmáticas de cortisol materno secundarias al uso de betametasona para la maduración pulmonar fetal

    OpenAIRE

    Keibis Jiménez Castillejo; Yolima Ruiz Lopez; Eduardo Reyna Villasmil; Duly Torres- Cepeda; Joel Santos-Bolívar; Jhoan Aragón-Charris; Jorly Mejia-Montilla; Nadia Reyna-Villasmil

    2014-01-01

    Resumen (español) El objetivo de la investigación fue determinar las concentraciones plasmáticas de cortisol materno secundarias al uso de betametasona para la maduración pulmonar fetal. Se realizó una investigación con un diseño tipo cuasi-experimental y una muestra no probabilística intencional de 106 pacientes que acudieron a la consulta pre-natal de alto riesgo del Hospital Central “Dr. Urquinaona". Una vez seleccionadas las pacientes se le administró inyecciones intramusculares de bet...

  10. Betametasona antenatal e incidencia de distrés respiratorio después de cesárea electiva: estudio aleatorizado pragmático

    OpenAIRE

    Donoso B,Bernardita; Vera P-G.,Claudio; Carvajal C,Jorge

    2006-01-01

    Objetivo: Evaluar si los corticoesteroides antenatales reducen el distrés respiratorio en recién nacidos por cesárea a término. Método: Estudio multicéntrico aleatorizado pragmático, realizado en 10 maternidades; 998 mujeres con consentimiento informado fueron randomizadas al momento de decidirse la cesárea electiva: 503 fueron randomizadas al grupo de tratamiento. El grupo de tratamiento recibió 2 dosis intramusculares de 12 mg de betametasona en las 48 horas anteriores al parto, el grupo co...

  11. Betametasona e extrato aquoso de Arctium lappa no tratamento da angiostrongilíase Betamethasone and aqueous extract of Arctium lappa for treating angiostrongyliasis

    Directory of Open Access Journals (Sweden)

    Camila Argenta Fante

    2008-12-01

    Full Text Available Angiostrongylus costaricensis é um parasita que causa angiostrongilíase abdominal em humanos, seu tratamento inclui o uso de antiinflamatórios apesar da falta de estudos que justifiquem esta conduta. O objetivo deste artigo é avaliar o efeito da betametasona e da Arctium lappa na evolução de lesões intestinais induzidas pelo parasita. Utilizou-se camundongos Swiss, machos, adultos, distribuídos em 4 grupos: infectados tratados com betametasona; com Arctium lappa; não tratados e grupo controle. Os tratamentos iniciaram no 15º dia de infecção e permaneceram por 15 dias. Infiltrado eosinofílico e granuloma foram avaliados (1-leve; 2-moderado; 3-severo. A betametasona permitiu a evolução das lesões para formas mais graves, enquanto o extrato não interferiu na progressão da patologia. As substâncias empregadas não mostraram eficácia na proteção das lesões induzidas pelo Angiostrongylus costaricensis em camundongos. Estes achados desmotivam o uso de betametasona e Arctium lappa em humanos acometidos por angiostrongilíase abdominal.Angiostrongylus costaricensis is a parasite that causes abdominal angiostrongyliasis in humans. The treatment for it includes the use of anti-inflammatory drugs, despite the lack of studies to justify this approach. The objective of this paper was to evaluate the effect of betamethasone and Arctium lappa on the evolution of intestinal lesions induced by this parasite. Adult male Swiss mice were used, distributed into four groups: infected and treated with betamethasone; infected and treated with Arctium lappa; infected and not treated; and control group. The treatments were started on the 15th day after infection and continued for 15 days. The presence of eosinophilic infiltration and granuloma was evaluated (1-mild; 2-moderate; 3-severe. Betamethasone allowed the lesions to evolve into more severe forms, while the extract did not interfere with disease progression. The substances applied were

  12. Doppler de las arterias pulmonares fetales posterior al uso de betametasona para la maduración pulmonar (Fetal lung arteries Doppler after to use of betamethasone for lung maturation)

    National Research Council Canada - National Science Library

    Keibis Jiménez Castillejo; Yolima Ruiz Lopez; Eduardo Reyna Villasmill; Duly Torres Cepeda; Joel Santos Bolívar; Jhoan Aragón Charry; Jorly Mejia Montilla; Nadia Reyna Villasmil

    2014-01-01

    Resumen (español) El objetivo de la investigación fue determinar las modificaciones del Doppler de las arterias pulmonares fetales posterior al uso de betametasona para la maduración pulmonar. Se realizó una...

  13. Curative effect of anatomical Ti-plate fixation combining with bone graft in the treatment of intra-articular calcaneal fractures%解剖型跟骨钛板并植骨治疗跟骨关节内骨折的临床疗效

    Institute of Scientific and Technical Information of China (English)

    王怀斌; 袁志; 裴国献; 刘建; 毕龙; 王连军; 孙克理; 隋天棋

    2014-01-01

    Objective To investigate the curative effect of anatomical Ti-plate combined with bone graft in treatment of intra-articular calcaneal fractures .Methods Retrospective analysis was conducted in 25 patients with 33 feet from Mar.2009 to May 2012,who were diagnosed as Sanders typeⅡ-Ⅳintra-articular calcaneal fractures .There were 20 males(26 feet) and 5 females (7 feet) with average age of (36.16 ±14.63)years(ranged from 15 to 65 years old) .There were 17 cases of single foot injury and 8 cases of double feet injury .All the patients were treated with Ti-plate fixation combined with bone graft and their calcaneal anatomic forms were recovered during operation .Mary-land foot score was used to evaluate the postoperative function .Results All the 25 cases (33 feet) were followed up for 12-36 months,with a mean time of 19.3 months.According to Maryland foot score ,17 feet were rated as excellent , 12 feet as good,4 feet as moderate.The excellent and good rate was 87.88 %.Conclusion Anatomical Ti-plate combined with bone graft for treatment of intra-articular calcaneal fractures can restore the smoothness of subtalar joint surface,help patients take earlier functional exercise and obtain a reliable curative effect .%目的:探讨解剖型跟骨钛板并植骨治疗跟骨关节内骨折的临床疗效。方法选择2009年3月~2012年5月期间收治的25例(33足)SanderslⅡ~Ⅳ型跟骨关节内骨折患者,男性20例(26足),女性5例(7足);年龄15~65岁,平均(36.16±14.63)岁。单足17例,双足8例,采用切开复位解剖型跟骨钛板内固定并植骨进行治疗,术中恢复跟骨解剖形态,按Maryland足部评分系统进行术后功能评分,评价手术效果,进行系统的回顾性总结分析。结果本组25例(33足)术后均获12~36个月随访(平均19.3个月),按Maryland足部评分标准:优17足、良12足、可4足,差0足;优良率为87.88%。

  14. 切开内固定联合外固定架治疗桡骨远端关节内骨折疗效观察%Observation of curative effect of open reduction internal fixation combined with external fixation of intra-articular fractures of the distal radius

    Institute of Scientific and Technical Information of China (English)

    王传文; 黄久勤; 王红旗

    2014-01-01

    Objective To investigate the clinical effect internal fixation combined with external fixator incision in the treatment of intra-articular fractures of the distal radius.Methods 80 cases of intra-articular distal radius fracture patients underwent cut internal fixation combined with external fixator in the treatment of orthopedic were chosen,postoperative rehabilitation exercises,fracture healing after the removal of the external fixator.All patients were followed up for 8 months to 12 months,an average of 9.2 months.Results 80 patients were intraarticular fractures healed,the time required was 4 to 10 months,an average of 6.3 months.In accordance with the assessment of functional systems Dienst wrist,51 cases wrist function were excellent,21 cases were good,the good rate was 90% (72/80).There were no clinical fractures common complication after surgery.Conclusion Open internal fixation combined with external fixator treatment of intra-articular fractures of the distal radius fractures not only makes reduction of fracture and immobilization satisfaction,but also conducive to the wrist of early postoperative functional rehabilitation exercise.%目的 观察采用切开内固定联合外固定架法治疗桡骨远端关节内骨折的临床效果.方法 80例采用切开内固定联合外固定架法治疗的桡骨远端关节内骨折患者,术后进行康复锻炼,骨折愈合后拆除外固定架.对所有患者进行随访,时间为8~12个月,平均9.2个月,按照Dienst腕关节功能系统评定治疗效果.结果 80例患者关节内骨折全部愈合,所需时间为4 ~ 10个月,平均6.3个月.腕关节功能优51例,良21例,可8例,优良率为90%(72/80).临床上骨折手术后常见的并发症均未出现.结论 切开内固定联合外固定架法治疗桡骨远端关节内骨折既能使骨折复位、固定满意,又有利于术后早期手腕部的功能康复锻炼.

  15. 活膝汤联合臭氧关节腔注射治疗膝关节骨性关节炎临床研究%Clinical Study of Treatment of Knee Osteoarthritis by Combination of Huoxi Decoction and Intra-articular Injection of Ozone

    Institute of Scientific and Technical Information of China (English)

    吴彪; 邵先舫

    2016-01-01

    目的:探讨活膝汤联合臭氧治疗膝关节骨性关节炎(KOA)的临床疗效。方法:90例KOA患者随机分为三组各30例,联合用药组采用活膝汤内服+臭氧关节腔注射;臭氧注射组单纯采用臭氧关节腔注射;活膝汤组单纯采用活膝汤内服。共治疗1个月,评价治疗前后患者骨性关节炎指数评分量表(WOMAC)评分、疼痛视觉模拟评分法(VAS)评分及综合疗效。结果:三组患者疼痛VAS评分、WOMAC评分,治疗前后差异均有统计学意义(P<0.05);综合疗效,联合治疗组总有效率96.7%;臭氧组总有效率90.0%;活膝汤组总有效率80.0%,三组间疗效差异有统计学意义(P<0.05)。结论:活膝汤联合臭氧治疗膝关节骨性关节炎可明显缓解临床症状,改善关节功能,且疗效优于单独臭氧关节腔注射和活膝汤内服。%Objective:To explore the clinical curative effect of Huoxi decoction combined with intra-articular injection of ozone on knee osteoarthritis(KOA). Methods:A total of 90 cases of KOA patients were randomly divided into three groups,with 30 cases in each group.The combined treatment group was treated with oral administration of Huoxi decoction combined with intra-articular injection of ozone. The ozone injection group was treated with intra-articular injection of ozone and the Huoxi decoction group was treated with oral ad-ministration of Huoxi decoction.The treatment time was one month. The WOMAC osteoarthritis index scores , visual analog scale(VAS) scores and comprehensive curative effects before and after treatment were evaluat-ed. Results:After treatment,the differences of VAS and WOMAC scores of the three groups was statistically significant(P<0.05). For the comprehensive curative effects,in the combined treatment group,the total ef-fective rate was 96.7%. In the ozone group,the total effective rate was 90.0%. In the Huoxi decoction group, the total effective rate was 80

  16. A clinical study on intra-articular injection of tramadol and ropivacaine for analgesia after arthroscopic knee surgery%曲马多联合罗哌卡因关节腔内注射用于膝关节镜术后镇痛的临床研究

    Institute of Scientific and Technical Information of China (English)

    何崎; 秦燕; 刘丹凤

    2015-01-01

    Objective To observe the analgesic effects and side -effects of intra-articular injection of tramadol and ropivacaine for analgesia after arthroscopic knee surgery .Methods Ninety patients with ASAⅠ ~Ⅱ undergoing scheduled arthroscopic knee sur -gery with general anesthesia were randomly divided into three groups :ropivacaine group(group A),tramadol group(group B)and ropiv-acaine plus tramadol group(group C).At 10 minutes before end of surgery,the three groups received intra-articular injection of 0.45%ropivacaine,100 mg tramadol or tramadol 100 mg plus 0.45% ropivacaine in 20 ml,respectively.Visual Analog Scale(VAS)scores of pain at time points of 8,16,24 and 48 hours after the surgery,and the side effects such asdizziness ,nausea,vomiting and urine retention were recorded.Results Compared with the groups A and B,the VAS score in the group C was significantly decreased (P <0.05).No side effect was observed in all the three groups .Conclusion The intra-articular injection of tramadol and ropivacaine after arthroscopic knee surgery could reinforce the analgesia effect .%目的:观察膝关节镜术后关节腔内注射曲马多与罗哌卡因混合液的镇痛效果及不良反应。方法选择全麻下行膝关节镜手术患者90例,ASAⅠ~Ⅱ级,采用随机数字表法分为3组各30例,分别于手术结束时放止血带前10分钟向关节腔内注射罗哌卡因(A 组)、曲马多(B 组)及罗哌卡因与曲马多混合液(C 组),观察并比较三组术后的8、16、24、48 h 疼痛视觉模拟评分(VAS)及头晕、恶心、呕吐、尿潴留、局部感染等不良反应发生情况。结果C 组术后16、24、48 h 疼痛 VAS 评分明显低于 A、B 两组,差异有统计学意义(P <0.05);三组患者均未出现恶心、呕吐及尿潴留等不良反应。结论膝关节镜术后联合应用曲马多与罗哌卡因镇痛时间延长,不良反应并未增多。

  17. Adalimumab added to a treat-to-target strategy with methotrexate and intra-articular triamcinolone in early rheumatoid arthritis increased remission rates, function and quality of life. The OPERA Study: an investigator-initiated, randomised, double-blind, parallel-group, placebo-controlled trial.

    Science.gov (United States)

    Hørslev-Petersen, Kim; Hetland, Merete Lund; Junker, Peter; Pødenphant, Jan; Ellingsen, Torkell; Ahlquist, Palle; Lindegaard, Hanne; Linauskas, Asta; Schlemmer, Annette; Dam, Mette Yde; Hansen, Ib; Horn, Hans Christian; Ammitzbøll, Christian Gytz; Jørgensen, Anette; Krintel, Sophine B; Raun, Johnny; Johansen, Julia S; Østergaard, Mikkel; Stengaard-Pedersen, Kristian

    2014-04-01

    An investigator-initiated, double-blinded, placebo-controlled, treat-to-target protocol (Clinical Trials:NCT00660647) studied whether adalimumab added to methotrexate and intra-articular triamcinolone as first-line treatment in early rheumatoid arthritis (ERA) increased the frequency of low disease activity (DAS28CRP<3.2) at 12 months. In 14 Danish hospital-based clinics, 180 disease-modifying anti-rheumatic drugs (DMARD)-naïve ERA patients (<6 months duration) received methotrexate 7.5 mg/week (increased to 20 mg/week within 2 months) plus adalimumab 40 mg every other week (adalimumab-group, n=89) or methotrexate+placebo-adalimumab (placebo-group, n=91). At all visits, triamcinolone was injected into swollen joints (max. four joints/visit). If low disease activity was not achieved, sulfasalazine 2 g/day and hydroxychloroquine 200 mg/day were added after 3 months, and open-label biologics after 6-9 months. Efficacy was assessed primarily on the proportion of patients who reached treatment target (DAS28CRP<3.2). Secondary endpoints included DAS28CRP, remission, Health Assessment Questionnaire (HAQ), EQ-5D and SF-12. Analysis was by intention-to-treat with last observation carried forward. Baseline characteristics were similar between groups. In the adalimumab group/placebo group the 12-month cumulative triamcinolone doses were 5.4/7.0 ml (p=0.08). Triple therapy was applied in 18/27 patients (p=0.17). At 12 months, DAS28CRP<3.2 was reached in 80%/76% (p=0.65) and DAS28CRP was 2.0 (1.7-5.2) (medians (5th/95th percentile ranges)), versus 2.6 (1.7-4.7) (p=0.009). Remission rates were: DAS28CRP<2.6: 74%/49%, Clinical Disease Activity Index≤2.8: 61%/41%, Simplified Disease Activity Index<3.3: 57%/37%, European League Against Rheumatism/American College of Rheumatology Boolean: 48%/30% (0.0008

  18. Clinical observation of intra-articular injections of sodium hyaluronate combined with periarticular pain spot nerve block for treatment of knee osteoarthritis-500 cases of report attached%玻璃酸钠关节腔内注射配合关节周围痛点神经阻滞治疗膝骨性关节炎临床观察500例

    Institute of Scientific and Technical Information of China (English)

    刘华; 洪春兰; 谢小香; 彭仁林

    2011-01-01

    目的:观察与探讨玻璃酸钠关节腔内注射配合关节周围痛点神经阻滞治疗膝骨性关节炎的临床疗效.方法:选取500例膝骨性关节炎患者,将其分为三组:股髌骨性关节炎组(156例)、股胫骨性关节炎组(167例)、全膝骨性关节炎组(177例).500例膝骨性关节炎患者每周关节腔内注射2.5 ml玻璃酸钠,配合利多卡因与泼尼松龙混合液痛点阻滞,连续治疗5周为1个疗程.结果:共治疗500例,随访24~36个月,临床疗效优149例,良247例,中82例,优良率为79.2%,有效率为95.6%.结论:玻璃酸钠腔内注射配合关节周围痛点神经阻滞治疗膝骨性关节炎疗效显著,安全可靠.%Objective: To observe and investigate the clinical effects of intra-articular injection of sodium hyaluronate combined with periarticular pain spot nerve block for the treatment of knee osteoarthritis.Methods: 500 patients with knee osteoarthritis were given intra-articular injection of 2.5 ml of sodium hyaluronate combined with the mixture of lidocaine and prednisolone for pain spot block per week.5 continuous weeks was a course of treatment.Results: 500 patients were treated and followed up for 24-36 months.The clinical effects of 149 patients were excellent, 247 patients were good and 82 patients were moderate, with the excellent and good rate of 79.2% and the effective rate of 95.6%.Conclusion: Intraarticular injection of sodium hyaluronate combined with periarticular pain spot nerve block for the treatment of knee osteoarthritis is significantly effective, safe and reliable.

  19. 郑氏正骨手法治疗桡骨远端关节内粉碎性骨折36例%Zhengshi Bone-setting manipulation treatment of intra-articular distal radius comminuted fracture in 36 cases

    Institute of Scientific and Technical Information of China (English)

    董霞; 陈天洪

    2012-01-01

    目的 探讨通过郑氏正骨手法、小夹板及中立板外固定治疗桡骨远端关节内粉碎性骨折的临床效果.方法 2009年1月-2010年6月采用郑氏正骨手法治疗桡骨远端关节内粉碎性骨折36例,骨折分型为AO C型,采用臂丛神经麻醉下郑氏正骨手法复位,小夹板、中立板外固定.骨折临床愈合时间6~8周,平均7周.治疗期问辅以活血化瘀、续筋接骨中药口服及指导功能锻炼.结果 36例患者均获得随访,随访时间3~6个月,平均4个月,末次随访时,腕关节功能评分(Gartland-Werley功能评分):优18例,良12例,可6例.结论 郑氏正骨手法整复并小夹板、中立板外固定是治疗桡骨远端关节内粉碎性骨折的有效方法,能尽可能避免手术治疗及其二次手术取除内固定所带来的痛苦,在达到较好疗效的同时又减少了医疗费用投入.%Objective To investigate the bone-setting techniques by Zhengshi, splint and neutral plate fixation of in-tra-articular distal radius fractures of the clinical effects. Methods 2009. 1 ~ 2010. 6 Zhengshi bone-setting techniques used on the treatment of intra-articular distal radius fractures in 36 cases, fracture classification for the AO C-type, the use of brachial plexus anesthesia in orthopedic manual reduction Cheng, splints, neutral plate fixation. Fracture healing time of 6 ~ 8 weeks, an average of 7 weeks. Supplemented by blood circulation during treatment, continued reinforcement of oral medicine and bone functional exercise guidance. Results 36 patients were followed up for 3 ~ 6 months, an average of 4 months and last follow-up, wrist function score ( Gartland-Werley functional score) ; excellent in 18 cases, good in 12 cases, 6 cases. Conclusion Zhengshi orthopedic manipulative and splints, external fixation is the treatment of neutral plate distal radial intra-articular fractures of the effective ways as possible to avoid surgery and second surgery to take in addition to the pain

  20. 丹参注射液腔内注射对早期骨关节炎中一氧化氮合酶的影响%Effect of intra-articular injection of Salvia on osteoarthritis early by inducible nitric oxide synthase

    Institute of Scientific and Technical Information of China (English)

    姜婷; 姚弘毅; 石大玲; 程凯; 何学斌

    2012-01-01

    目的 观察丹参注射液关节腔内注射对膝骨性关节炎早期诱导型一氧化氮合酶(iNOS)的影响.方法 将24只雄性大耳白兔随机分为A组(模型组)、B组(阳性对照组),C组(实验组),均用手术方法切开兔膝关节造成膝骨性关节炎(KOA)模型,后行石膏固定术;进而B组腔内注射玻璃酸钠0.3 ml/只、C组腔内注射丹参注射液0.3 ml/只、A组给予同体积的生理盐水,每周1次,延续4周.4周后处死兔,剥取滑膜、关节软骨检测iNOS含量.结果 B组滑膜组织及软骨中iNOS含量分别为(0.83±0.12) μmol/L和(0.13 ±0.06) μmol/L,与A组比较差异有统计学意义(P<0.05);C组滑膜组织及软骨中iNOS含量分别为(0.93±0.15) μmol/L和(0.20±0.08) μmol/L,与A组比较差异有统计学意义(P<0.05);但B组滑膜组织及软骨中iNOS含量与C组比较差异无统计学意义(P>0.05).结论 丹参注射液腔内注射可降低iNOS含量,抑制滑膜炎症,从而促进关节软骨的修复.%Objective To observe the effect of Intra-articular Injection of Salvia on knee osteoarthritis early by inducible nitric oxide synthase (iNOS),and to explore its therapeutic mechanism.Methods Twenty-four Japanese male white rabbits were made into knee osteoarthritis model and randomly divided into 3 groups:Group A (model group),B Group (Sham group) and Group C (experimental group).The rabbits of Group A,B,C were injected normal saline 0.3 ml,sodium hyaluronate 0.3ml and Salvia 0.3 ml,respectively.Each rabbits received injection 4 times.Four weeks after the administration,the levels of iNOS in synovial and articular cartilage were measured.Results There were significant differences between the levels of iNOS in synovial and articular cartilage of rabbits in Group A and B,Group A and C (P < 0.05),and no significant differences between that of rabbits in Group B and C.Conclusion Intra-articular Injection of Salvia could inhibit the expression of iNOS to decrease its level in

  1. 盐酸青藤碱关节腔注射用纳米粒温敏凝胶的制备及其性质考察%Preparation of sinomenine hydrochloride nanoparticle thermosensitive gel for intra-articular injection and its characteristic investigation

    Institute of Scientific and Technical Information of China (English)

    危红华; 李莎莎; 韩腾飞; 宋艳丽; 程亮; 鞠大宏; 赵宏艳; 刘梅洁; 郝保华

    2013-01-01

    Objective To prepare the solid lipid nanoparticle (SLN) thermosensitive gel of sinomenine hydrochloride (SH) for intra-articular injection and to investigate its in vitro drug release behavior.Methods Poloxamer 407 (P-407) and Poloxamer 188(P-188) were used as gel matrix to prepare the gel,and the gelatinization temperature was applied as a target to optimize the prescription.The SH-SLN was prepared based on the microemulsion technique,and the gel system containing SH-SLN was obtained by cold-dissolving methods.The content of SH was determined by HPLC,in vitro release characteristics of SH-SLN thermosensitive gel were investigated by dialysis method.Results The optimal gel prescription was finally confirmed as 18% P-407,5% P-188,and 0.6% HPMC.The gelatination temperature for SH-SLN thermosensitive gel was (34.5 + 0.2) ℃,and the in vitro accumulated release rates of SH in the SLN thermosensitive gel system were (57.79 ± 0.36)% after 24 h and (75.16 ± 0.12)% after 48 h.Conclusion The SH-SLN thermosensitive gel has the temperature sensitivity and obvious sustained-release effect.The combination of nanoparticle thermosensitive gel will be used as a new drug delivery for intra-articular injection.%目的 制备关节腔注射用盐酸青藤碱固体脂质纳米粒(盐酸青藤碱-SLN)温敏凝胶并考察其体外释放特征.方法 以泊洛沙姆407 (P-407)和泊洛沙姆188 (P-188)为凝胶基质,以凝胶胶凝温度为考察对象对处方进行优化;微乳液法制备盐酸青藤碱-SLN,冷溶法制备盐酸青藤碱-SLN温敏凝胶;用HPLC法测定盐酸青藤碱的量,透析法研究盐酸青藤碱-SLN温敏凝胶的体外释放特性.结果 最佳处方为18%P-407、5% P-188和0.6%羟丙基甲基纤维素(HPMC),所制盐酸青藤碱-SLN温敏凝胶胶凝温度为(34.5±0.2)℃.体外释放结果显示盐酸青藤碱-SLN温敏凝胶24 h内累积释放率为(57.79±0.36)%,48 h内累积释放率为(75.16±0.12)%,具有

  2. 桡骨远端复杂关节内骨折两种治疗策略疗效分析%Comparison of efficacies of two fixation methods in treatment of complex intra-articular fracture of the distal radius

    Institute of Scientific and Technical Information of China (English)

    卓乃强; 葛建华; 税巍; 李正疆; 鲁晓波

    2009-01-01

    目的 比较研究锁定加压钢板(LCP)与克氏针结合外固定支架治疗桡骨远端复杂关节内骨折的疗效及适应证. 方法 分别以LCP和克氏针结合外固定支架治疗复杂的桡骨远端关节内骨折共98例,对术后手的握持力、腕关节各方向活动度等方面进行回顾性评估和比较,初步评价其临床疗效. 结果 随访4~20个月,平均12.4个月,均获得骨折愈合.参照1990年纽约骨科医院腕关节评估标准,对于AO/ASIF分型C1、C2型骨折,LCP组与克氏针结合外固定支架组疗效比较,差异无统计学意义(P>0.05),C3型骨折克氏针结合外固定支架疗效优越(P 0.05), while the efficacy of external fixator plus Kirschner wires was significantly superior to that of LCP in treating type C3 fracture (P < 0.05). Conclusions For types C1 or C2 intra-articu-lar fractures of the distal radius, the efficacies of LCP and external fixator plus Kirschner wires are simi-lar, while the efficacy of external fixator plus Kirschner wires is superior to that of LCP in treating type C3 intra-articular fracture of the distal radius.

  3. 自制双边三角形万向可伸缩外固定支架治疗开放性关节内粉碎性跟骨骨折%Treatment of open comminuted intra-articular calcaneal fractures with extensible gimbaled bilateral triangle external fixators

    Institute of Scientific and Technical Information of China (English)

    梁伟; 邹光翼; 王济纬; 苗旭东

    2016-01-01

    目的 观察自制的双边三角形万向可伸缩外固定支架治疗开放性关节内粉碎性跟骨骨折的效果. 方法 对2011年1月至2014年6月收治并获得随访的12例开放性关节内粉碎性跟骨骨折患者资料进行回顾性分析,男8例,女4例;年龄23 ~ 58岁,平均36.8岁;骨折按照Sanders分型:Ⅱ型4例,Ⅲ型7例,Ⅳ型1例;软组织损伤按照Gustilo分型:Ⅱ型2例,ⅢA型7例,ⅢB型3例.所有患者急诊行伤口清创,根据伤口软组织损伤情况一期行闭合伤口或负压封闭引流覆盖,根据病情7例急诊、5例在伤后3~5d行自制的双边三角形万向可伸缩外固定支架撑开克氏针撬拨,克氏针或空心钉固定.待确定创口无明显感染后,6例择期行外侧切口切开复位内固定,6例一直使用外固定支架及辅助克氏针固定8 ~10周(平均9.1周).结果 12例患者术后获6~36个月(平均18.5个月)随访,美国足踝外科协会的踝-后足评分平均为84.6分(74 ~ 94分),有1例患者后期行游离植皮覆盖伤口,有3例患者发生伤口浅表感染,无深部感染及需要截肢治疗患者,6例患者二期行切开复位内固定者无一例发生切口感染及坏死. 结论 开放性跟骨骨折应用自制的双边三角形万向可伸缩外固定支架支撑辅助固定,把握内固定的时机和手术指征、选择恰当的固定方法可以有效降低术后深部感染和骨髓炎的发生率.%Objective To report the clinical outcomes of the patients with open comminuted intra-articular calcaneal fracture who were treated with our self-designed bilateral triangle external fixators which are extensible and gimbaled.Methods Between January 2011 and June 2014,12 patients with open comminuted intra-articular calcaneal fracture were treated and followed up.They were 8 men and 4 women,aged from 23 to 58 years (average,36.8 years).According to the Sanders classification,the fractures were type Ⅱ in 4 cases,type Ⅲ in 7,and type Ⅳ in

  4. Comparative study on subcutaneous versus intra-articular indwelling closed suction drainage in total knee arthroplasty%人工膝关节置换术后留置皮下或关节腔内引流的对比研究

    Institute of Scientific and Technical Information of China (English)

    陈东峰; 卢伟杰; 李之琛; 余楠生

    2015-01-01

    Objective To compare the clinical outcomes of different drains in total knee arthroplasty .Methods Thirty-two patients , who had undergone TKA from October 2011 to September 2012, were included in the comparative study .The same operative procedure and postoperative care were provided to all the patients .The patients were randomized to have either a subcutaneous indwelling or an intra-articular indwelling catheter and two months after surgery , the two groups were compared for blood loss ( hemoglobin decrease , transfusion requirements , hypotension episode ) , incidence of wound problems (requirements for dressing reinforcement , oozing, hematoma, hemarthrosis, ecchymosis, infection), and functional outcomes ( value score , American Knee Society ) .Results The mean vacuum drainage volume was less in the subcutaneous indwelling group [(142.5 ±140.3) ml] than in the intra-articular indwelling group [(421.2 ±231.7) ml] (t=4.116, P<0.05).There were differences between the two groups in allogenic transfusion requirements ( 6.25% versus 43.75%, χ2 =4.167, P <0.05 ) .There was no difference between the two groups in HB decrease , incidence of wound problems and functional scores . Conclusion Subcutaneous indwelling closed suction drainage in total knee arthroplasty could reduce blood loss and chances of allogenic blood transfusion .It is a reasonable alternative to intra-articular indwelling closed-suction drainage .%目的:研究人工膝关节置换术后留置皮下或关节腔内引流对临床疗效的影响。方法2011年10月至2012年9月,把本组接受单侧初次人工全膝关节置换( TKA)手术的32例患者随机分为两组:A组(留置皮下引流组)16例,在缝合深筋膜后皮下留置引流管,接真空负压瓶引流;B组(留置关节腔内引流组)16例,在缝合前将引流管留置在关节腔内,接真空负压瓶,夹闭3 h后开放引流。各组采用相同的手术技术和术后处理,观察记录术

  5. Comparison of therapeutic effects of platelet-rich plasma and hyaluronic acid intra-articular injection in the treatment of knee osteoarthritis%富血小板血浆与透明质酸钠关节腔内注射治疗膝骨关节炎的疗效比较

    Institute of Scientific and Technical Information of China (English)

    邹国友; 郑闽前; 贾伟涛; 殷俊; 曹正春

    2014-01-01

    Objective To compare the efficacy of Platelet Rich Plasma (PRP)and Hyaluronic Acid (HA)intra-articular injection in patients with knee osteoarthritis.Methods All 205 patients with knee osteoarthritis in Yancheng City No.1 People′s Hospital were enrolled,which were assigned to the PRP and HA group based on patients′voluntary choice and random principle.Eighty two cases 96 knees in HA group and 104 cases 124 knees in PRP group have got the complete follow-up.Both the two groups were added with 4 mL of 5% lidocaine for intra-articular injection.All patients were prospectively evaluated before and at 3,6,and 12 months after the treatment by WOMAC scores.The patients′knee swelling subsided was observed.Between the two groups WOMAC scores were compared using t test at each time point,within groups were compared using repeated measures analysis of variance,at different time points were compared with Bonferroni test.The knee swelling subside were measured over time.Results No serious adverse events were detected in both groups. At the follow-up evaluations, both groups presented a clinical improvement (F=206.430,122.984,P0.05 ).Six months and 12 months after treatment,PRP group [(21.43 ±4.92),(21.57 ±7.32)points]and HA group [(23.44 ±5.41),(29.12 ±8.27)points]WOMAC score,the difference was statistically significant(t=-2.519 、-5.768,P<0.05).HA group and PRP group ofter treatment of knee joint swelling subsided were 22 knees (31.4%)and 41 knees (56.95%),there was significant difference between the two groups (χ2 =9.362,P<0.05).Conclusions PRP intra-articular injection in the treatment of knee osteoarthritis was more durable compared to HA.The more patients′knee swelling was subsided in PRP group.%目的:比较自体富血小板血浆(PRP)与透明质酸(HA)钠关节腔内注射治疗膝骨关节炎的临床效果。方法2011年10月至2013年11月,盐城市第一人民医院门诊205例(278膝)膝关节炎患者纳入了本研究,根

  6. 骨骼肌对前交叉韧带重建腱性移植物关节内愈合效果的影响%Effect of residual skeletal muscle on intra-articular incorporation of tendon graft in anterior cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    侯存强; 周宪华; 孙磊

    2012-01-01

      目的探讨骨骼肌对前交叉韧带(ACL)重建腱性移植物关节内愈合效果的影响.方法取新西兰兔跟腱制备半腱半肌移植物(SSG)与全腱移植物(TTG),切断其双侧ACL后,一侧采用SSG(SSG侧)、另一侧采用TTG(TTG侧)重建ACL,于术后2、4、8周将造模成功的30只新西兰兔处死(每个时相点10只),于移植物关节内中央部取材制成5μm纵向切片,行苏木精—伊红(HE)染色和甲苯胺蓝(TB)染色,观察组织结构,高倍镜视野下对切片中央部进行细胞计数.结果术后2周,SSG骨骼肌占总面积的10%~40%,骨骼肌变性、萎缩,腱性组织胶原纤维排列规整,内部有少量成纤维细胞;TTG胶原纤维排列规整,内部偶见成纤维细胞.术后4周, SSG内已无大片骨骼肌残留,中央部为致密胶原纤维,排列不规整,可见大量新生成纤维细胞;TTG胶原纤维排列不规整,中央部仅见少量成纤维细胞.术后8周,SSG为致密结缔组织,胶原纤维排列较规整,中央部仍有较多成纤维细胞;TTG亦为致密结缔组织,胶原纤维排列较规整,移植物中央部细胞数较少.术后2、4、8周,SSG侧中央部成纤维细胞数均多于TTG侧,两侧比较,差异有统计学意义(t =6.194、16.738、9.613,P<0.05).2×3析因方差分析结果显示,不同种类的移植物中央部成纤维细胞计数存在显著差异(F =277.67,P<0.05);术后不同观察时相点,移植物中央部成纤维细胞计数存在显著差异(F=262.72,P<0.05);移植物处理方式与观察时相点之间存在显著交互作用(F =69.68,P<0.05).结论腱性移植物上残留骨骼肌有利于关节内段移植物内组织细胞的增生,有可能加快移植物的愈合与改建.%  Objective To explore the effect of residual skeletal muscle on intra-articular healing of tendon graft in anterior cruciate ligament (ACL) reconstruction. Methods After ablation of ACL from bilateral of 30 New Zealand rabbits, the semi-tendon and semi

  7. The therapeutic effects of isokinetic strength training combined with intra-articular injection of hyaluronate and joint mobilization for patients with knee osteoarthritis%等速肌力训练联合关节腔内注射及关节松动术治疗膝骨性关节炎的疗效观察

    Institute of Scientific and Technical Information of China (English)

    雒晓甜; 梁英; 李鹏; 邓剑伟

    2014-01-01

    Objective To observe any effects of using isokinetic strengthening exercises combined with intra-articular injection of sodium hyaluronate and joint mobilization in treating patients with knee osteoarthritis (KOA).Methods Eighty-one KOA patients were divided into a combined treatment group,a conventional treatment group and a control group.The combined treatment group received isokinetic strengthening training,intra-articular injections of sodium hyaluronate and joint mobilization therapy; the conventional treatment group received the injections and mobilization only; the control group was instructed to do ankle pumps at home on their own.Before the start of treatment and after 4 weeks,knee pain was self-assessed [using a visual analogue scale (VAS) for pain] along with knee range of motion (ROM),quality of life (using the WOMAC condensed health survey rating scale) and indexes of isokinetic strength [including the knee flexors,extensor peak torque (PT),and the flexion and extension angles corresponding peak torque (AOPT)] in both groups.Results After 4 weeks of treatment,statistically significant improvements compared to the baseline values were observed in both groups.The combined treatment group,however,improved to a significantly greater extent than the conventional treatment group in terms of all of the measures.Conclusion Isokinetic strength training combined with intra-articular injections of sodium hyaluronate and joint mobilization has a synergistic effect in enhancing knee stability and improving the performance in activities of daily life of KOA patients.%目的 观察等速肌力训练联合玻璃酸钠关节腔内注射及关节松动术治疗膝骨性关节炎(KOA)的疗效.方法 采用随机数字表法将81例KOA患者分为联合治疗组、常规治疗组及对照组.联合治疗组给予等速肌力训练、玻璃酸钠关节腔内注射及关节松动术治疗,常规治疗组给予玻璃酸钠关节腔内注射及关节松动术治疗,对照

  8. Treatment of nail psoriasis with Pulse Dye Laser plus calcipotriol betametasona gel vs. Nd:YAG plus calcipotriol betamethasone gel: An intrapatient left-to-right controlled study.

    Science.gov (United States)

    Arango-Duque, L C; Roncero-Riesco, M; Usero Bárcena, T; Palacios Álvarez, I; Fernández López, E

    2017-03-01

    Treatment of nail psoriasis remains a challenging and often disappointing situation. To compare the efficacy, adverse reactions and tolerability of treatment of nail psoriasis with PDL vs. Nd:YAG, in association with betametasona calcipotriol gel. An open, prospective intrapatient left-to-right study was designed. The right hand of each patient received treatment with PDL and the left hand with Nd:YAG. Betamethasone calcipotriol gel was applied once a day during the first week after each laser session. A total of four sessions were administered. The clinical efficacy was evaluated according to the NAPSI score. All patients showed improvement in nail bed and nail matrix psoriasis. The global NAPSI mean declined in 15.46 (p<0.000). There was neither statistical difference between the reduction in nail bed and matrix NAPSI nor in the treatment with PDL vs. Nd:YAG. The administration of Nd:YAG was more painful. No serious adverse effects were documented. No random assignment and the small number of patients. PDL and Nd:YAG have proven to be an effective treatment for nail psoriasis with no serious adverse effect. No statistically significant difference was found between the two treatments. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  9. Arthroscopic laser in intra-articular knee cartilage disorders

    Science.gov (United States)

    Nosir, Hany R.; Siebert, Werner E.

    1996-12-01

    Different assemblies have endeavored to develop arthroscopic laser surgery. Various lasers have been tried in the treatment of orthopaedic problems, and the most useful has turned out to be the Hol-YAG laser 2.1 nm which is a near- contact laser. By using the laser as a powerful tool, and cutting back on the power level, one is able to better achieve the desired treatment effect. Clinical studies to evaluating the role of the laser in different arthroscopic knee procedures, comparing to conventional techniques, showed that the overall outcome attains a momentous confidence level which is shifted to the side of the laser versus the conventional for all maneuvers, barring meniscectomy where there is not perceiving disparity between laser versus the conventional. Meniscectomy continues to be one of the most commonly performed orthopaedic procedures. Laser provides a single tool which can ablate and debride meniscal rims with efficiency and safety. Chondroplasty can also be accomplished with ease using defocused laser energy. Both lateral release and soft tissue cermilization benefit from the cutting effect of laser along with its hemostatic effect. Synovial reduction with a defocused laser is also easily accomplished. By one gadget, one can cut, ablate, smooth, coagulate, congeal and with authentic tissue depth control The future of laser arthroscopic surgery lies in its ability to weld or repair tissues. Our research study has shown that laser activated photoactive dyes can produce a molecular bonding of collagen fibers, and therefore a repair 'weld' can be achieved with both meniscal tissues and with articular cartilage lesions.

  10. Intra Articular Therapeutic Delivery for Post Traumatic Osteoarthritis

    Science.gov (United States)

    2016-10-01

    me.gatech.edu 15 2 [SF298] Abstract There are currently no treatment methods on the market for modifying OA – only drugs that help relieve pain and...onset due to sports injuries or other factors could significantly benefit from the development of strategies to mitigate disease progression...combat-related cases, post-traumatic OA typically manifests less than 2 years after injury compared to post- traumatic OA resulting from sports

  11. Intra-articular regional migratory osteoporosis of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Wambeek, N.; Munk, P.L.; Lee, M.J. [Dept. of Radiology, Vancouver General Hospital, BC (Canada); University of British Columbia, Vancouver (Canada); Meek, R.N. [Department of Orthopedic Surgery, Vancouver General Hospital, Vancouver (Canada)

    2000-02-01

    We report a case of lntra-articular regional migratory osteoporosis of the knee in a 53-year-old man. The case demonstrates an unusual pattern of migration of the marrow edema within the knee joint. This phenomenon has received scant attention in the radiological literature. (orig.)

  12. Carpal intra-articular blastomycosis in a Labrador retriever

    OpenAIRE

    Woods, Katharine S.; Barry, Maureen; Richardson, Danielle

    2013-01-01

    A 6-month-old male castrated Labrador retriever was presented for coughing and forelimb lameness. Blastomyces dermatitidis was identified in cytology of sputum and synovial fluid. Repeat arthrocentesis 7 months later revealed resolution of septic arthritis. Fungal septic arthritis should be considered for cases of monoarthritis and may respond to oral itraconazole treatment.

  13. Early intra-articular complement activation in ankle fractures

    DEFF Research Database (Denmark)

    Schmal, Hagen; Salzmann, Gian M; Niemeyer, Philipp;

    2014-01-01

    osteochondritis dissecans (OCD) of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1 β, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture...... and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures....

  14. Intra-Articular Therapeutic Delivery for Post Traumatic Osteoarthritis

    Science.gov (United States)

    2015-10-01

    treatment methods on the market for modifying OA – only drugs that help relieve pain and inflammation but do not address the underlying disease, allowing it...to continue destroying joint tissues. When joint function becomes severely impaired and other management strategies are ineffective, arthroscopic or...benefit from the development of strategies to mitigate disease progression. Furthermore, post-traumatic OA experienced by military personnel injured

  15. 微创锁定板内固定和切开复位内固定治疗跟骨关节内骨折效果分析%Analysis Efficacy of Minimally Invasive Locking Plate Fixation and Open Reduction Internal Fixation in the Treatment of Intra-articular Calcaneal Fractures

    Institute of Scientific and Technical Information of China (English)

    张番; 郑淑媛

    2014-01-01

    Objective:To investigate the clinical treatment efficacy of minimally invasive locking plate fixation and open reduction internal fixation in the treatment of intra-articular calcaneal fractures.Method:76 patients with calcaneal fracture in orthopedic department for elective surgery in our hospital from June 2012 to July 2013 were selected.All cases were randomly divided into the minimally invasive fixation group and the open reduction internal fixation group according to the admission number parity,38 cases in each group.The surgical time,intraoperative and postoperative bleeding, hospitalization time,healing time of the two groups were compared.The postoperative treatment efficacies of the two groups were evaluated by AOFAS ankle and hindfoot scoring system,visual analog scale(VAS method)and condensed Health Status Scale(SF-36).Postoperative complications of the two groups were recorded.Result:The surgical time and intraoperative and postoperative bleeding volume of the minimally invasive fixation group were significantly less than the open reduction internal fixation group,the differences were statistically significant(P0.05).The total complication rate of the minimally invasive fixation group was 7.9%,it was significantly lower than 36.8% of the open reduction internal fixation group,the difference was statistically significant(P0.05);微创内固定组总并发症发生率7.9%明显低于切口内固定组的36.8%,差异有统计学意义(P<0.05)。结论:微创锁定板内固定治疗跟骨关节内骨折临床效果优于切开复位内固定,有助于减少术后并发症的发生,促进跟骨术后功能恢复,提高患者生活质量,值得在临床推广使用。

  16. Evaluation of the Effect of a Single Intra-articular Injection of Allogeneic Neonatal Mesenchymal Stromal Cells Compared to Oral Non-Steroidal Anti-inflammatory Treatment on the Postoperative Musculoskeletal Status and Gait of Dogs over a 6-Month Period after Tibial Plateau Leveling Osteotomy: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Mathieu Taroni

    2017-06-01

    Full Text Available ObjectiveCompare the clinical and pressure walkway gait evolution of dogs after a tibial plateau leveling osteotomy (TPLO for a cranial cruciate ligament rupture (CrCLR and treatment with either a 1-month course of non-steroidal anti-inflammatory drugs (NSAIDs or a single postoperative intra-articular (IA injection of allogeneic neonatal mesenchymal stromal cells (MSCs.Study designProspective, double-blinded, randomized, controlled, monocentric clinical study.AnimalsSixteen client-owned dogs.Materials and methodsDogs with unilateral CrCLR confirmed by arthroscopy were included. Allogeneic neonatal canine MSCs were obtained from fetal adnexa retrieved after C-section performed on healthy pregnant bitches. The dogs were randomly allocated to either the “MSCs group,” receiving an IA injection of MSCs after TPLO, followed by placebo for 1 month, or the “NSAIDs group,” receiving IA equivalent volume of MSCs vehicle after TPLO, followed by oral NSAID for 1 month. One of the three blinded evaluators assessed the dogs in each group before and after surgery (1, 3, and 6 months. Clinical score and gait and bone healing process were assessed. The data were statistically compared between the two groups for pre- and postoperative evaluations.ResultsFourteen dogs (nine in the MSCs group, five in the NSAIDs group completed the present study. No significant difference was observed between the groups preoperatively. No local or systemic adverse effect was observed after MSCs injection at any time point considered. At 1 month after surgery, bone healing scores were significantly higher in the MSCs group. At 1, 3, and 6 months after surgery, no significant difference was observed between the two groups for clinical scores and gait evaluation.ConclusionA single IA injection of allogeneic neonatal MSCs could be a safe and valuable postoperative alternative to NSAIDs for dogs requiring TPLO surgery, particularly for dogs intolerant to this class of

  17. 关节腔内注射透明质酸钠可以延缓创伤性骨关节炎的软骨退变%Local intra-articular injection of sodium hyaluronate delays articular cartilage degeneration after traumatic osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    周建林; 邓爽; 方洪松; 彭昊; 邱波

    2015-01-01

    Abstract BACKGROUND: Sodium hyaluronate is an effective treatment for osteoarthritis, but the underlying mechanism remains unclear. There is evidence that abnormal expressions of matrix metaloproteinase (MMP)-1, -3 and -9 and tissue inhibitor of metaloproteinase (TIMP)-1 and -2 show great effects on osteoarthritis. OBJECTIVE: To assess the influence of intra-articular injection of sodium hyaluronate on expressions of MMPs-1, 3, 9 and tissue inhibitor of TIMPs-1, 2 in the rabbit cartilage after osteoarthritis. METHODS: Twenty-four mature New Zealand white rabbits were divided into normal control, model, and sodium hyaluronate groups. The model and sodium hyaluronate groups underwent unilateral anterior cruciate ligament transection, and rabbits in the sodium hyaluronate group received 0.3 mL of 1% sodium hyaluronate via intra-articular injection at 4 weeks after modeling, once a week for 5 weeks. At 11 weeks folowing surgery, the rabbits were kiled and the cartilage was harvested to extract total RNA. mRNA expressions of MMPs-1, 3, 9 and TIMPs-1, 2 in the cartilage were analyzed using real-time PCR for each group. RESULTS AND CONCLUSION:Compared with the model group, the range and extent of cartilage damage was reduced in the sodium hyaluronate group (P < 0.01), and Mankin scores were noticeably decreased (P < 0.05). In the cartilage, mRNA expressions of MMPs-1, 3, 9 were enhanced and mRNA expressions of TIMPs-1, 2 were down-regulated in the model group. However, the mRNA expression levels of MMPs-1, 3, 9 and TIMPs-1, 2 in the articular cartilage were not obviously changed in the sodium hyaluronate group. These results suggest that MMPs-1, 3, 9 and TIMPs-1, 2 are involved in the progression of osteoarthritis and the therapeutic mechanism of sodium hyaluronate is not realized through the down-regulation of their expressions during development of osteoarthritis. Sodium hyaluronate for treatment of osteoarthritis is a complex process and the underlying mechanisms

  18. 盐酸青藤碱注射液关节腔注射治疗膝骨关节炎急性疼痛的效果分析%Effect of intra-articular cavity injection of Sinomenine hydrochloride for acute pain of knee osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    梁丽君; 贾雪芹; 朱惠; 朱蓉; 许夏雨; 沈海丽

    2015-01-01

    Objective To observe the effect of intra-articular cavity injection of Sinome nine hydrochloride for acute pain of knee osteoarthritis. Methods 40 patients with knee osteoarthritis from March 2012 to March 2013 in rheuma-toid immunology of our hospital were divided into study group and control group randomly,20 patients in each group,the control group was treated with non-steroidal anti-inflammatory drug orally and the drugs which could improve the con-dition,the study group injected Sinomenine hydrochloride injection 50 mg,once a day,5 days for a course.After knee point puncture except for basic treatment.Both groups scored by visual analog scale (VAS),tenderness,swelling and dys-function and other observation indexes 6 days before and after treatments and one month after treatments. Results VAS scores of study group and control group were (3.15±0.60) points and (4.10±0.75) points(P<0.05) respectively 6 days af-ter treatments;(1.90±0.76)points and (2.60±0.88) points (P<0.05)respectively one month after treatments.Swelling index scores of the study group and the control group were(0.90±0.91) points and(1.80±0.89) points(P<0.01) respectively one month after treatments.Tenderness index scores of the study group and the control group were (0.60±0.60) points and (2.00±0.65) points (P<0.01) respectively one month after treatments.Dysfunction index scores of study group and control group were (0.80±0.74) points and (2.10±0.81) points (P<0.01) respectively one month after treatments.Routine blood test,liver and kidney function between two groups had no significant changes. Conclusion Intra-articular cavity injec-tion of Sinome nine hydrochloride is an effective treatment for acute pain of knee osteoarthritis.%目的:观察盐酸青藤碱注射液关节腔注射治疗膝骨关节炎急性疼痛的效果。方法选择2012年3月~2013年3月本院风湿免疫科膝关节炎患者40例,随机分为试验组和对照组,每组20例,对照组口服非甾体

  19. Combination of plate screw and Steinmann pin in repair of comminuted calcaneal intra-articular and posterosuperior fractures%钢板螺钉结合斯氏针内固定修复粉碎性跟骨关节内伴后上方骨折

    Institute of Scientific and Technical Information of China (English)

    李广峰; 张鑫; 彭勇; 吴献民; 王思成; 杨国庆; 张友忠; 曹中华; 何国云; 尹志峰; 杨笑宇

    2014-01-01

    背景:目前跟骨关节内粉碎性骨折的治疗方案一般选择钢板螺钉内固定,但对于伴有跟骨后上方骨折的病例,往往因为跟腱牵拉及钢板螺钉内固定的薄弱导致骨折复位困难或者复位难以保持。目的:探讨切开复位钢板螺钉结合斯氏针置入内固定在粉碎性跟骨关节内移位骨折伴后上方骨折中的疗效。方法:选取2009年12月至2013年12月上海中冶医院骨科收治的粉碎性跟骨关节内骨折伴跟骨后上方骨折患者40例,随机分为2组。对照组予切开复位钢板螺钉内固定,试验组予切开复位钢板螺钉结合斯氏针内固定。分别于术前、术后4周测量患者GISSANE角、BOHLER角,末次随访时进行MARYLAND足部评分,并进行组内及组间比较。结果与结论:所有患者均获随访,时间9-23个月。两组患者术后4周BOHLER角、GISSANE角均显著大于术前(P <0.05);术后4周试验组BOHLER角、GISSANE角均显著大于对照组(P <0.05)。末次随访时MARYLAND足部评分试验组平均78分,优良率为80%;对照组平均67分,优良率为73%,试验组优良率显著高于对照组(P<0.05)。提示钢板螺钉内固定辅助斯氏针置入固定修复粉碎性跟骨骨折伴有跟骨后上方骨折,可较单纯钢板螺钉置入内固定取得更为满意的关节内骨折及后上方骨折复位,固定牢靠,可早期功能锻炼,术后患肢功能恢复较单纯钢板螺钉内固定较好。%BACKGROUND:The therapeutic regimen of intraarticular calcaneal comminuted fractures commonly selects plate and screw fixation. However, for case of posterosuperior calcaneal fracture, the weakness of achil es tendon stretch and plate screw fixation results in difficulty or maintenance of reduction. OBJECTIVE:To investigate the therapeutic effects of open reduction and internal fixation with steel screw and Steinmann pins for comminuted calcaneal intra-articular and posterosuperior

  20. 火针联合碘酊与曲安奈德关节腔内注射治疗膝骨关节炎的疗效%Efficacy of fire-needle therapy combined with intra-articular iodine injection in the treatment of knee osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    单建生

    2015-01-01

    目的 探讨火针联合碘酊与曲安奈德关节腔内注射治疗慢性膝骨关节炎的疗效.方法 膝骨关节炎患者83例,随机分为碘酊复合组46例和透明质酸钠组37例.碘酊复合组采用2%碘酊0.5 ml联合曲安奈德10 mg、1%利多卡因2 ml关节腔内注射,每周1次,2周1疗程;透明质酸钠组采用透明质酸钠20 mg联合曲安奈德10 mg、1%利多卡因2 ml关节腔内注射,每周1次,4周1疗程,两组均治疗1疗程.所有患者均行火针痛点治疗1次.比较治疗前及后1周、1个月、3个月、6个月时两组患者的VAS评分与疗效.结果 与治疗前相比,治疗后各时点VAS均降低(P<0.05),治疗后当日透明质酸钠组降低更为明显(P<0.05),治疗后1周、1个月时两组间无统计学差异(P>0.05),治疗后3、6个月时碘酊复合组VAS降低更明显(P<0.05);治疗后当日优良率玻璃酸钠组优于碘酊复合组(P<0.05),治疗后1周、1个月时优良率两组比较无统计学差异(P>0.05),治疗后3、6个月时优良率碘酊复合组优于透明质酸钠组(P<0.05).结论 火针联合关节腔内注射碘酊、利多卡因、曲安奈德治疗慢性膝骨关节炎疼痛与疗效明显,尤其是远期疗效.%Objective To explore the clinical efficacy of fire-needle therapy combined with iodine tincture intra-articular injection in the treatment of knee osteoarthritis.Methods Eighty-three patients with knee osteoarthritis were randomly divided into iodine tincture comprehensive group (n=46) and sodium hyaluronate group (n=37).All patients received the fire-needle therapy in pain points one time.2% iodine tincture 0.5 ml,triamcinolone acetonide 10 mg and 1% lidocaine 2 ml were injected into knee joint cavity of patients in iodine tincture comprehensive group.Sodium hyaluronate 20 mg,triamcinolone acetonide 10 mg and 1% lidocaine 2 ml were injected into knee joint cavity of patients in sodium hyaluronate group.VAS and the effective rate of all

  1. 本体感觉训练结合透明质酸钠关节腔注射治疗老年患者膝关节骨性关节炎的疗效观察%The effects of proprioception training and intra-articular injections of sodium hyaluronate on knee osteoarthritis in the elderly

    Institute of Scientific and Technical Information of China (English)

    蔡西国; 钱宝延; 曹留拴; 杨阳; 庄卫生

    2014-01-01

    Objective To observe any therapeutic effect of proprioception training and intra-articular injection of sodium hyaluronate on knee osteoarthritis (KOA) in the elderly.Methods Forty-five patients with KOA were randomly divided into a treatment group (23 cases) and a control group (22 cases).The arthritic knees of both groups were treated with sodium hyaluronate injections,but the patients in the treatment group also received proprioception training.Before treatment,and after 5 weeks and 3 months of treatment,knee function was assessed against Lysholm's assessment standard.Results There was no significant difference in the average Lysholm scores of the two groups before treatment.After 5 weeks and 3 months the patients in each group scored significantly higher than before treatment.After 3 months the average score of the treatment group was significantly higher than that of the control group.Conclusion Proprioception training and sodium hyaluronate injections together constitute a useful method to treat KOA in elderly patients.%目的 探讨本体感觉训练结合透明质酸钠关节腔注射治疗对膝关节骨性关节炎(KOA)老年患者的影响.方法 选取KOA老年患者45例,按照随机数字表法将其分为对照组(22例)和治疗组(23例),2组患者均给予透明质酸钠膝关节腔注射治疗,治疗组在此基础上增加本体感觉训练.治疗前、治疗5周后及治疗3个月后,采用Lysholm膝关节功能评分量表对患者的膝关节功能进行评定.结果 治疗前,2组患者膝关节功能评分之间比较,差异无统计学意义(P>0.05).治疗5周后及治疗3个月后,2组患者的膝关节功能评分均较组内治疗前增高(P<0.05).与组内治疗5周后比较,治疗组治疗3个月后的膝关节功能评分[(84.39±9.51)分]较高,差异有统计学意义(P<0.05).与对照组同时间点比较,治疗组治疗3个月后的膝关节功能评分[(84.39±9.51)分]显著高于对照组[(73.5 ±9.64)

  2. The effects of intrathecal administration of betamethasone over the dogs' spinal cord and meninges Efeitos determinados na medula e nas meninges pela administração subaracnóidea de betametasona em cães

    Directory of Open Access Journals (Sweden)

    Guilherme Antonio Moreira de Barros

    2007-10-01

    Full Text Available PURPOSE: To determinate the potential clinical and histological changes due the injection of betamethasone, when administered into the canine intrathecal space. METHODS: Twenty one animals were included in a random and blind manner in the study. After general anesthesia, intrathecal puncture was performed and 1 ml of the random solution was injected. The G1 dogs received 0.9% saline solution, the G2 dogs received 1.75 mg betamethasone and the G3 dogs received 3.5 mg of betamethasone. The animals were clinically evaluated for 21 days and then sacrificed. The lumbar and sacral portions of the spinal cord were removed for light microscopy histological analyses. RESULTS: No clinical changes were observed in any of the animals included in this study. No histological changes were observed in G1 animals. Inflammatory infiltration was observed in two dogs, one in G2, another in G3. Hemorrhage and necrosis were also seen in the G2 dog which inflammatory infiltration was detected. In other two dogs, one from G2 and another from G3, there was discreet fibrosis and thickness of the arachnoid layer which was focal in one and diffuse in the other. CONCLUSION: Intrathecal administration of betamethasone caused histological changes in the spinal cord and meninges in some of the dogs involved in this study.OBJETIVO: Determinar possíveis alterações clínicas e histológicas determinadas pela administração da betametasona no espaço subaracnóideo de cães. MÉTODOS: Vinte e um cães foram incluídos no estudo de forma aleatória e encoberta. Depois de anestesiados, os cães foram submetidos a punção subaracóidea com injeção de 1 ml da solução sorteada. Os animais receberam solução salina 0,9% em G1, betametasona na dose de 1,75 mg em G2 e betametasona na dose de 3,5 mg em G3. Todos os animais foram mantidos em observação clínica por 21 dias, sendo posteriormente sacrificados. Porções da medula espinhal e sacral foram removidas para an

  3. Efectividad y seguridad de la viscosuplementación con dosis única de ácido hialurónico estabilizado de origen no animal (NASHA para el tratamiento del dolor secundario a gonartrosis Efficacy and safety of single intra-articular injection of non-animal stabilized hyaluronic acid (NASHA for gonarthrosis pain treatment

    Directory of Open Access Journals (Sweden)

    M. M. Monerris Tabasco

    2012-10-01

    patients, intra-articular viscosupplementation single dose of stabilized hyaluronic acid of non-animal origin (NASHA, Durolane® for the treatment of pain related to gonarthritis has been effective and safe and is a weapon for the management of pain and disability gonarthritis generated.

  4. Clinical research on treatment of normal saline flush combined with Intra-articular injection of Hyaluronic acid on knee osteoarthitis%生理盐水冲洗联合玻璃酸钠注射治疗膝骨性关节炎的临床研究

    Institute of Scientific and Technical Information of China (English)

    李兴

    2014-01-01

    目的:观察生理盐水冲洗联合玻璃酸钠关节内注射治疗膝骨性关节炎的临床疗效。方法将130例膝骨性关节炎患者随机分为3组,分别采用关节内生理盐水(N S)冲洗、玻璃酸钠(H A)关节内注射、生理盐水冲洗+玻璃酸钠注射(N S+H A)治疗,临床观察膝关节疼痛、肿胀和功能改善情况,并进行评分,三类评分累加为症状体征积分,以此评价疗效。结果各组患者治疗后即时症状体征积分均明显降低,并随时间延长,积分呈平缓下降,第8周治疗结束后,各组症状体征积分均较治疗前降低(t=10.020,P=0.003;t=22.110,P=0.001;t=56.190,P=0.000);3组间症状体征积分差异有统计学意义(F=8.784, P=0.001),组间两两比较,NS组积分高于HA组和NS+HA组(q=3.003,P=0.037;q=4.063,P=0.001),HA组积分高于NS+HA组(q=2.537,P=0.024)。结论膝关节内生理盐水冲洗后注射玻璃酸钠治疗骨性关节炎效果好、起效快、持续时间长,对快速改善患者症状和缩短疗程、节省治疗费有非常积极的意义。%Objective: To observe the clinical curative effect of normal saline flush combined with intra-articular injection of hyaluronicacid knee osteoarthritis.Methods:Randomly divide the patients to 3 groups and treat them with methods of NS, HA and -NS+HA differently and separately, then observe the extension of the situation of joint pain, swel ing and improvement of joint function of the knees, a scoring was also taken in the meantime. The accumulation of the above mentioned 3 scoring is referred to as symptomatical score, which is used to evaluate the effects of the afore-mentioned different 3 methods.Result: The on-spot scores of the 3 groups’patients after the treatments were al significantly lowered. Meanwhile, the scoring shows a gentle trend of decreasing with the elongation of the time of treatment.When the treatments ends in the 8th week

  5. Doppler de las arterias pulmonares fetales posterior al uso de betametasona para la maduración pulmonar (Fetal lung arteries Doppler after to use of betamethasone for lung maturation

    Directory of Open Access Journals (Sweden)

    Keibis Jiménez Castillejo

    2014-06-01

    Full Text Available Resumen (español El objetivo de la investigación fue determinar las modificaciones del Doppler de las arterias pulmonares fetales posterior al uso de betametasona para la maduración pulmonar. Se realizó una investigación de tipo explicativa, prospectiva y longitudinal con un diseño cuasi-experimental y una muestra no probabilística intencional de 106 pacientes que acudieron a la consulta Pre-natal de Alto Riesgo del Hospital Central “Dr. Urquinaona". Una vez seleccionadas las pacientes se les administró inyecciones intramusculares de betametasona (12 mg/día por dos días consecutivos. Se realizaron las mediciones de índice de pulsatilidad, índice de resistencia y relación sistólico / diastólica de las arterias pulmonares fetales. Se observó disminución significativa de los valores promedio del índice de pulsatilidad en la segunda medición comparado con la medición inicial (p < 0,05. Sin embargo, el promedio de la tercera medición no mostró diferencia significativas con los valores iniciales (p = ns. El índice de resistencia disminuyó en la segunda medición para luego aumentar en la tercera medición comparado con el valor inicial (p < 0,05 para las dos mediciones. El valor promedio de la relación sistólico / diastólica presentó disminución significativa durante la segunda medición para luego presentar un aumento significativo al momento de la tercera medición comparado con el valor inicial (p < 0,05 para las dos mediciones. Se concluye que el uso de betametasona para la inducción de la maduración pulmonar produce modificaciones en las mediciones Doppler de las arterias pulmonares fetales. Abstract (english The objective of research was to determine Doppler modifications of fetal pulmonary arteries after use of betamethasone for lung maturation. An explicative, prospective and longitudinal research was done with a quasi-experimental design and an intentional non-probabilistic sample of 106 patients who assisted

  6. 对比关节腔内注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白对脊柱关节炎和类风湿关节炎膝关节炎的疗效%The effect of intra-articular injection of recombinant human tumor necrosis factor-Fc in knee in patients with spondyloarthritis and rheumatoid arthritis

    Institute of Scientific and Technical Information of China (English)

    梁东风; 黄烽; 张江林; 朱剑; 张红

    2013-01-01

    目的 比较单次膝关节腔内注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(rhTNFR:Fc)对脊柱关节炎(SpA)和类风湿关节炎(RA)膝关节炎的疗效差异.方法 入选确诊SpA或RA并伴有至少一侧膝关节肿胀及积液的受试者,X线显示该膝关节无变形、中重度骨破坏及关节间隙明显狭窄,入组前经过常规剂量改善病情抗风湿药(DMARDs)治疗至少6周,于目标膝关节腔穿刺,吸净滑液后注射1次25 mg rhTNFR:Fc.在注射4周后评价疗效和不良事件,主要疗效指标为改良(纽约)特种外科医院(HSS)膝关节评分.采用配对t检验,两样本t检验和秩和检验进行统计学分析.结果 27例SpA和15例RA受试者入选并完成研究.SpA组改良HSS膝关节评分基线值为(66±14)分,注射4周后为(86±11)分,治疗前后比较差异有统计学意义(P<0.05);RA组基线值为(64±13)分,注射4周后为(80±9)分,治疗前后比较差异有统计学意义(P<0.05).SpA组的改良HSS膝关节评分改善率为24.2%(16.5%~41.9%),RA组为22.2%(15.3%~37.7%),2组比较差异无统计学意义(P>0.05).SpA组膝关节滑膜厚度改善率为31.8%(9.3%~57.3%),RA组为1.5%(-19.3%~25.5%),2组比较差异有统计学意义(P<0.05).SpA组6例、RA组2例发生了不良事件,无严重不良事件发生.结论 单次膝关节腔内注射rhTN FR:Fc对SpA和RA膝关节炎安全有效,且SpA膝关节滑膜厚度的减轻程度要大于RA膝关节.%Objective To compare the effect of intra-articular injection of recombinant human tumor necrosis factor-Fc (rhTNFR:Fc) in the treatment of knee arthritis in spondyloarthritis (SPA) with that in rheumatoid arthritis (RA).Methods The subjects included in this study were SpA and RA patients with knee arthritis without deformity,moderate or severe bone erosion and obvious joint space narrowing in radiography,who had taken at least 6-week therapy with routine dosage of disease modifying anti

  7. EYE CLINICAL STUDY IN SWINE CORNEA IMPLANT DOGS TREATED WITH 2-1 BETAMETHASONE DISSODIC FOSPHATE AND DISSODIC FOSPHATED/ACETATE DEXAMETHASONE ESTUDO CLÍNICO NOS OLHOS DOS CÃES, TRATADOS COM 2-1 FOSFATO DISSÓDICO DE BETAMETASONA E FOSFATO DISSÓDICO/ACETATO DE DEXAMETASONA, QUE RECEBERAM IMPLANTES COM CÓRNEAS DE SUÍNOS

    Directory of Open Access Journals (Sweden)

    Nilo Sérgio Troncoso Chaves

    2007-09-01

    ça definida, com peso médio de 10kg, examinados e considerados sadios. Cada cão, a seu tempo, teve implantada no olho esquerdo córnea de suíno, e, antes da cirurgia, recebeu 4 mg de fosfato dissódico/acetato de dexametasona, por via intramuscular, e uma gota de fosfato dissódico de betametasona e sulfato de gentamicina. Conservou-se a medicação ocular 4 vezes/dia e a intramuscular semanalmente, até o seu sacrifício. Após os xenoenxertos, cada córnea foi examinada, de sete em sete dias, para se avaliarem a transparência, a neoformação de vasos, a reação dos vasos episclerais e conjuntivais, a espessura da córnea (sobre-relevo, a profundidade e a presença de depósitos na câmara anterior. Na avaliação clínica do 7° dia, todos os olhos (100%, que receberam xenotransplantes de córnea, perderam a transparência (++,+++, houve reação dos vasos episclerais (P, a profundidade da câmara anterior estava preservada (N, não houve edema (leucoma, bem como depósitos (A na câmara anterior. No 14° dia, com a perda de duas córneas por autotraumatismo, os outros cães tiveram suas córneas implantadas (80%, completamente opacificadas (+++, com importante reação ciliar (P, edema com sobre-relevo (A, porém mantiveram a integridade da câmara anterior (N e sem depósitos nas mesmas (A. Com o sacrifício de mais três cães, no intervalo do 14° ao 2l° dia, devido a efeitos colaterais dos corticosteróides, os cães restantes (50% mantiveram seus implantes com as alterações do l4° dia até o final do experimento.

    PALAVRAS-CHAVE: Lesões anatomopatológicas; xenotransplantes; córnea; canino; suíno; anatomopathological lesions; corticosteroids; xenotransplant; cornea; canine; swine.

  8. Correlation of intra-articular osseous measurements with posterior cruciate ligament length on MRI scans.

    LENUS (Irish Health Repository)

    Orakzai, S H

    2010-01-01

    Six patients with a clinical diagnosis of chronic posterior cruciate ligament (PCL) rupture, based on a positive posterior drawer test, had a normal appearance of the PCL on an MRI scan. It is postulated that the PCL had been ruptured but healed in a lengthened state. 12 volunteers with no history of knee trauma underwent an MRI scan of the knee. In this control group (n = 12), there was a close correlation between the lateral femoral condylar width in the sagittal plane and the PCL length, with a ratio of 2:1 (95% confidence interval (CI) = 1.817-2.095). In the clinically abnormal group (n = 6), the ratio was 1.49:1 (95% CI = 1.206-1.782) (p< 0.0005). In conclusion, the ratio of the lateral femoral condylar width in the sagittal plane to the PCL length is a useful index for diagnosing PCL attenuation and lengthening in the presence of a normal morphological MR appearance.

  9. Development of Intra-Articular Drug Delivery to Alter Progression of Arthritis Following Joint Injury

    Science.gov (United States)

    2013-04-01

    assessment using modified Mankin total joint score and representative MicroCT and Safranin -O/Fast Green stained sections. Modified Mankin total joint...values and 25th-75th quartile range displayed (n=6-8 per group). (C) Representative histological pictures with MicroCT (blue) and Safranin -O/Fast Green

  10. The results of intra-articular tenoxicam injection in the patients with gonarthrosis

    OpenAIRE

    Güner, Dr. Güntekin; Elmalı, Dr. Nurzat; Ertem, Dr. Kadir; Müezzinoğlu, Dr. Ü. Sefa; Şarlak, Dr. Ömer

    1997-01-01

    In this study, the local tolerance, reliability and effectiveness of 20 mg/day single dose tenoxicam was evaluated in a group of 40 patients with a mean age of 58 years. 16 of the group recovered and 12 of them had partial pain relief two weeks after application. 6 of the patients showed total failure and another 6 of them had increase in symptoms. The range of movements increased in %60 of the patients. Mild allergic reactions developed after injection in 4 patients. After 2 months, patients...

  11. Septic arthritis in 15 standardbred racehorses after intra-articular injection.

    Science.gov (United States)

    Lapointe, J M; Laverty, S; Lavoie, J P

    1992-11-01

    Case histories, results of synovial fluid analyses, treatment regimens and outcome are described for 15 adult Standardbred horses with confirmed post-injection septic arthritis. Joint sepsis followed injection of corticosteroids, hyaluronic acid, polysulphated glycosaminoglycan, or local anaesthetic. The median interval from injection to appearance of clinical signs was 2.5 days, and median interval from injection to referral was 9 days. The median initial synovial leucocyte count on admission was 57 x 10(9)/litre, but there was a wide range of values (18-258 x 10(9)/litre). The median synovial neutrophil percentage was 95% (77-99%). All bacterial isolates were Gram-positive cocci, 86% of which were staphylococci. All treated horses (12/15) initially received broad-spectrum parenteral antibiotic therapy, and the articulations of all horses except one were lavaged, either with non-surgical through-and-through techniques only (N = 3), or surgically with arthrotomy (N = 1) or arthroscopy (N = 7). The owners of all treated horses were contacted and racing records were consulted. Eleven of 12 horses returned to racing. Outcome was judged as either satisfactory (3/12) if the horse had returned to racing levels similar to or better than before treatment, or unsatisfactory (9/12) if the horse had poorer performance or could not return to racing. The 3 horses with satisfactory follow-up had been treated with arthroscopy and post-surgical closed suction drainage. The results of bacterial cultures suggest that the initial antimicrobial agents used should be effective against penicillin-resistant staphylococci.

  12. Intra-articular basic calcium phosphate and monosodium urate crystals inhibit anti-osteoclastogenic cytokine signalling.

    Science.gov (United States)

    Cunningham, C C; Corr, E M; McCarthy, G M; Dunne, A

    2016-12-01

    Basic calcium phosphate (BCP) and monosodium urate (MSU) crystals are particulates with potent pro-inflammatory effects, associated with osteoarthritis (OA) and gout, respectively. Bone erosion, due to increased osteoclastogenesis, is a hallmark of both arthropathies and results in severe joint destruction. The aim of this study was to investigate the effect of these endogenous particulates on anti-osteoclastogenic cytokine signalling. Human osteoclast precursors (OcP) were treated with BCP and MSU crystals prior to stimulation with Interleukin (IL-6) or Interferon (IFN-γ) and the effect on Signal Transducer and Activator of Transcription (STAT)-3 and STAT-1 activation in addition to Mitogen Activated Protein Kinase (MAPK) activation was examined by immunoblotting. Crystal-induced suppressor of cytokine signalling (SOCS) protein and SH-2 containing tyrosine phosphatase (SHP) expression was assessed by real-time polymerase chain reaction (PCR) in the presence and absence of MAPK inhibitors. Pre-treatment with BCP or MSU crystals for 1 h inhibited IL-6-induced STAT-3 activation in human OcP, while pre-treatment for 3 h inhibited IFN-γ-induced STAT-1 activation. Both crystals activated p38 and extracellular signal-regulated (ERK) MAPKs with BCP crystals also activating c-Jun N-terminal kinase (JNK). Inhibition of p38 counteracted the inhibitory effect of BCP and MSU crystals and restored STAT-3 phosphorylation. In contrast, STAT-1 phosphorylation was not restored by MAPK inhibition. Finally, both crystals potently induced the expression of SOCS-3 in a MAPK dependent manner, while BCP crystals also induced expression of SHP-1 and SHP-2. This study provides further insight into the pathogenic effects of endogenous particulates in joint arthropathies and demonstrates how they may contribute to bone erosion via the inhibition of anti-osteoclastogenic cytokine signalling. Potential targets to overcome these effects include p38 MAPK, SOCS-3 and SHP phosphatases. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  13. [Intra-articular injections of hyaluronic acid for anterior disc displacement of temporomandibular joint].

    Science.gov (United States)

    Long, X

    2017-03-09

    Anterior disc displacement (ADD) of temporomandibular joint (TMJ) is regarded as one of the major findings in temporomandibular disorders (TMD). It is related to joint noise, pain, mandibular dysfunction, degenerative change and osteoarthritis. In the mean time, the pathological changes were found in synovial membrane and synovial fluid. Hyaluronic acid is a principal component of the synovial fluid which plays an important role in nutrition, lubrication, anti-inflammation and cartilage repair. The synthesis, molecule weight, and concentration of hyaluronic acid are decreased during TMD and cause TMJ degenerative changes. The clinical conditions, pathological changes, the mechanism of action for hyaluronic acid and the treatment of anterior disc displacement of TMJ are discussed in this article.

  14. Functional Outcomes to Surgical Treatment of the Distal Humerus Intra-Articular Fractures in Adults

    Directory of Open Access Journals (Sweden)

    Abdulkadir Yýðman

    2013-11-01

    Full Text Available Aim: Displaced and intraarticular humerus distal fractures require surgical treatment.  In this study we  evaluated to functional results of the surgical treatment of distal humerus intraarticular fractures in adults. Additionally, we evaluated the factors affecting surgical outcomes. Material and Method: Between 2005 to 2010, 22 elbows of 21 patients who were operated for distal humerus intraarticular fractures were evaluated retrospectively. 11(52.4% patiens were male and 10(47.6% were female, mean age 46.2 (range 17 to 71.  Fractures were classified as type B3 for 10, type C1 for 6 and type C2 for 6 subjects according to AO classifications. We performed paralel double locking plate for 9(41%, perpendicular double plate for 2(9%, K wires and screw combination for 7(32%, and single plate for 4(18% patients. Functional assesment were performed with the MEPS and q-DASH scoring systems. Results: Mean follow-up  was 30.4(5-68 months. Fracture healing was observed in all of the patients. Mean elbow flexion of 117 (90-145 degrees and extension loss of 24.3 (0-60 were noted. 10 (47.6% patients were excellent, 6 (28.6% were good, 3 (14.3% were fair and 2(9.5% were poor according to MEPS. Mean q-DASH scores were 15 (0-69.8 in 21 patients. Good results were obtained in fractures treated with stable fixation, in early performed surgeries, and in early  started rehabilitation. Discussion: Treatment of distal humerus intraarticular fractures with anatomical reduction, stable osteosynthesis, and early rehabilitation are very important in obtaining successful outcomes. Additionally, age and fracture type are important factors to conclude good results..

  15. Serum methylprednisolone levels following intra-articular injection of methylprednisolone acetate.

    OpenAIRE

    Armstrong, R D; English, J; Gibson, T.; Chakraborty, J.; Marks, V

    1981-01-01

    Twenty-one patients with rheumatoid arthritis received injections of either 40 mg or 80 mg of methylprednisolone acetate into one or both knee joints. Serum methylprednisolone and cortisol levels were measured at intervals up to 1 week following injection. Peak serum levels of methylprednisolone were reached at between 2 and 12 hours following injection, and increasing the injected dose resulted in correspondingly higher serum levels. Injection of 80 mg of methylprednisolone as 40 mg into eac...

  16. Experimental intra-articular calcaneal fractures: anatomic basis for a new classification.

    Science.gov (United States)

    Carr, J B; Hamilton, J J; Bear, L S

    1989-10-01

    Experimental calcaneus fractures were produce by axially loading 18 specimens. Anatomic dissections were performed and documented. Two constant primary fracture lines were identified, dividing the calcaneus in the coronal and sagittal planes. A constant anterolateral fragment was identified, as were three patterns of calcaneocuboid joint fracture involvement. Based on the pathoanatomy and surgical anatomy of the calcaneus, a medial and lateral column classification is proposed. The medial column includes the superomedial fragment. The lateral column includes the calcaneocuboid joint, lateral wall and posterior facet. This concept can help identify fracture displacements and correlate them with a treatment plan.

  17. A Clinically Realistic Large Animal Model of Intra-Articular Fracture

    Science.gov (United States)

    2014-12-01

    development of a definitive post-operative treatment protocol. These methods were used in a series of 22 animals to document the natural history of the...did not lead to deep infection. After ex-fix removal, animals gradually started to use the experimental legs, and load protective gait patterns...achieved in all 18 animals at 12 weeks. The only complication related to healing was in experimental Animal #3, in which a delayed union was apparent

  18. Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, L Ø; Husted, H; Kristensen, B B

    2010-01-01

    The optimal site for wound delivery of local anaesthetic after total knee arthroplasty is undetermined. Sixty patients having total knee arthroplasty received intra-operative infiltration analgesia with ropivacaine 0.2% and were then were randomly assigned to receive either intracapsular or intra...

  19. Intra-articular fibroma of tendon sheath arising in the acromioclavicular joint.

    Science.gov (United States)

    Glover, McKinley; Chebib, Ivan; Simeone, F Joseph

    2014-05-01

    Fibroma of the tendon sheath, a rare benign soft tissue tumor that most often occurs in the distal upper extremities (hands and wrist), is exceedingly rare to present as an intraarticular mass. Presented here is the first case in the English literature, to our knowledge, of a fibroma of the tendon sheath arising in the acromioclavicular joint. The patient presented with recurrent shoulder pain with activity without antecedent trauma. Radiographs were essentially normal. MR images demonstrated a lobulated, heterogeneous mass with contrast enhancement arising from the acromioclavicular joint. Following surgical resection, histopathology revealed hypocellular collagen matrix with spindle-shaped fibroblasts, confirming the diagnosis of fibroma of tendon sheath. The imaging features of the fibroma of the tendon sheath and a brief review of the literature are presented.

  20. Intra-articular infiltration therapy for patients with glenohumeral osteoarthritis: A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Sascha Colen

    2014-01-01

    Conclusion: IA treatment with HA has a good efficacy at follow-up compared to baseline. However, the difference in efficacy between HA and placebo never reaches the minimal clinically important difference at any of the follow-up points. We are not able to give clear recommendations for the use of IA CS injections in patients with GH-OA. In future research, we recommend focusing on sufficiently powered randomized trials to compare the efficacies of HA, CS, placebo and other IA treatment options in patients with GH-OA.

  1. Development of Intra-Articular Drug Delivery to Alter Progression of Arthritis Following Joint Injury

    Science.gov (United States)

    2012-04-01

    Arthritis Following Joint Injury Steven A. Olson, M.D. W81XWH-10-1-0890 Duke University Durham, NC 27705 15 September 2011 - 14 March ...4 Appendices – Abstract accepted for presentation at ORASI ( Osteoarthritis Research Society International) meeting in...NC 2Department of Biomedical Engineering, Duke University, Durham, NC PURPOSE: Post-traumatic arthritis (PTA) is a form of osteoarthritis (OA

  2. Anaerobic osteomyelitis of femoral head with intraosseous, intra-articular, bursal and muscle pneumatosis

    Energy Technology Data Exchange (ETDEWEB)

    Potocki, Jason [Department of Orthopaedic Surgery, Medical College of Virginia Hospital, Virginia Commonwealth University, PO Box 980257, Richmond, VA 23298-0615 (United States); Kaushik, Shaifali [Department of Radiology, Medical College of Virginia Hospital, Virginia Commonwealth University, 401 N 12th Street, 3-407A, PO Box 980615, Richmond, VA 23298-0615 (United States); Mira, Jose L. [Department of Pathology, Medical College of Virginia Hospital, Virginia Commonwealth University, PO Box 980662, Richmond, VA 23298-0662 (United States)

    2003-01-01

    A case is presented of anaerobic osteomyelitis with intraosseous pneumatosis resulting in extension of gas in soft tissue structures and femur in a patient with mitral valve vegetation and bacteremia. The finding of intraosseous pneumatosis and its extension into the hip joint, iliopsoas bursa and subgluteus medius bursa is depicted. Intraosseous pneumatosis is a rare but concerning finding for osteomyelitis in the absence of a penetrating wound, recent surgery, biopsy or fracture. (orig.)

  3. Magnesium-Based Absorbable Metal Screws for Intra-Articular Fracture Fixation

    Directory of Open Access Journals (Sweden)

    Roland Biber

    2016-01-01

    Full Text Available MAGNEZIX® (Syntellix AG, Hanover, Germany is a biodegradable magnesium-based alloy (MgYREZr which is currently used to manufacture bioabsorbable compression screws. To date, there are very few studies reporting on a limited number of elective foot surgeries using this innovative implant. This case report describes the application of this screw for osteochondral fracture fixation at the humeral capitulum next to a loose radial head prosthesis, which was revised at the same time. The clinical course was uneventful. Degradation of the magnesium alloy did not interfere with fracture healing. Showing an excellent clinical result and free range-of-motion, the contour of the implant was still visible in a one-year follow-up.

  4. Self-assembling polymeric nanoparticles for enhanced intra-articular anti-inflammatory protein delivery

    Science.gov (United States)

    Whitmire, Rachel Elisabeth

    Osteoarthritis (OA) affects 26 million Americans, or approximately 14% of the adult population. The incidence of OA is predicted to dramatically increase in the next 20 years as the US grows older and the rate of obesity continues to increase. There are currently no clinical interventions that cure OA. Current biomaterial delivery systems exhibit several limitations. First, most drug-delivery particles are hydrophobic, which is not optimal for hydrophilic protein encapsulation. Second, hydrophobic particles, such as PLGA, could cause wear damage to the already-fragile OA cartilage structure. Additionally, these particles usually suffer from non-specific protein adsorption, which causes increased phagocytosis and can lead to increased inflammation. New therapies that increase the effectiveness of OA treatments or reverse OA disease progression will greatly decrease the economic costs and individual pain associated with this disease. The goal of this thesis was to develop a new drug-delivering material to deliver anti-inflammatory protein for treating OA. Our central hypothesis for this work is that a controlled release/presentation system will more effectively deliver anti-inflammatory protein therapies to the OA joint. The primary goal of this work was to synthesize a block copolymer that could self-assemble into injectable, sub-micron-scale particles and would allow an anti-inflammatory protein, IL-1ra, to be tethered to its surface for efficient protein delivery. The block copolymer incorporated an oligo-ethylene monomer for tissue compatibility and non-fouling behavior, a 4-nitrophenol group for efficient protein tethering, and cyclohexyl methacrylate, a hydrophobic monomer, for particle stability. We engineered the copolymer and tested it in both in vitro culture experiments and an in vivo model to evaluate protein retention in the knee joint. The rationale for this project was that the rational design and synthesis of a new drug- and protein-delivering material can create a modular polymer particle that can deliver multi-faceted therapies to treat OA. This work characterizes the in vitro and in vivo behavior of our polymer particle system. The protein tethering strategy allows IL-1ra protein to be tethered to the surface of these particles. Once tethered, IL-1ra maintains its bioactivity and actively targets synoviocytes, cells crucial to the OA pathology. This binding happens in an IL-1-dependent manner. Furthermore, IL-1ra-tethered particles are able to inhibit IL-1β-induced NF-κB activation. These studies show that this particle system has the potential to deliver IL-1ra to arthritic joints and that it has potential for localizing/targeting drugs to inflammatory cells of interest as a new way to target OA drug treatments.

  5. Chemoprophylaxis without intra-articular wound drainage can replace autotransfusion in primary TKA.

    Science.gov (United States)

    Hourlier, Hervé; Fennema, Peter

    2011-06-14

    We compared outcomes in 2 groups undergoing total knee arthroplasty (TKA) with different blood-saving strategies (ie, chemoprophylaxis vs reinfusion). We hypothesized that chemoprophylaxis would lead to reduced blood loss and fewer transfusions, with no increase in associated complications. Group A was a prospective series of 91 consecutive cemented TKAs undertaken with chemoprophylaxis to reduce bleeding and blood allogeneic exposure. Group B consisted of 44 historical TKAs undertaken with postoperative reinfusion. With the exception of mean patient age (group A, 74.3 years; group B, 70.9 years; P=.006), there were no statistically significant differences between the 2 study groups.Mean total blood loss throughout the 7-day perioperative period was 1490 mL in group A and 1828 mL in group B. The rate of blood transfusion in group A was almost zero. In group B, 41 of 44 patients were administered blood intravenously. Despite the absence of autotransfusion, postoperative hemoglobin levels were significantly higher in group A than in group B. No major bleeding complications emerged in the immediate postoperative period in either group.Chemoprophylaxis proved superior to reinfusion at decreasing blood transfusion requirements in the routine daily setting of unilateral cemented primary TKA.

  6. Effect of betamethasone and diclofenac sodium on serum and tissue concentration of amoxicillin: in vivo study in rats Efeito da betametasona e do diclofenaco sódico na concentração sérica e tecidual da amoxicilina: estudo in vivo em ratos

    Directory of Open Access Journals (Sweden)

    Thales Rocha Mattos Filho

    2006-10-01

    ratos, os efeitos da betametasona e do diclofenaco sódico nas concentrações sérica e tecidual da amoxicilina. MÉTODOS: Foram utilizados 48 ratos Wistar machos (6 grupos, n=8, com idade de 60 dias. Esponjas de PVC (policlorovinil foram implantadas em quatro pontos no dorso de cada animal. Após sete dias, foram administrados por via intragástrica ou intramuscular: Grupo 1: amoxicilina (25 mg/kg; G2: diclofenaco sódico (2,5 mg/kg/i.m.; G3: betametasona (0,1 mg/kg/i.m.; G4: diclofenaco sódico e amoxicilina; G5: betametasona e amoxicilina; e G6: solução de cloreto de sódio a 0,9% (1,0 mL - grupo controle. Após 90 minutos, foram colhidos 2 tecidos granulomatosos e amostras séricas de cada animal e colocados em meios de cultura inoculados com 10(8 ufc/mL de Staphylococcus aureus ATCC 25923. Os halos de inibição foram medidos após 18 horas de incubação (37ºC, e através do teste microbiológico foram obtidas as concentrações séricas e teciduais da amoxicilina. RESULTADOS: Não foram observados halos de inibição para os grupos 2, 3 e 6. As concentrações séricas e teciduais de G1 (4,14µg/g e 2,06µg/mL, respectivamente e G5 (3,87µg/g e 1,70µg/mL, respectivamente demonstraram diferenças estatisticamente significantes (Kruskal-Wallis, p0,05. CONCLUSÃO: Considerando uma dose única, a betametasona não interferiu nas concentrações sérica e tecidual de amoxicilina, enquanto o diclofenaco sódico reduziu as concentrações sérica e tecidual de amoxicilina em ratos.

  7. Intra-articular lentivirus-mediated gene therapy targeting CRACM1 for the treatment of collagen-induced arthritis

    Directory of Open Access Journals (Sweden)

    Shuang Liu

    2017-03-01

    Full Text Available Abnormal store-operated calcium uptake has been observed in peripheral T lymphocytes of rheumatoid arthritis (RA patients, and sustained intracellular calcium signalling is known to mediate the functions of many types of immune cells. Thus, it is hypothesized that regulating calcium entry through CRACM1 (the pore-forming subunit of calcium release-activated calcium (CRAC channels; also known as ORAI1 may be beneficial for the management of RA. Localized CRACM1 knockdown in the joints and draining lymph nodes (DLNs of mice with collagen-induced arthritis (CIA was achieved via lentiviral-based delivery of shRNA targeting mouse CRACM1. Consistent with CRACM1 knockdown, calcium influx in synovial cells and the histopathological features of CIA were reduced. These effects were also associated with reduced levels of several notable inflammatory cytokines, such as IL-6, IL-17A, and IFN-γ, in the joints. Additionally, CRACM1-shRNA reduced the number of bone marrow-derived osteoclasts in vitro as well as osteoclasts in CIA joints, which was associated with reduced RANKL levels in the serum and joints. In summary, inhibiting calcium entry by CRACM1 knockdown suppressed arthritis development and may be therapeutically beneficial for RA patients.

  8. Intra-articular Hyaluronic Acid in Treating Knee Osteoarthritis: a PRISMA-Compliant Systematic Review of Overlapping Meta-analysis.

    Science.gov (United States)

    Xing, Dan; Wang, Bin; Liu, Qiang; Ke, Yan; Xu, Yuankun; Li, Zhichang; Lin, Jianhao

    2016-09-12

    Numerous meta-analyses have been conducted aiming to compare hyaluronic acid (HA) and placebo in treating knee osteoarthritis (OA). Nevertheless, the conclusions of these meta-analyses are not in consistency. The purpose of the present study was to perform a systematic review of overlapping meta-analyses investigating the efficacy and safety of HA for Knee OA and to provide treatment recommendations through the best evidence. A systematic review was conducted based on the PRISMA guidelines. The meta-analyses and/or systematic reviews that compared HA and placebo for knee OA were identified. AMSTAR instrument was used to evaluate the methodological quality of individual study. The information of heterogeneity within each variable was fetched for the individual studies. Which meta-analyses can provide best evidence was determined according to Jadad algorithm. Twelve meta-analyses met the eligibility requirements. The Jadad decision making tool suggests that the highest quality review should be selected. As a result, a high-quality Cochrane review was included. The present systematic review of overlapping meta-analyses demonstrates that HA is an effective intervention in treating knee OA without increased risk of adverse events. Therefore, the present conclusions may help decision makers interpret and choose among discordant meta-analyses.

  9. [Postoperative analgesic effect after intra-articular morphine or ropivacaine following knee arthroscopy - a prospective randomized, doubleblinded study].

    Science.gov (United States)

    Müller, M; Burkhardt, J; Borchardt, E; Büttner-Janz, K

    2001-02-01

    Recent studies for postoperative pain relief after arthroscopy by intraarticular morphine or bupivacaine showed controversial results. The aim of the study was to evaluate the analgesic effect of intraarticular morphine and ropivacaine. 135 patients were randomized into 9 groups (n=15) after standardized knee-arthroscopy. They received either 1 mg or 5 mg morphine or 150 mg ropivacaine or a combination of 5 mg morphine and 75 mg ropivacaine. Drains were opened either after 10 or 30 minutes. A control-group received isotonic saline. Pain was assesed 1 h and 4 h after surgery, at 8 pm on the day of the operation and at 8am and 4 pm the following two days by a VAS scale. Tramadol consumption as rescue medication was registred. Ropivacaine showed the best pain relief after surgery. After 24 h the pain intensity approximated in all groups and after 48 h there was no difference. Tramadol consumption was highest in the control group and lowest in the ropivacaine group (p<0,05). Ropivacaine showed better pain reduction than morphine. An influence of the time, when drains were opened, could only be demostrated for the 75 mg ropivacain combination group. Intraarticular ropivacaine following elective knee-arthroscopy reduces postoperative analgetic consumption significantly and improves patient comfort.

  10. Inflammation affects the viability and plasticity of equine mesenchymal stem cells: possible implications in intra-articular treatments

    Science.gov (United States)

    Barrachina, Laura; Remacha, Ana Rosa; Romero, Antonio; Vázquez, Francisco José; Albareda, Jorge; Prades, Marta; Ranera, Beatriz; Zaragoza, Pilar; Martín-Burriel, Inmaculada

    2017-01-01

    Mesenchymal stem cells (MSCs) are gaining relevance for treating equine joint injuries because of their ability to limit inflammation and stimulate regeneration. Because inflammation activates MSC immunoregulatory function, proinflammatory priming could improve MSC efficacy. However, inflammatory molecules present in synovial fluid or added to the culture medium might have deleterious effects on MSCs. Therefore, this study was conducted to investigate the effects of inflammatory synovial fluid and proinflammatory cytokines priming on viability and plasticity of equine MSCs. Equine bone marrow derived MSCs (eBM-MSCs) from three animals were cultured for 72 h in media supplemented with: 20% inflammatory synovial fluid (SF); 50 ng/mL IFN-γ and TNF-α (CK50); and 20 ng/mL IFN-γ and TNF-α (CK20). Proliferation assay and expression of proliferation and apoptosis-related genes showed that SF exposed-eBM-MSCs maintained their viability, whereas the viability of CK primed-eBM-MSCs was significantly impaired. Tri-lineage differentiation assay revealed that exposure to inflammatory synovial fluid did not alter eBM-MSCs differentiation potential; however, eBM-MSCs primed with cytokines did not display osteogenic, adipogenic or chondrogenic phenotype. The inflammatory synovial environment is well tolerated by eBM-MSCs, whereas cytokine priming negatively affects the viability and differentiation abilities of eBM-MSCs, which might limit their in vivo efficacy. PMID:27297420

  11. Combating Posttraumatic Osteoarthritis via Enhanced Intra-Articular Recruitment of Stem Cells and Targeting Delivery of a Chondrogenic Agent

    Science.gov (United States)

    2016-08-01

    publications. Report any book, monograph , dissertation, abstract, or the like published as or in a separate publication, rather than a periodical or...products;  software;  models;  educational aids or curricula;  instruments or equipment;  research material (e.g., Germplasm; cell lines, DNA

  12. Differentiating between signs of intra-articular joint bleeding and chronic arthropathy in haemophilia : a narrative review of the literature

    NARCIS (Netherlands)

    Timmer, M. A.; Pisters, M. F.; de Kleijn, P.; de Bie, R. A.; Fischer, K.; Schutgens, R. E.

    2015-01-01

    Introduction: Elderly patients with haemophilia (PWH) suffer from both haemarthrosis and haemophilic arthropathy (HA). Diagnosis of haemarthrosis in PWH is currently based on clinical presentation. No diagnostic protocols or validated criteria are available to identify haemarthrosis or to differenti

  13. Joint Distraction Treatments of Intra-Articular Fracture-Induced Posttraumatic Osteoarthritis in a Large Animal Model

    Science.gov (United States)

    2016-10-01

    short, at odd angles, etc.) This device was able to achieve symmetric medial/lateral and symmetric anterior/posterior distraction with installation...They are a relatively local source (for cheaper shipping) with economically priced animals. Unfortunately, as described above, this vendor was...source was Sinclair Bioresources, and that vendor did have animals of the necessary age available. However purchase price was approximately ~$2,300

  14. External Fixation versus two-stage Open Reduction Internal Fixation of distal intra-articular Tibia fractures; a Systematic Review

    DEFF Research Database (Denmark)

    Ladeby Erichsen, Julie; Jensen, Carsten; Damborg, Frank Lindhøj

    Internal Fixation (ORIF) or External Fixation (EF). Method : A search was conducted using PUBMED, Embase, Cochrane Central, Open Grey, Orthopaedic Proceedings and WHO International Clinical Trials Registry Platform. Studies with level of evidence I-IV comparing EF with two-stage ORIF of DIATF in patients...

  15. Intra-articular versus intravenous magnesium-sulfate as adjuvant to femoral nerve block in arthroscopic knee sur

    Directory of Open Access Journals (Sweden)

    Mohamed Abdulatif

    2015-07-01

    Conclusion: The combined use of femoral nerve block with IA or IV MgSO4 is associated with significant reduction of the intensity and duration of postoperative pain and postoperative analgesic requirements in patients undergoing arthroscopic knee surgery with the IA MgSO4 being superior to IV route of administration.

  16. Viscosupplementation with intra-articular hyaluronic acid for hip disorders. A systematic review and meta-analysis

    Science.gov (United States)

    Piccirilli, Eleonora; Oliva, Francesco; Murè, Mihaela Aconstantinesei; Mahmoud, Asmaa; Foti, Calogero; Tarantino, Umberto; Maffulli, Nicola

    2016-01-01

    Summary Background Hip joint diseases are common in adult population and their prevalence increases with age. Osteoarthritis, rheumatoid arthritis and femoroacetabular impingement are the most common chronic diseases in the hip joint. Viscosupplementation with exogenous hyaluronic acid (HA) is one of the most widely used conservative treatment aiming to improve synovial fluid properties and to decrease pain. There is no global consensus on the type of HA, method of injection and frequency, or on its efficacy in hip joint. Methods We selected published data in English in the PubMed and Google Scholar electronic databases up to March 2016 about hyaluronic acid injections in hip disorders. Results 26 articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Conclusion There is a lack of standardization of HA injections for hip conditions. Our results suggest that this is the best conservative therapy before surgery and it can act on pain relief and function however there is no evidence to prove its ability to modify the morphological structure of the pathological hip and the natural history of the disease. There are few data about the use of HA in other hip disorders rather than osteoarthritis. The most relevant evidence seems to show the utility of HA injections in improving synovial inflammation, but only a few studies have been conducted. Level of evidence I. PMID:28066733

  17. In situ formed suspensions for local sustained action of celecoxib following intra-articular administration

    DEFF Research Database (Denmark)

    Larsen, Susan Weng; Frost, Anna Buus; Østergaard, Jesper;

    donor compartment was followed by reverse phase HPLC. After an initial fast release a constant flux was observed. Likewise, a similar constant flux was found for a preformed aqueous suspension of the drug. The highly comparable fluxes observed indicate that the solid celecoxib precipitated from...... of an in situ formed suspension of celecoxib. In the field of IA drug administration the in situ suspension forming drug delivery principle appears promising for the provision of local prolonged drug action. However, for clinical use the reproducibility of the precipitation step in the biological matrix may...

  18. Aerosolized alpha-hemolytic Streptococcus as a cause of knee sepsis after intra-articular injection: predisposing factors.

    Science.gov (United States)

    Reeves, K Dean; Horvat, Rebecca Thayer

    2010-01-01

    Joint sepsis from an aerosol source of any organism during knee injection has never been reported and the standard of care for joint injection does not include facial masking. This case collection suggests that simple talking or teaching during injection procedures near an open hub needle may create a significant aerosol contamination risk with viridans group alpha-hemolytic strep. In addition, it suggests that the pathogenicity of alpha-hemolytic Streptococcus may be facilitated by the combination of dextrose and methylprednisolone. This finding has potential implications for the use of protective masking and/or avoidance of verbal communication (teaching or patient explanations) during the process of knee injection, especially of patients who are in an immunocompromised state. Potential parallels with the literature on aerosol-transmitted postdural meningitis with alpha hemolytic strep are explored.

  19. The pathogenesis of arthritis in Lyme disease: humoral immune responses and the role of intra-articular immune complexes.

    Science.gov (United States)

    Hardin, J. A.; Steere, A. C.; Malawista, S. E.

    1984-01-01

    We studied 78 patients with Lyme disease to determine how immune complexes and autoantibodies are related to the development of chronic Lyme arthritis. Circulating C1q binding material was found in nearly all patients at onset of erythema chronicum migrans, the skin lesion that marks the onset of infection with the causative spirochete. In patients with only subsequent arthritis this material tended to localize to joints where it gradually increased in concentrations with greater duration of joint inflammation. In joints, its concentration correlated positively with the number of synovial fluid polymorphonuclear leukocytes. Despite the prolonged presence of putative immune complexes, rheumatoid factors could not be demonstrated. These observations suggest that phlogistic immune complexes based on spirochete antigens form locally within joints during chronic Lyme arthritis. PMID:6334939

  20. Intra-Articular Knee Contact Force Estimation During Walking Using Force-Reaction Elements and Subject-Specific Joint Model.

    Science.gov (United States)

    Jung, Yihwan; Phan, Cong-Bo; Koo, Seungbum

    2016-02-01

    Joint contact forces measured with instrumented knee implants have not only revealed general patterns of joint loading but also showed individual variations that could be due to differences in anatomy and joint kinematics. Musculoskeletal human models for dynamic simulation have been utilized to understand body kinetics including joint moments, muscle tension, and knee contact forces. The objectives of this study were to develop a knee contact model which can predict knee contact forces using an inverse dynamics-based optimization solver and to investigate the effect of joint constraints on knee contact force prediction. A knee contact model was developed to include 32 reaction force elements on the surface of a tibial insert of a total knee replacement (TKR), which was embedded in a full-body musculoskeletal model. Various external measurements including motion data and external force data during walking trials of a subject with an instrumented knee implant were provided from the Sixth Grand Challenge Competition to Predict in vivo Knee Loads. Knee contact forces in the medial and lateral portions of the instrumented knee implant were also provided for the same walking trials. A knee contact model with a hinge joint and normal alignment could predict knee contact forces with root mean square errors (RMSEs) of 165 N and 288 N for the medial and lateral portions of the knee, respectively, and coefficients of determination (R2) of 0.70 and -0.63. When the degrees-of-freedom (DOF) of the knee and locations of leg markers were adjusted to account for the valgus lower-limb alignment of the subject, RMSE values improved to 144 N and 179 N, and R2 values improved to 0.77 and 0.37, respectively. The proposed knee contact model with subject-specific joint model could predict in vivo knee contact forces with reasonable accuracy. This model may contribute to the development and improvement of knee arthroplasty.

  1. Intra-articular Pressure Based Stress Analysis of the Distal Tibia Following Insertion of a Total Ankle Replacement

    OpenAIRE

    Soodmand, Ehsan; Natsakis, Tassos; Jonkers, Ilse; Vander Sloten, Jos

    2015-01-01

    The ankle joint plays an important role in transferring the human body weight to the ground. Given the associated loading, Osteoarthritis (OA) is one of the most common disorders in the ankle joint. The most common treatment of ankle OA is total ankle arthroplasty (TAA). However it is not known whether TAA influences the stress levels of the bone structures and specially the distal tibia. Clinical studies previously related the occurrence of tibia cysts to focal stress concentrations. In this...

  2. Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Boesen, Mikael; Jensen, Karl Erik; Torp-Pedersen, Søren

    2007-01-01

    /ml), 0.5 ml Lidocaine (5mg/ml) and 0.15 ml gadolinium (Omniscan 0.5 mmol/ml). The drug solution was placed in the central proximal part of the wrist between the distal radius and the lunate bone. Coronal and axial MRI sequences were performed after the injection to visualize the distribution. Carpal...... to the clinical parameters and the MRI OMERACT scores. RESULTS: No uniform pattern was seen in the distribution of the contrast. Only two patients had full contrast distribution to all four compartments, and the mean distribution count for all patients was 2.4 (range 0.5-4). The distribution count correlated...... with the MRI synovitis score, while no association was found with the erosion- and bonemarrow oedema score. These results indicate that a single injection into a standard injection site in the proximal part of the wrist cannot be assumed to distribute--and treat--the whole joint Udgivelsesdato: 2009/2...

  3. Digital signage sobre IP

    OpenAIRE

    Casademont Filella, Albert

    2012-01-01

    Projecte que versa sobre el disseny i la implementació d'un sistema de Digital Signage (Cartelleria Digital) sobre IP, creant un gestor que permeti controlar de forma remota tot un conjunt de petits dispositius connectats a pantalles que emeten continguts multimèdia com vídeos, imatges, feeds rss...

  4. Impuesto sobre la renta

    OpenAIRE

    Universitat de Barcelona. Grup d'Innovació Docent en Economia dels Impostos (GIDEI)

    2016-01-01

    Tema 7. Esquema de presentación del tema "Impuesto sobre la renta". Incorpora datos actuales, gráficos, cuadros y tablas. Esquema de presentació del tema "Impuesto sobre la renta". Incorpora dades actuals, gràfics, quadres i taules.

  5. Impuesto sobre sociedades

    OpenAIRE

    Universitat de Barcelona. Grup d'Innovació Docent en Economia dels Impostos

    2016-01-01

    Tema 8. Esquemas de la presentación del tema "Impuesto sobre sociedades". Incorpora datos actuales, gráficos, cuadros y tablas. Esquemes de la presentació del tema "Impuesto sobre sociedades". Incorpora dades actuals, gràfics, quadres i taules

  6. Todo sobre el neobarroco

    Directory of Open Access Journals (Sweden)

    Arturo Carrera

    2007-07-01

    Full Text Available Lo que hemos escuchado y atendido hasta aquí, hoy, ayer, sobre todo en la propuesta poética esbozada por Sergio Raimondi en su ensayo sobre Aldo Oliva, demuestra que las singularidades, su pasión, anulan subrepticiamente las nominaciones.Anoche en la televisión una orquesta sinfónica y un coro numeroso. Súbitamente, me hubiera gustado ser uno de esos intérpretes solitarios para sí, a pesar de la armonía, anónimos, a pesar del brillo sonoro… un violín, un triángulo… apenas… tres grillos… como ...

  7. ESTUDO DO LEUCOGRAMA COMO MONITOR DO 2-1 FOSFATO DISSÓDICO DE BETAMETASONA DO FOSFATO DISSÓDICO/ACETATO DE DEXAMETASONA, EM CÃES QUE RECEBERAM TRANSPLANTES COM CÓRNEAS DE SUÍNOS WHITE BLOOD COUNT AS A 2-1 BETAMETHASONE DISSODIC FOSFHATE AND DEXAMETHASONE DISSODIC FOSPHATE/ACETATE MONITOR IN SWINE CORNEA TRANSPLANTED DOGS

    Directory of Open Access Journals (Sweden)

    Larissa Franco de Araújo

    2007-09-01

    Full Text Available

    Foram utilizados dez cães, sem raça definida, com peso médio de 10kg, selecionados no Centro de Zoonoses de Goiânia. Após serem examinados e considerados sadios, foram numerados de 11 a 20 na respectiva coleira. Cada animal, a seu tempo, teve implantada no olho esquerdo córnea de suíno, este abatido no frigorífico Casa de Banha Caçula. A córnea foi conservada em câmara úmida pelo período máximo de seis horas. Cada cão recebeu, antes da cirurgia, 4mg por via intramuscular de fosfato dissódico/acetato de dexametasona e uma gota de sulfato de gentamicina/fosfato dissódico de betametasona. Foi conservado o uso da medicação ocular 4 vezes/dia e a intramuscular semanalmente, até o sacrifício do cão. Cada animal teve uma amostra de sangue colhida no dia 0, antes da cirurgia, uma no 14° e outra no 28° dia, para o estudo do leucograma, como monitor dos corticosteróides. Nas dez amostras colhidas no dia 0, 80% não apresentaram alterações, já 10% apresentaram leucocitose com neutrofilia e 10% não foram analisadas. Como três animais foram sacrificados no intervalo do 14° ao 21° dia, estas amostras (40%, foram analisadas e comparadas com aquelas do tempo 0. Cinco animais (50% tiveram suas amostras examinadas no 28° dia. Tanto no 14° como no 28° dia encontraram-se 100% de neutrofilia, 100% de eosinopenia e 44,4% de linfocitopenia, num sinal clássico de supressão imunocelular.

    PALAVRAS-CHAVE: Corticosteróides; xenotransplantes; córnea; canino; suíno.

    Ten mixed breed dogs, with a 10 kg average weight were selected at Centro de Zoonoses de Goiânia. After being examined and considered healthy, the dogs were enumerated from 11 to 20 on their collars

  8. OCULAR MICROBIAL POPULATION AS A 2-1 BETAMETHASONE DISSODIC FOSPHATE AND DISSODIC FOSPHATE/ACETATE DEXAMETHASONE MONITOR IN SWINE CORNEA TRANSPLANTED DOGS ESTUDO DA MICROBIOTA OCULAR COMO MONITOR DO 2-1 FOSFATO DISSÓDICO DE BETAMETASONA E DO FOSFATO DISSÓDICO/ACETATO DE DEXAMETASONA, EM CÃES QUE RECEBERAM TRANSPLANTES COM CÓRNEAS DE SUÍNOS

    Directory of Open Access Journals (Sweden)

    Nilo Sérgio Troncoso Chaves

    2007-09-01

    período máximo de seis horas. Cada animal antes da cirurgia recebeu 4mg de fosfato dissódico/acetato de dexametasona, por via intramuscular, e uma gota de fosfato dissódico de betametasona/sulfato de gentamicina. A medicação foi mantida até o seu sacrifício. De cada cão colheu-se no dia 0, antes da cirurgia, uma amostra do fórnice superior do olho esquerdo, com zaragatoa estéril e imediatamente embebida em água peptonada 0,1%, para os testes das bactérias aeróbicas e fungos. Cada teste foi repetido nas amostras colhidas no 7°, 14°, 21° e 28° dias, após o enxerto e comparado ao do dia 0. Das 39 amostras obtidas do saco conjuntival encontrou-se a prevalência do Staphylococcus epidermidis (12,8%, que, nas amostras iniciais, foram contaminação de colheita, pois não se manifestaram nas amostras do 28° dia, sugerindo a eficiência do antibiótico de escolha.

    PALAVRAS-CHAVE: Microbiota; corticosteróides; xenotransplantes; córnea; canino; suíno.

  9. Resumen estudios sobre tabaquismo

    OpenAIRE

    Gónzalez, M.M. (M.)

    2009-01-01

    Este documento se realizó para publicar en la página Web de la Gerencia de Atención primaria del Área III. Este documento es una recopilación de estudios sobre tabaquismo. Gerencia de Atención Primaria Área III

  10. Multimedia sobre mantenimiento industrial

    National Research Council Canada - National Science Library

    2012-01-01

    ..., entre otras facilidades. Puntualizado, el mantenimiento industrial es una actividad que conserva la calidad del servicio que se presta, y sobre todo en la infraestructura existente en los centros de produccion con optimas condiciones de seguridad, eficiencia y economia. El mantenimiento es de gran importancia, pues sus objetivos son la base para un adecuado f...

  11. Ley sobre Realengos

    Directory of Open Access Journals (Sweden)

    Historia Social y de la Cultura Anuario Colombiano de

    1983-01-01

    Full Text Available Propuesta y Aprobada por el Senado y la Cámara de Antioquia en el año de 1.812 En nombre del Estado de Antioquia, el Senado y la Cámara de Representantes han decretado lo siguiente: Proyecto de Ley sobre Realengos: …

  12. Inferencias sobre Grafos

    Directory of Open Access Journals (Sweden)

    Sira M. Allende

    2002-05-01

    Full Text Available El estudio de un juego puede ser modelado asumiendo que solo algunas partidas son observadas. Entonces el árbol del juego debe ser estimado utilizando información muestral. Similarmente ocurre al obtener información sobre el comportamiento de las decisiones tomadas por individuos muestreados sobre un árbol de decisión teórico. Al considerar una medida de probabilidad que caracterice el comportamiento de redes aleatorias se puede obtener un estimado del árbol asociado. Este problema es el analizado en este trabajo. Algunos resultados experimentales obtenidos usando Recocido Simulado ilustran el procedimiento. Su papel en el estudio de modelos económicos y de mercadeo es discutido.

  13. Tesis sobre municipalismo libertario

    OpenAIRE

    Bookchin, Murray

    2014-01-01

    Históricamente, la teoría y la práctica social radical se han centrado sobre dos campos de la actividad social humana: el lugar de trabajo y la comunidad. A partir de la creación del Estado-nación y de la Revolución Industrial, la economía ha ido adquiriendo una posición predominante sobre la comunidad; y no sólo en la ideología capitalista, sino también en los diferentes socialismos, libertarios y autoritarios, que han ido apareciendo en el último siglo. Este cambio de posición del socialism...

  14. Escrito sobre el cuerpo

    Directory of Open Access Journals (Sweden)

    Antonio Malalana Ureña

    2013-09-01

    Full Text Available El catálogo, en una edición bilingüe español-inglés, es una pequeña guía de la exposición Shirin Neshat. Escrito sobre el cuerpo, muestra que se integra dentro de los actos de PHOTOESPAÑA13, el festival internacional de fotografía y artes visuales. El esquema del libro es sencillo y los textos son extremadamente divulgativos. El primero de ellos, Escrito sobre el cuerpo (pp. 10-15, cuyo autor es Octavio Zaya, comisario de la exposición, resume la trayectoria de esta intelectual, que "interactúa" con la fotografía y los formatos audiovisuales, y nos presenta la argumentación narrativa de los documentos expuestos, contextualizando la obra recopilada.

  15. Puente sobre el Rin

    Directory of Open Access Journals (Sweden)

    Gortz, Wilhelm

    1961-12-01

    Full Text Available Del total de 35 proyectos presentados al concurso del puente para carretera sobre el Rin, entre Duisburg-Ruhrort y Homberg, sólo dos proposiciones de la Demag fueron consideradas: Una con tablero suspendido por vientos que parten de dos torres, y otra, con suspensión por cables flexibles que se apoyan en dos torres y anclaje en la misma estructura. Por razones netamente estéticas fue elegida la propuesta Demag de puente suspendido por cables, aunque la solución con vientos hubiera sido la más económica, teniendo en cuenta las condiciones existentes.

  16. Excertos sobre o sedentarismo

    OpenAIRE

    Alexandre Palma; Murilo Mariano Vilaça; Monique Ribeiro de Assis

    2014-01-01

    O sedentarismo tem sido tratado como algo perfeitamente determinável, objetivo e, portanto, que pode ser apreendido. Por outro lado, o conceito de sedentarismo ainda permanece questionável e, por conseguinte, os instrumentos mostram-se inconsistentes. Neste sentido, o objetivo do presente estudo foi mostrar que diferentes discursos de verdade vêm concorrendo por esse conceito, o que nos motiva a pensar qual é a verdade ou, até mesmo, se há alguma verdade sobre ele. Após apresentarmos diferent...

  17. Saber sobre la radio

    OpenAIRE

    Mata, María Cristina; Universidad Nacional de Córdoba. Argentina

    1998-01-01

    La autora propone en este artículo repensar los fundamentos sobre los cuales se estructuran las asignaturas y talleres de radio en las escuelas de Comunicación Social en Latinoamérica, con el proposito de romper la escisión  entre teoría/práctica y de no violentar su complejidad: en la radio, entendida como práctica comunicativa, se juega en primer lugar una "red de vinculaciones e intercambios" en condiciones privilegiadas para la dialoguicidad. En un segundo lugar, asociado al desarrollo de...

  18. Sobre historia mundial hoy

    Directory of Open Access Journals (Sweden)

    Vera Weiler

    2010-08-01

    Full Text Available Los procesos de globalización son una realidad; su enorme impacto sobre la vida humana los ha convertido en un tema recurrente sobre el que se escribe y se comenta a diario también en Colombia. Los libros que de ellos tratan, ante todo los que 10 hacen en tono crítico, baten records en la industria editorial en todo el mundo. Las expectativas que acerca del futuro abrigan cientos de millones de personas se relacionan con 10 que ellas esperan, para bien o para mal, de la globalización. Las posturas que los gobernantes ocupan al respecto en el mundo son, cuando menos de aceptación, generalmente de activa participación en pos de la globalización. Por un lado, crece la preocupación y se multiplican las protestas; por el otro, dominan los razonamientos de los especialistas en materia de maximización de los rendimientos de los capitales que presentan la globalización, al estilo que se viene imponiendo, como el camino ineludible del gobierno universal de la eficiencia. ¿Tienen que decir algo los historiadores frente a todo esto?.

  19. Sobre la tragedia griega

    Directory of Open Access Journals (Sweden)

    Mauricio Vélez Upegui

    2015-01-01

    Full Text Available Luego de caracterizar la tragedia griega clásica como expresión de un arte ciudadano que participa por igual de un carácter festivo, cierto régimen discursivo y una clara inscripción físico-espacial, el texto se demora en considerar tres aspectos fundamentales de esta forma dramática inventada por los griegos, a saber: una exposición sobre las fuentes orales míticas de las que los autores echan mano para componer la historia de cada una de las piezas que son llevadas a escena al amparo de un espíritu agonal; una explicación del funcionamiento formal de la tragedia, basado en la alternancia de partes cantadas (coro y partes recitadas (héroe; y, finalmente, una acotación sobre el sentido –interno y externo– que la acción dramática posee, en tanto elemento articulador de la trama.

  20. Sobre multifunciones Fuzzy

    Directory of Open Access Journals (Sweden)

    Renato César Scarparo

    2002-01-01

    Full Text Available En este trabajo se presentan y demuestran algunos resultados de D.T. Luc y C, Vargas referentes a multifunciones con dominio y blanco en espacios vectoriales topológicos de Hausdorff sobre R, como así mismo se explícita el concepto de multifunción fuzzy de acuerdo a Papageogiou, y se demuestran dos teorema de S. S. Chag, con respecto a las multifunciones fuzzy, proposiciones todas estas, que integran una línea de resultados necesarios para la demostración de desigualdades variacionales para multifunciones fuzzy, a su vez necesarias, para la extensión fuzzy de conocido teorema de Walras.

  1. Sobre el Portugal ilustrado

    OpenAIRE

    Santolaya Heredero, Laura

    1992-01-01

    El mismo título invita a preguntarse, a modo de introducción, en qué consistió la Ilustración en Portugal. Me refiero a las prácticas, sin pretender entrar en un debate filosófico. Desde luego, las prácticas políticas y económicas de los Estados del XVIII poco tuvieron que ver con las ideas de los filósofos de la Ilustración. El fenómeno de la Ilustración se aprovechió de una propaganda anecdótica para hacer suponer a los lectores de libros sobre ella que en los diversos ...

  2. Excertos sobre o sedentarismo

    Directory of Open Access Journals (Sweden)

    Alexandre Palma

    2014-09-01

    Full Text Available O sedentarismo tem sido tratado como algo perfeitamente determinável, objetivo e, portanto, que pode ser apreendido. Por outro lado, o conceito de sedentarismo ainda permanece questionável e, por conseguinte, os instrumentos mostram-se inconsistentes. Neste sentido, o objetivo do presente estudo foi mostrar que diferentes discursos de verdade vêm concorrendo por esse conceito, o que nos motiva a pensar qual é a verdade ou, até mesmo, se há alguma verdade sobre ele. Após apresentarmos diferentes possibilidades de compreender o sedentarismo, através do uso de aforismos, entendemos que postular um discurso como verdade talvez apenas signifique que as pessoas nele creem e que há uma vontade de verdade como uma vontade voltada para o poder.

  3. Notas sobre o marcellismo

    Directory of Open Access Journals (Sweden)

    Jorge Sampaio

    2007-01-01

    Full Text Available Para el salazarismo, la estabilidad consistía en erradicar de la sociedad la elección de alternativas, esto es el conflicto. Ese orden comenzó a desmoronarse sobre todo desde los años 60, como consecuencia de los cambios socioeconómicos y culturales que acentuaban los factores de información y de concurrencia en la sociedad portuguesa. Ante este nuevo panorama, el éxito de Marcelo Caetano sólo era posible mediante un compromiso con los nuevos actores sociales y con las nuevas fuerzas políticas empeñadas en la instauración de la democracia. Sin embargo el Presidente del Consejo no quiso o no pudo asumir ese compromiso, viéndose obligado al cabo de un tiempo a volver sobre sus iniciales pasos aperturistas.The social and political stability under salazarism was contemplated as a result of alternatives choice and conflicts suppression. That order was mainly eroding along the decade of sixteenth as a consequence of social, economic and cultural changes that were accentuating information and concurrence factors in Portuguese society. Facing this new stage, the success of Marcelo Caetano’s reformism was depending on his capacity of commitment with the new social actors and the opposition political forces solidly engage in democratic goal. However, the President wasn’t capable —or wasn’t allowed— to assume this commitment, even reversing after the first hopeful times his initial reformist trends.

  4. Sobre la muerte voluntaria

    Directory of Open Access Journals (Sweden)

    Juan Álvarez-Cienfuegos Fidalgo

    2012-03-01

    Full Text Available El problema de cómo morir en nuestra sociedad se ha convertido en una inquietud para los ciudadanos y la reflexión moral. Especialmcnte por dos razones: por el desarrollo de la tecnología médica y por el hecho de que la mayor parte de los fallecimientos tienen lugar fuera del hogar, donde tradicionalmente ocurra el deceso. El presente artículo tiene como objetivo acercarse a esta cuestión. Para ello, se parte de la autonomía del ciudadano, con derecho a decidir sobre lo que considera cuál sea su manera de vivir y de morir. A tal fin, se hace una breve introducción sobre el dolor, el suicidio y la muerte, desde un punto de vista antropológico, pasando, después, a mostrar las cuestiones relacionadas con el problema de la eutanasia, donde la atención se dirigirá, ante todo, al enjuiciamiento crítico del tenso equilibrio en el que se mantienen dos principios fundamentales de la bioética: el de no maleficencia y el de autonomía del ciudadano.The problem of how to die in modern society has become a concern for both the citizen and moral reflection for two reasons in particular: due to developments in medical technology, and because most deaths occur outside the honre, where they traditionaÍlY took place. This paper addresses this issue, starting from citizen autonomy, the right to decide on what s/he considers to be his or her way of living and dying. To this end, a brief introduction considers pain, suicide and death from an anthropological viewpoint. Questions related to the problem of euthanasia are then exposed, with particular attention to, above all the critical judgement of the tense balance in which two fundamental principies of bioethics are held, the principle of non-maleficence and that of citizen autonomy.

  5. Debate sobre el parto (normal).

    OpenAIRE

    Vidal Puèrtolas, Adela

    2008-01-01

    El artículo pretende una reflexión sobre la asistencia al parto, desde el punto de vista de una comadrona. A raíz de la apuesta oficial sobre el cómo para humanizar la asistencia obstétrica hospitalaria, se plantea un análisis de las implicaciones profesionales y los matices culturales que influyen sobre la vivencia de la experiencia del parto. La importancia de la psico-profilaxis en la preparación al parto como vehículo terapéutico de acercamiento a la realidad y de ...

  6. Puente sobre el Maracaibo

    Directory of Open Access Journals (Sweden)

    Equipo Editorial

    2017-05-01

    Full Text Available Para salvar el lago de Maracaibo (Venezuela, el conocido ingeniero italiano Riccaido Morandi ha presentado un proyecto de puente para ferrocarril y carretera, de hormigón pretensado, de tramos independientes, constituyendo un sistema Gerber, que tiene una longitud total de 8.720 m y un vano central de 400 m de luz. Este último tramo, en unión de los dos adyacentes al mismo, constituirán, una vez terminada la obra, un conjunto continuo. El tablero del puente se halla a una altura de 45 m sobre el nivel del agua en la zona del canal, con objeto de permitir la navegación. El tablero, de 20,90 m de anchura total, se ha subdividido en tres partes, dos simétricas respecto al eje, laterales, de 7,20 m de anchura, para la circulación en sentidos opuestos por carretera, una plataforma central, de 5 m de ancho, para el ferrocarril y dos andenes para el paso de peatones y servicios.

  7. Debate internacional sobre pobreza

    Directory of Open Access Journals (Sweden)

    Neritza Alvarado Chacín

    2016-01-01

    Full Text Available El objetivo del artículo es organizar la proliferación de ideas en torno de la pobreza, a menudo dispersas, difusas y confusas en la literatura, bosquejando sistematizadamente un marco teórico referencial útil al abordaje científico de este fenómeno, en investigaciones teóricas y aplicadas, así como en la enseñanza y discusión de tales temas en el ámbito universitario. Para ello, se compendian, organizan y clasifican diversos enfoques sobre la pobreza, según los criterios presentes en los planteamientos de autores e instituciones relevantes que han contribuido a la reflexión desde distintas lecturas, teniendo en cuenta que no existe consenso en torno a una definición. La investigación es exploratoria-documental. Se aplican las técnicas del arqueo electrónico y físico de la información, el fichaje computarizado y la reducción de la misma en tablas de contenido. Se precisa el alcance de las mismas en el tiempo, según la evolución conceptual que han experimentado en el debate internacional. Se señalan algunas ventajas y desventajas de los principales enfoques, que han sido reconocidas en el mismo debate.

  8. Sobre el nombre "Quechua"

    Directory of Open Access Journals (Sweden)

    Rodolfo Cerrón-Palomino

    1985-06-01

    Full Text Available Uno de los primeros problemas con el que a menudo tropiezael estudioso de los idiomas ágrafos, como es el caso de las lenguasaborígenes de América, es el de su denominación (glotónimo.En la medida ,en que, por razones históricas, las noticias sobretales lenguas, y por consiguiente los primeros estudios sobre lasmismas, surgen a partir del contacto con los miembros de la civilización occidental, los nombres de los distintos idiomas, así comode los grupos étnicos que los manejan, son el resultado casi siempre arbitrario cie designaciones fortuitas hechas por viajeros, misiioneros y exploradores, quienes por lo general se basan, para ello, bien en descripciones físicas de los grupo étnicos, en ciertos indios geográficos que constituyen el habitat de los mismos, e incluso en prejuicios que se nutren de un marcado europocentrismo.

  9. Sobre invenciones y truculencias

    Directory of Open Access Journals (Sweden)

    Rafael Mendez

    2016-01-01

    Full Text Available Es muy probable que, antes que la experiencia misma de la vida, lo que nos constituye y nos otorga sentido, sea la versión que podamos construir a partir de esa experiencia. Su memoria. Pero esa construcción no se da, bajo ninguna circunstancia, de manera natural o desinteresada. Todo lo contrario, el territorio que ocupa es básicamente conflictivo, hecho de pura tensión, de forcejeos sin tregua al final de los cuales se resuelve una imposición: alguien, algunos, consiguen obligar a los demás a reconocer su versión, como la versión de todos, lo que implica, en definitiva, olvidar su artificialidad básica, pasar por alto su naturaleza arbitraria y por lo tanto, perfeccionar, de manera casi siempre tácita y silenciosa, su naturalización. Así las cosas, y en consecuencia de tamaña truculencia, los hechos y las experiencias que constituyen nuestro día a día, se nos dan de una manera que podríamos calificar de incontestable. Están ahí: ocupan su momento y su lugar, despliegan sus circunstancias. Su contundencia es tal, que el armazón entero de eso que llamamos realidad, construye sobre el poder de esa evidencia el conjunto pleno de sus estrategias y complejidades. Confianza descomunal, pues esa realidad, tan airosa y, en tantas oportunidades, tan arrogante, termina constituyéndose en mundo. En nuestro mundo. El único que, aparentemente, nos corresponde y que se nos impone en la “verdad” de la experiencia y de la memoria.

  10. Algunos apuntes sobre comunidad

    Directory of Open Access Journals (Sweden)

    Clara Pérez Cárdenas

    2000-08-01

    Full Text Available Comunidad es, entre los temas de estudio del curriculum de los residentes en Medicina General Integral, uno de aquellos en las que mayores dificultades encontramos para poderlo impartir, pues la bibliografía sobre el tema está un tanto dispersa. Es un aspecto que los propios residentes no evalúan con justeza; sin embargo es de sumo interés que como profesionales de la salud no obviemos que nuestro trabajo de promoción, prevención y tratamiento, debe darse a nivel de individuo, pero también en las familias y en la comunidad como un todo, y por lo tanto debamos incorporar, al menos, nociones de lo que es una comunidad y qué es participación comunitaria para tener idea de cómo fomentarla, única vía para que nuestras acciones de salud sean más efectivasCommunity is one of the most difficult subjects to be taught among those included in the curriculum of General Comprehensive Medicine residents, since bibliography on this topic is a bit dispersed. This aspect, which is not properly evaluated by residents, is very important for health professionals to do our work of promotion, prevention and treatment not only at the level of the individual, but also at the level of the family and of the community as a whole. Therefore, we need to have some notions about community and community participation to be able to promote them, as the only way to make our health actions more effective

  11. Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. Surgical technique

    NARCIS (Netherlands)

    Kerkhoffs, G.M.M.J.; Rademakers, M.V.; Altena, M.; Marti, R.K.

    2009-01-01

    BACKGROUND: Reconstructive surgical measures for treatment of posttraumatic deformities of the lateral tibial plateau are seldom reported on in the literature. We report the long-term follow-up results of a consecutive series of reconstructive osteotomies performed to treat depression and valgus mal

  12. Accuracy of magnetic resonance in identifying traumatic intraarticular knee lesions; Acuracia da ressonancia magnetica para identificar lesoes traumaticas intra-articulares do joelho

    Energy Technology Data Exchange (ETDEWEB)

    Vaz, Carlos Eduardo Sanches; Camargo, Olavo Pires de; Santana, Paulo Jose de; Valezi, Antonio Carlos [Universidade Estadual de Londrina, PR (Brazil). Hospital Regional do Parana. Dept. de Ortopedia e Traumatologia]. Email: carvaz@uol.com.br

    2005-12-15

    Purpose: To evaluate the diagnostic accuracy of magnetic resonance imaging of the knee in identifying traumatic intraarticular knee lesions. Method: 300 patients with a clinical diagnosis of traumatic intraarticular knee lesions underwent prearthoscopic magnetic resonance imaging. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for a positive test, likelihood ratio for a negative test, and accuracy of magnetic resonance imaging were calculated relative to the findings during arthroscopy in the studied structures of the knee (medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, and articular cartilage). Results: Magnetic resonance imaging produced the following results regarding detection of lesions: medial meniscus: sensitivity 97.5%, specificity 92.9%, positive predictive value 93.9%, positive negative value 97%, likelihood positive ratio 13.7, likelihood negative ratio 0.02, and accuracy 95.3%; lateral meniscus: sensitivity 91.9%, specificity 93.6%, positive predictive value 92.7%, positive negative value 92.9%, likelihood positive ratio 14.3, likelihood negative ratio 0.08, and accuracy 93.6%; anterior cruciate ligament: sensitivity 99.0%, specificity 95.9%, positive predictive value 91.9%, positive negative value 99.5%, likelihood positive ratio 21.5, likelihood negative ratio 0.01, and accuracy 96.6%; posterior cruciate ligament: sensitivity 100%, specificity 99%, positive predictive value 80.0%, positive negative value 100%, likelihood positive ratio 100, likelihood negative ratio 0.01, and accuracy 99.6%; articular cartilage: sensitivity 76.1%, specificity 94.9%, positive predictive value 94.7%, positive negative value 76.9%, likelihood positive ratio 14.9, likelihood negative ratio 0.25, and accuracy 84.6%. Conclusion: Magnetic resonance imaging is a satisfactory diagnostic tool for evaluating meniscal and ligamentous lesions of the knee, but it is unable to clearly identify articular cartilage lesions. (author)

  13. Natural nitration of CXCL12 reduces its signaling capacity and chemotactic activity in vitro and abrogates intra-articular lymphocyte recruitment in vivo

    DEFF Research Database (Denmark)

    Janssens, Rik; Mortier, Anneleen; Boff, Daiane

    2016-01-01

    The chemokine CXCL12/stromal cell-derived factor-1 is important for leukocyte migration to lymphoid organs and inflamed tissues and stimulates tumor development. In vitro, CXCL12 activity through CXCR4 is abolished by proteolytic processing. However, limited information is available on in vivo ef...

  14. Partial-thickness articular surface rotator cuff tears in patients over the age of 35: Etiology and intra-articular associations

    Directory of Open Access Journals (Sweden)

    Chetan S Modi

    2012-01-01

    Full Text Available Purpose: Partial-thickness articular-sided rotator cuff tears have a multifactorial etiology and are associated with degeneration of the tendon. They are often described as an injury of the young athlete, although they are also found in the older population. The aim of this study was to investigate the frequency and associations of partial-thickness articular-sided tears in patients over the age of 35 years. Design: Retrospective Materials and Methods: A retrospective study of all arthroscopic procedures for rotator cuff pathology in patients over the age of 35 years over a 2-year period by a single surgeon was performed. The included patients were divided into two groups based on the arthroscopic findings: those with a partial-thickness articular-sided rotator cuff tear and those with pure tendinopathy. The groups were then compared to identify the associated pathology with the rotator cuff lesions. 2×2 contingency table analysis and unpaired Student′s t-test were used for statistical analysis. Results: One hundred patients were included in the study of whom 62 had a partial articular-sided tear. Those with a partial articular-sided tear were older (P=0.0001, were more commonly associated with a documented injury (P=0.03, and more commonly had biceps degeneration (P=0.001 and synovitis (P=0.02 within the joint. Conclusion: Partial-thickness articular-sided tears are a common occurrence in patients requiring arthroscopic surgery for rotator cuff pathology over the age of 35 years. This probably reflects an injury in an already degenerate cuff. This would support the theory of intrinsic degeneration of the tendon in this age group and probably represent a different etiology to those seen in the young athletes. Level of Evidence: Level 3

  15. Intra-Articular Injection of Cross-Linked Hyaluronic Acid-Dexamethasone Hydrogel Attenuates Osteoarthritis: An Experimental Study in a Rat Model of Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Zhiwei Zhang

    2016-04-01

    Full Text Available Cross-linked hyaluronic acid hydrogel (cHA gel and dexamethasone (Dex have been used to treat knee osteoarthritis (OA in clinical practice owing to their chondroprotective and anti-inflammatory effects, respectively. The aim of the present study was to compare the treatment effects of the cHA gel pre-mixed with/without Dex in a surgery-induced osteoarthritis model in rats. Anterior cruciate ligament transection (ACLT surgery was performed on the right knee of rats to induce OA. Male 2-month-old Sprague-Dawley rats were randomly divided into five groups (n = 10/per group: (1 ACLT + saline; (2 ACLT + cHA gel; (3 ACLT + cHA-Dex (0.2 mg/mL gel; (4 ACLT + cHA-Dex (0.5 mg/mL gel; (5 Sham + saline. Intra-joint injections were performed four weeks after ACLT in the right knee. All animals were euthanized at 12 weeks post-surgery. Cartilage damage and changes in the synovial membrane were assessed by micro X-ray, Indian ink articular surface staining, Safranin-O/Fast Green staining, immunohistochemistry, hematoxylin and eosin staining of the synovial membrane, and quantitative reverse transcription-polymerase chain reaction for changes in gene expression. Micro X-ray revealed that the knee joint treated with the cHA-Dex gel was wider than those treated with cHA gel alone or saline. The cHA-Dex gel group had less Indian ink staining (indicator of cartilage fibrillation than the cHA gel or saline injection groups. Safranin-O/Fast Green staining indicated that increased proteoglycan staining and less cartilage damage were found in the cHA-Dex gel group compared with the cHA gel or saline injection groups. Quantification of histology findings from saline, cHA gel, cHA-Dex (0.2 mg/mL gel, cHA-Dex (0.5 mg/mL gel, and sham groups were 5.84 ± 0.29, 4.50 ± 0.87, 3.00 ± 1.00, 2.00 ± 0.48, and 0.30 ± 0.58 (p < 0.05, respectively. A strong staining of type II collagen was found in both the cHA-Dex gel groups compared with saline group or cHA alone group. Similar result was found for the mRNA level of aggrecan and opposite result for type X collagen. Hematoxylin and eosin staining in the synovial membrane showed less synovial lining cell layers and reduced inflammatory cell infiltration in cHA-Dex gel-treated animals compared with saline or cHA only groups. Altogether, cHA-Dex gel has better chondroprotective and anti-inflammatory effects in rat surgery-induced osteoarthritis than cHA alone.

  16. [Effect of SL-1010 (sodium hyaluronate with high molecular weight) on experimental osteoarthritis induced by intra-articularly applied papain in rabbits].

    Science.gov (United States)

    Kitoh, Y; Katsuramaki, T; Tanaka, H; Tanaka, M; Kitabayashi, N; Kataoka, M; Fujimori, S; Umemoto, J; Namba, K

    1992-07-01

    Sodium hyaluronate (HA) with a molecular weight of approximately 600,000-1,200,000 is reportedly effective against osteoarthritis (OA). However, since HA with higher molecular weight is expected to be more effective against OA, we investigated the effects of HA (SL-1010) newly produced by fermentation with a molecular weight of 1,800,000-2,100,000 on the experimental OA induced by intraarticular injection of papain, into the knee joint of the rabbit, in comparison with those of HA with a molecular weight of about 950,000 (HA-95). When 0.4, 0.8, and 1.6% papain (0.5ml) was injected into the knee joint of the animal twice with a 3-day interval, there were dose-dependent degenerative changes and a decrease in sulfated glycosaminoglycan (S-GAG) in the articular cartilage with slight synovial inflammatory changes 6 weeks after the final injection of papain. In this OA model, intraarticular application of SL-1010 slightly reduced the degeneration of articular cartilage, compared with the injections of HA-95 or saline (control). SL-1010 also caused a significant recovery in the S-GAG level which was decreased in the cartilage of the OA model, compared with the control. In addition, SL-1010 inhibited the release of 35S-GAG from the cartilage obtained from normal and OA model joints. These results suggest that SL-1010 is effective in inhibiting the degeneration of cartilage in the OA model, probably due to the recovery of the S-GAG level by reducing the release of S-GAG from the cartilage.

  17. Ultrasound guidance to perform intra-articular injection of gadolinium-based contrast material for magnetic resonance arthrography as an alternative to fluoroscopy: the time is now

    Energy Technology Data Exchange (ETDEWEB)

    Messina, Carmelo [Universita degli Studi di Milano, Scuola di Specializzazione in Radiodiagnostica, Milano (Italy); Banfi, Giuseppe [IRCCS Istituto Ortopedico Galeazzi, Milano (Italy); Universita Vita-Salute San Raffaele, Milano (Italy); Aliprandi, Alberto [Universita degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano (Italy); Mauri, Giovanni [Universita degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano (Italy); Istituto Europeo di Oncologia, Unita di Radiologia Interventistica, Milano (Italy); Secchi, Francesco; Sardanelli, Francesco; Sconfienza, Luca Maria [Universita degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano (Italy); IRCCS Policlinico San Donato, Servizio di Radiologia, San Donato, Milanese (Italy)

    2016-05-15

    Magnetic resonance (MR) imaging has been definitively established as the reference standard in the evaluation of joints in the body. Similarly, magnetic resonance arthrography has emerged as a technique that has been proven to increase significantly the diagnostic performance if compared with conventional MR imaging, especially when dealing with fibrocartilage and articular cartilage abnormalities. Diluted gadolinium can be injected in the joint space using different approaches: under palpation using anatomic landmarks or using an imaging guidance, such as fluoroscopy, computed tomography, or ultrasound. Fluoroscopy has been traditionally used, but the involvement of ionizing radiation should represent a remarkable limitation of this modality. Conversely, ultrasound has emerged as a feasible, cheap, quick, and radiation-free modality that can be used to inject joints, with comparable accuracy of fluoroscopy. In the present paper, we discuss the advantages and disadvantages of using fluoroscopy or ultrasound in injecting gadolinium-based contrast agents in joints to perform magnetic resonance arthrography, also in view of the new EuroSAFE Imaging initiative promoted by the European Society of Radiology and the recent updates to the European Atomic Energy Community 2013/59 directive on the medical use of ionizing radiation. (orig.)

  18. Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Hetland, Merete Lund; Østergaard, Mikkel; Ejbjerg, Bo;

    2012-01-01

    by Kaplan-Meier plots of the joint injection survival (ie, the time between injection and renewed flare). Potential predictors of joint injection survival were tested.RESULTS: 1373 Unique joints (ankles, elbows, knees, metacarpophalangeal (MCP), metatarsophalangeal, proximal interphalangeal (PIP), shoulders...

  19. Fluoroscopy-guided intra-articular steroid injection for sternoclavicular joint arthritis secondary to limited cutaneous systemic sclerosis: a case report

    Science.gov (United States)

    Güler, Emel; Cüce, Isa; Erol, Kemal

    2017-01-01

    We report a case of fluoroscopy-guided intraarticular steroid injection for sternoclavicular joint (SCJ) arthritis caused by limited cutaneous systemic sclerosis (SSc). A 50-year-old woman diagnosed with limited cutaneous SSc presented with swelling and pain in the right SCJ. MRI revealed signs of inflammation consistent with right-sided sternoclavicular joint arthritis. After the failure of oral medications, we performed fluoroscopy-guided injection in this region. She reported complete resolution of her symptoms at 4 and 12-week follow-ups. This outcome suggests that a fluoroscopy-guided SCJ injection might be a safe and successful treatment option for sternoclavicular joint arthritis. PMID:28119772

  20. Accurate intra-articular knee joint injection in the obese? 'Fat Chance!'-A clinical lesson and recommendations for secondary referral.

    LENUS (Irish Health Repository)

    McGarry, James G

    2011-04-12

    Abstract Corticosteroid joint injections are perceived as being an effective treatment for symptomatic knee osteoarthritis, with a very low risk of complications. While the procedure is often performed in secondary care by orthopaedic surgeons and rheumatologists (and trainees in either specialty), the role of general practitioners (GPs) in chronic disease management has long existed with joint injections also frequently performed in primary care. The perception that serious complications from corticosteroid knee joint injections are rare and that their benefits in treating symptomatic knee osteoarthritis significantly outweigh the risks has not been well addressed. We present a case of a 71-year-old obese female who presented to her general practitioner (GP) with worsening left knee pain and radiographic changes consistent with osteoarthritis. She was administered a corticosteroid joint injection, which gave minimal relief, and over the next few days resulted in worsening severe pain, erythema and swelling. She returned to the GP who commenced oral antibiotics and referred her to casualty. A large knee abscess was diagnosed and intravenous antibiotics were commenced. The patient was admitted under the orthopaedic surgeons with her treatment consisting of multiple surgical procedures over a prolonged duration. Although lengthy, her postoperative recovery was unremarkable. Based on this case report and our review of the literature, we highlight the potential complications associated with corticosteroid knee joint injections and suggest certain patients for whom we would recommend secondary referral before any intervention in primary care.

  1. Effects of intra-articular injection of mesenchymal stem cells associated with platelet-rich plasma in a rabbit model of osteoarthritis.

    Science.gov (United States)

    Hermeto, L C; DeRossi, R; Oliveira, R J; Pesarini, J R; Antoniolli-Silva, A C M B; Jardim, P H A; Santana, A E; Deffune, E; Rinaldi, J C; Justulin, L A

    2016-09-02

    The current study aims to evaluate the macroscopic and histological effects of autologous mesenchymal stem cells (MSC) and platelet-rich plasma on knee articular cartilage regeneration in an experimental model of osteoarthritis. Twenty-four rabbits were randomly divided into four groups: control group, platelet-rich plasma group, autologous MSC undifferentiated group, and autologous MSC differentiated into chondrocyte group. Collagenase solution was used to induce osteoarthritis, and treatments were applied to each group at 6 weeks following osteoarthritis induction. After 60 days of therapy, the animals were euthanized and the articular surfaces were subjected to macroscopic and histological evaluations. The adipogenic, chondrogenic, and osteogenic differentiation potentials of MSCs were evaluated. Macroscopic and histological examinations revealed improved tissue repair in the MSC-treated groups. However, no difference was found between MSC-differentiated and undifferentiated chondrocytes. We found that MSCs derived from adipose tissue and platelet-rich plasma were associated with beneficial effects in articular cartilage regeneration during experimental osteoarthritis.

  2. A Case-Control Study Comparing Bone Bruising and Intra-articular Injuries in Patients Undergoing Anterior Cruciate Ligament Reconstruction With and Without Medial Collateral Ligament Tears

    Science.gov (United States)

    Kluczynski, Melissa A.; Marzo, John M.; Rauh, Michael A.; Bernas, Geoffrey A.; Bisson, Leslie J.

    2016-01-01

    Background: Concomitant injuries can occur in patients with combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears; however, no studies have compared these injuries in patients undergoing ACL reconstruction with an MCL tear to those with an intact MCL. Purpose: To compare bone bruising, meniscus tears, and chondral lesions in patients undergoing ACL reconstruction with an MCL tear (cases) to those with an intact MCL (controls). Study Design: Case-control study; Level of evidence, 3. Methods: Thirty-two cases and 352 controls were identified from a prospective registry. Bone bruising was confirmed on magnetic resonance imaging, and meniscus tears and chondral lesions were confirmed arthroscopically. Demographics and concomitant injuries were compared between cases and controls using exact chi-square tests. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% CIs adjusted for age, sex, body mass index, and mechanism and type of injury. Results: Cases had significantly more contact injuries than controls (58.1% vs 21.3%, P < .0001). The prevalence and odds of bone bruising of the lateral tibial plateau (89.7% vs 84.6%; P = .59; OR, 3.53; 95% CI, 0.45-27.71), lateral femoral condyle (82.8% vs 72.8%; P = .28; OR, 1.94; 95% CI, 0.64-5.88), medial tibial plateau (20.7% vs 31.7%; P = 0.29; OR, 0.53; 95% CI, 0.19-1.53), and medial femoral condyle (6.9% vs 8.3%; P ≥ .999; OR, 1.07; 95% CI, 0.21-5.40) did not differ significantly between cases and controls. The prevalence and odds of lateral meniscus tears (53.3% vs 43%; P = .34; OR, 1.85; 95% CI, 0.76-4.52), medial meniscus tears (31.3% vs 33.5%; P = .85; OR, 0.90; 95% CI, 0.37-2.21), and chondral lesions (16% vs 10.8%; P = .50; OR, 0.70; 95% CI, 0.15-3.21) also did not significantly differ between cases and controls. Conclusion: ACL-MCL injuries were most often due to a contact mechanism, whereas ACL tears without associated MCL injury were more frequently due to a noncontact mechanism. However, there were no significant differences in concomitant injuries in ACL-MCL knees versus ACL knees. PMID:27540558

  3. Intra-Articular Blockade of P2X7 Receptor Reduces the Articular Hyperalgesia and Inflammation in the Knee Joint Synovitis Especially in Female Rats.

    Science.gov (United States)

    Teixeira, Juliana Maia; Dias, Elayne Vieira; Parada, Carlos Amílcar; Tambeli, Cláudia Herrera

    2017-02-01

    Synovitis is a key factor in joint disease pathophysiology, which affects a greater proportion of women than men. P2X7 receptor activation contributes to arthritis, but whether it plays a role in articular inflammatory pain in a sex-dependent manner is unknown. We investigated whether the P2X7 receptor blockade in the knee joint of male and female rats reduces the articular hyperalgesia and inflammation induced by a carrageenan knee joint synovitis model. Articular hyperalgesia was quantified using the rat knee joint incapacitation test and the knee joint inflammation, characterized by the concentration of cytokines tumor necrosis factor-α, interleukin-1β, interleukin-6, and cytokine-induced neutrophil chemoattractant-1, and by neutrophil migration, was quantified using enzyme-linked immunosorbent assay and by myeloperoxidase enzyme activity measurement, respectively. P2X7 receptor blockade by the articular coadministration of selective P2X7 receptor antagonist A740003 with carrageenan significantly reduced articular hyperalgesia, pro-inflammatory cytokine concentrations, and myeloperoxidase activity induced by carrageenan injection into the knee joint of male and estrus female rats. However, a lower dose of P2X7 receptor antagonist was sufficient to significantly induce the antihyperalgesic and anti-inflammatory effects in estrus female but not in male rats. These results suggest that P2X7 receptor activation by endogenous adenosine 5'-triphosphate is essential to articular hyperalgesia and inflammation development in the knee joint of male and female rats. However, female rats are more responsive than male rats to the antihyperalgesic and anti-inflammatory effects induced by P2X7 receptor blockade.

  4. [Animal experiment studies on the effect of intra-articular injections of antiphlogistic-antirheumatic agents on articular cartilage in vivo].

    Science.gov (United States)

    Kalbhen, D A; Schauer, M; Wentsche, B

    1978-01-01

    Animal experiments have shown that weekly intraarticular injections of various antiphlogistic/antirheumatic drugs into the knee joint induce progressive degenerative alterations in joint cartilage. The observed degenerations and destructions are most similar to the pathophysiology of osteoarthrosis in humans. By X-ray and macroscopic techniques the degenerative processes can be studied qualitatively and quantitatively. A decrease of joint space is a sensitive and early indicator of osteoarthrosis and showed that 10 weeks after intraarticular application of Ibuprofen, Phenylbutazone, Oxyphenbutazone, Flufenamic acid, Niflumic acid, Na-salicylate, Clofezone, Bumadizone and Dexamethasone the degenerative alterations in the injected knee joints were more severe than by applications of Chloroquine,D-penicillamine, Salicylamide and Indometacin. The degenerative effect on articular cartilage by the investigated drugs can be explained by their inhibitory potency on anabolic metabolism of connective tissue. The results of our animal experiments lead to the conclusion, that antiinflammatory drugs may also in man induce or accelerate degenerative joint diseases especially after long term treatment with high doses of these drugs.

  5. Incorporating Novel Mobile Health Technologies Into Management of Knee Osteoarthritis in Patients Treated With Intra-Articular Hyaluronic Acid: Rationale and Protocol of a Randomized Controlled Trial

    OpenAIRE

    Jones, Donald; Skrepnik, Nebojsa; Toselli, Richard M; Leroy, Bruno

    2016-01-01

    Background Osteoarthritis (OA) of the knee is one of the leading causes of disability in the United States. One relatively new strategy that could be helpful in the management of OA is the use of mHealth technologies, as they can be used to increase physical activity and promote exercise, which are key components of knee OA management. Objective Currently, no published data on the use of a mHealth approach to comprehensively monitor physical activity in patients with OA are available, and sim...

  6. Intra-articular contact stress distributions at the ankle throughout stance phase-patient-specific finite element analysis as a metric of degeneration propensity.

    Science.gov (United States)

    Anderson, Donald D; Goldsworthy, Jane K; Shivanna, Kiran; Grosland, Nicole M; Pedersen, Douglas R; Thomas, Thaddeus P; Tochigi, Yuki; Marsh, J Lawrence; Brown, Thomas D

    2006-06-01

    A contact finite element (FE) formulation is introduced, amenable to patient-specific analysis of cumulative cartilage mechano-stimulus attributable to habitual functional activity. CT scans of individual human ankles are segmented to delineate bony margins. Each bone surface is projected outward to create a second surface, and the intervening volume is then meshed with continuum hexahedral elements. The tibia is positioned relative to the talus into a weight-bearing apposition. The articular members are first engaged under light preload, then plantar-/dorsi-flexion kinematics and resultant loadings are input for serial FE solutions at 13 instants of the stance phase of level walking gait. Cartilage stress histories are post-processed to recover distributions of cumulative stress-time mechano-stimulus, a metric of degeneration propensity. Consistency in computed contact stress exposures presented for seven intact ankles stood in contrast to the higher magnitude and more focal exposures in an incongruously reduced tibial plafond fracture. This analytical procedure provides patient-specific estimates of degeneration propensity due to various mechanical abnormalities, and it provides a platform from which the mechanical efficacy of alternative surgical interventions can be estimated.

  7. Exploring reasons for the observed inconsistent trial reports on intra-articular injections with hyaluronic acid in the treatment of osteoarthritis

    DEFF Research Database (Denmark)

    Johansen, Mette; Bahrt, Henriette; Altman, Roy D

    2016-01-01

    ). METHODS: A systematic review and meta-regression analyses of available randomized trials were conducted. The outcome, pain, was assessed according to a pre-specified hierarchy of potentially available outcomes. Hedges׳s standardized mean difference [SMD (95% CI)] served as effect size. REstricted Maximum...

  8. Accuracy of non-arthrographic 3T MR imaging in evaluation of intra-articular pathology of the hip in femoroacetabular impingement

    Energy Technology Data Exchange (ETDEWEB)

    Linda, Dorota D. [University of Toronto, Department of Medical Imaging, Joint Department of Medical Imaging, Division of Musculoskeletal Imaging, Toronto (Canada); Mount Sinai Hospital, Toronto, ON (Canada); Naraghi, Ali; White, Lawrence M. [University of Toronto, Department of Medical Imaging, Joint Department of Medical Imaging, Division of Musculoskeletal Imaging, Toronto (Canada); Murnaghan, Lucas; Whelan, Daniel [University of Toronto, Department of Surgery, Division of Orthopedics, Toronto (Canada)

    2017-03-15

    To investigate the accuracy of non-arthrographic 3-T MRI compared to hip arthroscopy in the assessment of labral and cartilaginous pathology in patients with suspected FAI. Following IRB approval and waived consent, 42 consecutive cases of suspected FAI with non-arthrographic 3-T MRI and arthroscopy of the hip were reviewed. High-resolution TSE MR imaging was evaluated in consensus by two musculoskeletal radiologists, blinded to arthroscopic findings, for the presence of labral tears and articular cartilage lesions. Acetabular cartilage was categorized as normal, degeneration/fissuring, delamination, or denudation. MRI findings were compared to arthroscopy. Sensitivity, specificity, accuracy, and predictive values for MRI were calculated using arthroscopy as the standard of reference. Forty-two hips in 38 patients with a mean age of 29 (range 13-45 years) were assessed. Mean interval between MRI and arthroscopy was 154 days (range 27-472 days). MRI depicted 41 cases with labral tears (sensitivity 100%, specificity 50%, accuracy 98%, PPV 98%, NPV 100%), 11 cases with femoral cartilage abnormalities (sensitivity 85%, specificity 100%, accuracy 95%, PPV 100%, NPV 94%), and 36 cases with acetabular cartilage lesions (sensitivity 94% specificity 67%, accuracy 90%, PPV 94%, NPV 67%). Of the 36 cases with acetabular cartilage lesions on MRI, 7 were characterized as degeneration/fissuring, 26 as delamination, and 3 as denudation, with discordant results between MRI and arthroscopy for grading of articular cartilage in ten cases. Non-arthrographic 3-T MR imaging is a highly accurate technique for evaluation of the labrum and cartilage in patients with clinically suspected FAI. (orig.)

  9. Apuntes sobre encuestas electorales

    Directory of Open Access Journals (Sweden)

    Luis Benavente Gianella

    2013-12-01

    Full Text Available Las encuestas preelectorales suelen despertar gran interés por el valor predictivo que se les puede atribuir o que puedan tener, y por el efecto que puedan generar en los votantes. También se usan como herramienta efectiva para el manejo de las campañas de los candidatos. Existen tres tipos de encuestas electorales: preelectorales, boca de urna y postelectorales, en cada caso cumplen funciones diferentes en relación con los procesos electorales. Philippe Maarek (1 considera que la publicación de encuestas preelectorales influye en la decisión de voto mediante efectos directos e indirectos. Es en coyunturas preelectorales cuando las encuestas suelen concitar la mayor atención, especialmente por el valor predictivo que se les puede atribuir o que puedan tener, y por el efecto que puedan generar en los votantes, de manera especial en los indecisos, que constituyen un porcentaje usualmente muy alto durante casi toda la etapa preelectoral. Esto hace que las encuestas sean controvertidas y discutidas en el mundo. En los procesos electorales, las encuestas también son utilizadas como una herramienta efectiva para el manejo eficiente de las campañas de los candidatos, asumiendo de esta manera un papel protagónico y permanente en las campañas. Además de sus implicancias electorales, las encuestas tienen asimismo presencia en la vida política institucional en épocas no electorales. Actualmente son utilizadas para conocer la opinión de los ciudadanos acerca de diversos temas políticos, económicos y sociales. Las encuestadoras realizan sondeos periódicos sobre todos estos aspectos que son difundidos a través de los medios de comunicación, alimentando de este modo el debate político. En la actualidad, las encuestas de opinión son una práctica habitual en todos los países con regímenes democráticos, constituyéndose en un instrumento de medición de la opinión de los ciudadanos.

  10. ESTUDO HISTOPATÓLOGICO NAS CÓRNEAS DOS CÃES TRATADOS COM 2-1 FOSFATO DISSÓDICO DE BETAMETASONA E FOSFATO DISSÓDICO/ACETATO DE DEXAMETASONA, QUE RECEBERAM TRASPLANTES COM CÓRNEAS DE SUÍNOS HISTOPHATOLOGICAL STUDY IN CORNEAS OF DOGS, TREATED WITH 2-1 DISSODIC FOSPHATE OF BETAMETHASONE AND DISSODIC FOSPHATED/ACETATE OF DEXAMETHASONE, THAT HAD RECEIVED IMPLANTATION OF SWINE CORNEAS

    Directory of Open Access Journals (Sweden)

    Luiz Antônio Franco da Silva

    2007-09-01

    Full Text Available

    Foram utilizados 10 cães, sem raça definida, com peso médio de 10kg, examinados e considerados sadios. Cada cão, a seu tempo, teve implantada no olho esquerdo córnea de suíno, conservada em câmara úmida pelo período máximo de seis horas. Cada animal antes da cirurgia recebeu 4 mg de fosfato dissódico/acetato de dexametasona, por via intramuscular, e uma gota de fosfato dissódico de betametasona/sulfato de gentamicina colírio. Conservou-se a medicação ocular 4 vezes/dia e a intramuscular semanalmente, até o sacrifício do cão. Cada qual foi sacrificado por processo indolor (thiopental sódico + cloreto de succinilcolina e teve o olho que recebeu implante com córnea de suíno enucleado. Foi injetado formol 10% na câmara do vítreo e a córnea foi removida com aba escleral, tratada e corada com hematoxilina-eosina. Foram analisadas as seguintes áreas: enxerto, áreas adjacentes receptoras e observadas as várias alterações.

    PALAVRAS-CHAVE: Histopatologia; corticosteróides; xenotransplantes; córnea; canino; suíno.

    Ten dogs, with no definitive breed, average weight of 10 kg, were in this research. After being examined and considered healthy they received numbers, from 11 to 20 in their collars. Each dog received implantation, in the left eye, of swine cornea, obtained at Casa de Banha Caçula, a slaughterhouse, and maintained in wet chamber for six hours at most. Before surgery, each animal received 4 mg of dissodic phosphate/acetate dexamethasone IM and, once a week one drop of dissodic phosphate betamethasone and gentamicin sulphate, four times a day, until the 28th day. when the animals were sacrificed through painless process (Thiopental sodic

  11. Historicismo: notas sobre um paradigma

    National Research Council Canada - National Science Library

    José D’Assunção Barros

    2012-01-01

    Este artigo tem por objetivo desenvolver algumas considerações sobre o Historicismo e sua possibilidade de ser examinado como um dos paradigmas que concorrem para o estabelecimento de uma história científica no século XIX...

  12. Acueducto pretensado sobre el Holme

    Directory of Open Access Journals (Sweden)

    Editorial, Equipo

    1958-04-01

    Full Text Available Breve descripción del paso de una canalización de 0,60 m de diámetro, destinada al abastecimiento de aguas, sobre el río Holme (Inglaterra. El puente formado tiene dos vigas de hormigón pretensado, cuyas armaduras se componen de barras McCall.

  13. Sobre Humanismo y Medicina

    Directory of Open Access Journals (Sweden)

    Adolfo de Francisco Zea

    2000-12-01

    Full Text Available

    En esta disertación sobre “Humanismo y Medicina”, título del libro que tuve ocasión de publicar hace un par de años, destacaré algunas de las relaciones que existen entre la medicina y las bellas artes, concretamente la música y la pintura. La Medicina tiene como objeto de su acción al Hombre. Definida como la ciencia y el arte de prevenir, curar o aliviar la enfermedad, no tiene como meta la simple prolongación de la vida biológica.

    Su tarea consiste en postergar la muerte, prevenir o reducir los padecimientos y las deformidades, curar las enfermedades, ampliar las capacidades biológicas y psicológicas de los seres humanos y ocuparse de los sufrimientos de las personas. Para Tristam Engelhardt, es la Medicina de las personas.

    Se concibe a la persona humana como el individuo de conciencia reflexiva normal que es a la vez miembro pleno de la comunidad, con los deberes y derechos que presuponen su pertenencia a ella. A esta acepción de carácter moral de la persona humana, que corresponde a lo que se llama persona “en sentido estricto”, se agrega la acepción social, que hace relación con aquellas personas a las que se otorgan prácticamente los mismos derechos, como es el caso de los niños, de los individuos que perdieron el carácter de personas por padecer de lesiones cerebrales o demencia, y de aquellos que nunca llegarán a serlo como los retrasados mentales profundos.

    Al sostener que no todos los seres humanos son personas “en sentido estricto”, la Bioética que expone Engelhardt impone, sin embargo, como obligación moral, tratar a estos últimos con pleno respeto y comprensión. Lo que es importante acerca de nosotros mismos como seres humanos, es el hecho real de que seamos personas; no simplemente nuestra pertenencia al género Horno sapiens como tal.

    Para Víctor Frankl, la persona humana es de carácter espiritual y en tal virtud, es diferente del organismo psicofísico cuya

  14. Breve informe sobre la coca

    Directory of Open Access Journals (Sweden)

    Lauro Hinostroza García

    1985-12-01

    Full Text Available El presente informe se integra en la investigación dirigida por el doctor Juan Ossio, por encargo de la Organización de los Estados Americanos (O.E.A. sobre “EFECTOS SOCIALES, CULTURALES, MÉDICOS Y ECONÓMICOS DEL USO TRADICIONAL DE LA COCA EN POBLACIONES DEL ANTIPLANO Y SIERRA DEL PERÚ, EN ESPECIAL DE LAS POBLACIONES INDÍGENAS”. Expone tópicos sobre la hoja de coca en la cultura andina: criterios clasificatorios, mitos, canciones y una muestra de qatipay o seguimiento. Este último es una práctica ritual importante para el campesinado andino, orienta el presente, pasado y futuro de toda su actividad. Cada hoja, por su forma, posición y tamaño, develará los roles sociales que ha de asumir, es decir los misterios del tiempo.

  15. Sobre la verdad en periodismo

    Directory of Open Access Journals (Sweden)

    Julio Estremadoyro Alegre

    2011-05-01

    Full Text Available Cuando un periodista informa sobre un desastre natural, con granpérdida de vidas, las autoridades y las fuentes de primera manodan cifras que son difundidas como verdades del suceso. Sinembargo, y la experiencia lo confirma, al día siguiente la cifraspueden haber cambiado y, por lo tanto, la verdad informativa esotra. Y así, sucesivamente, cada día habrá novedades y nuevas cifras verdaderas.

  16. Manual de lecciones sobre objetos

    OpenAIRE

    2010-01-01

    Pautas para la enseñanza inicial con niños, apoyado con Objetos. Traducido por S. Bond (Profesor de la Universidad Nacional). Contiene: Desarrollo de la observación - Desarrollo de las ideas de forma - Ejercicios preliminares para enseñar a los niños a observar formas - Desarrollo de las ideas de dibujo -  de color - de número - de tamaño - de peso -  de sonido -  sobre el cuerpo humano - de lugar - morales

  17. Prototipo de RINA sobre Ethernet

    OpenAIRE

    Bergesio, Leonardo

    2013-01-01

    Este PFM se enmarca dentro del trabajo a realizar por el proyecto IRATI. IRATI es un proyecto STReP (Specific Targeted Research Project) financiado por la Unión Europea dentro del programa FP7 (Seventh Framework Programme for Research and Technological Development). El objetivo general de IRATI es conseguir una mayor compresión y exploración de RINA. El trabajo que se reportará en este PFM es (aproximadamente) la primera fase del diseño y desarrollo de un prototipo de RINA sobre Ethernet en e...

  18. Sobre el Kelsen de Ferrajoli

    OpenAIRE

    Ruiz Manero, Juan

    2015-01-01

    El objeto de este trabajo es el de dar cuenta de las críticas a Kelsen contenidas en el último libro, todavía inédito, de Luigi Ferrajoli, Diritto e lógica. Dieci aporie nell'opera di Hans Kelsen, y formular algunas críticas a las tesis sostenidas en él por el propio Ferrajoli. Entre las críticas que el autor considera que cabe dirigir a este respecto a Ferrajoli, las principales afectan al carácter exclusivamente interno de la mirada ferrajoliana sobre el derecho, al carácter siempre opinabl...

  19. Sobre el contenido del despertar

    OpenAIRE

    Badr, Marisa

    2013-01-01

    El presente trabajo tiene como propósito situar algunas referencias, sobre lo que Freud denomina “la perturbación” en los sueños. De este modo, intentaremos situar algunas consideraciones respecto a los sueños de angustia como principal antecedente del fracaso de la función del sueño y del principio del placer como principio rector del aparato anímico. Tomaremos como punto de partida los sueños de angustia, en “La interpretación de los sueños” de Sigmund Freud.

  20. Sobre el contenido del despertar

    OpenAIRE

    Badr, Marisa

    2013-01-01

    El presente trabajo tiene como propósito situar algunas referencias, sobre lo que Freud denomina “la perturbación” en los sueños. De este modo, intentaremos situar algunas consideraciones respecto a los sueños de angustia como principal antecedente del fracaso de la función del sueño y del principio del placer como principio rector del aparato anímico. Tomaremos como punto de partida los sueños de angustia, en “La interpretación de los sueños” de Sigmund Freud.