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European Journal of Orthopaedic Surgery... Jul 2023The purpose of this prospective randomized clinical trial is to compare the clinical outcomes of three injections of leucocyte-poor platelet-rich plasma (LP-PRP) and... (Randomized Controlled Trial)
Randomized Controlled Trial
Autologous microfragmented adipose tissue and leukocyte-poor platelet-rich plasma combined with hyaluronic acid show comparable clinical outcomes for symptomatic early knee osteoarthritis over a two-year follow-up period: a prospective randomized clinical trial.
PURPOSE
The purpose of this prospective randomized clinical trial is to compare the clinical outcomes of three injections of leucocyte-poor platelet-rich plasma (LP-PRP) and hyaluronic acid (HA) to a single dose of autologous microfragmented adipose tissue (AMAT) in patients with mild osteoarthritis at a two-year follow-up.
METHODS
Eighty symptomatic knees in fifty patients (mean age: 62.38 ± 11.88 years) with Kellgren-Lawrence grade 0 to 2 osteoarthritis were non blinded, randomly allocated into two equal groups. Group 1 consisted of 40 knees that received autologous LP-PRP + HA; Group 2 consisted of 40 knees treated with a single dose of AMAT injection. The outcomes were measured by Tegner, Marx, Visual Analogue Scale (VAS) for pain, International Knee Documentation Committee, and Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6 (T), 12 (T), and 24 (T) months. Adverse events were recorded at each follow-up timepoint. To assess score differences among subjects of the same gender and age, a subgroup analysis was performed.
RESULTS
Both groups had significant clinical and functional improvement at 6, 12, and 24 months (p < 0.05). Comparing the two groups, the AMAT groups showed significantly higher pre-operative Marx score (3.35 ± 4.91 vs. 1.78 ± 3.91) and VAS score (5.03 ± 2.02 vs. 3.85 ± 1.68) (p < 0.05), higher VAS (3.89 ± 2.51 vs. 2.64 ± 2.00) at T and KOOS-ADL (79.60 ± 20.20 vs. 65.68 ± 23.62), and lower KOOS-Sports (50.30 ± 30.15 vs. 68.35 ± 30.39) at T (p < 0.05). No patient from either group had experienced major adverse effects. In the LP-PRP group 12 (30%) patients presented swelling, redness, and mild pain for one day after injection and two patients had synovitis for two days and required paracetamol and local ice. In AMAT group 5 (12.5%) patients had ecchymosis and bruising at the fat aspiration site for three days.
CONCLUSION
AMAT did not show significant superior clinical improvement compared with three LP-PRP combined with HA injections in terms of functional improvement at different follow-up points. Both procedures were safe with no major complications reporting good results at mid-term follow-up, improving knee function, pain, and quality of live regardless of age and gender.
LEVEL OF EVIDENCE
Level I-Prospective Randomized Clinical Trial.
Topics: Humans; Middle Aged; Aged; Hyaluronic Acid; Osteoarthritis, Knee; Follow-Up Studies; Prospective Studies; Treatment Outcome; Injections, Intra-Articular; Pain; Platelet-Rich Plasma; Leukocytes
PubMed: 35997833
DOI: 10.1007/s00590-022-03356-2 -
Pediatric Rheumatology Online Journal Jan 2024Germline heterozygous gain-of-function (GOF) mutations in the PIK3CD gene lead to a rare primary immunodeficiency disease known as activated phosphoinositide 3-kinase...
BACKGROUND
Germline heterozygous gain-of-function (GOF) mutations in the PIK3CD gene lead to a rare primary immunodeficiency disease known as activated phosphoinositide 3-kinase (PI3K) δ syndrome type 1(APDS1). Affected patients present a spectrum of clinical manifestations, particularly recurrent respiratory infections and lymphoproliferation, increased levels of serum immunoglobulin (Ig) M, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) viremia. Due to highly heterogeneous phenotypes of APDS1, it is very likely that suspected cases may be misdiagnosed.
METHODS
Herein we reported three patients with different clinical presentations but harboring pathogenic variants in PIK3CD gene detected by trio whole-exome sequencing (trio-WES) and confirmed by subsequent Sanger sequencing.
RESULTS
Two heterozygous mutations (c.3061G > A, p.E1021K and c.1574 A > G, p.E525G) in PIK3CD (NM_005026.3) were identified by whole exome sequencing (WES) in the three patients. One of two patients with the mutation (c.3061G > A) presented with abdominal pain and diarrhea as the first symptoms, which was due to intussusception caused by multiple polyps of colon. The patient with mutation (c.1574 A > G) had an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)-like clinical manifestations, including multisystemic inflammation, acute nephritic syndrome, and positive perinuclear ANCA (p-ANCA), thus the diagnosis of ANCA-AAV was considered.
CONCLUSIONS
Our study expands the spectrums of clinical phenotype and genotype of APDS, and demonstrates that WES has a high molecular diagnostic yield for patients with immunodeficiency related symptoms, such as respiratory infections, multiple ecchymosis, ANCA-associated vasculitis, multiple ileocecal polyps, hepatosplenomegaly, and lymphoid hyperplasia.
TRIAL REGISTRATION
Retrospectively registered.
Topics: Humans; Phosphatidylinositol 3-Kinase; Phosphatidylinositol 3-Kinases; Epstein-Barr Virus Infections; Antibodies, Antineutrophil Cytoplasmic; Herpesvirus 4, Human; Class I Phosphatidylinositol 3-Kinases; Phenotype; Mutation; Respiratory Tract Infections
PubMed: 38287413
DOI: 10.1186/s12969-024-00955-7 -
Wideochirurgia I Inne Techniki... Dec 2023Endoscopic parathyroidectomy(EPTX) has been gradually introduced as a minimally invasive treatment for refractory secondary hyperparathyroidism (SHPT). However, it is...
INTRODUCTION
Endoscopic parathyroidectomy(EPTX) has been gradually introduced as a minimally invasive treatment for refractory secondary hyperparathyroidism (SHPT). However, it is uncertain about the efficacy and safety compared between EPTX and open parathyroidectomy (OPTX) for refractory SHPT.
AIM
This meta-analysis was conducted to evaluate the efficacy and safety of EPTX and OPTX for secondary hyperp arathyroidism (SHPT).
MATERIAL AND METHODS
Databases including PubMed, EMbase, Cochrane Library, CNKI, and Wanfang were searched. Eligible studies comparing EPTX and OPTX for refractory SHPT were included.
RESULTS
Compared with OPTX, EPTX has the shorter hospital stay (p < 0.01) and lower incidences of hoarseness or recurrent laryngeal nerve injury (p = 0.04). There was no significant difference between EPTX and OPTX concerning operation time (p = 0.49), intraoperative blood loss (p = 0.24), postoperative parathyroid hormone levels (p = 0.22), postoperative calcium levels (p = 0.93), postoperative phosphorus levels (p = 0.37), and complications including neck ecchymosis (p = 0.87), subcutaneous haematoma (p = 0.18), and wound infection (p = 0.11).
CONCLUSIONS
EPTX and OPTX are both effective methods for refractory SHPT. EPTX had the shorter hospital stay and lower incidences of hoarseness or recurrent laryngeal nerve injury.
PubMed: 38239584
DOI: 10.5114/wiitm.2023.132439 -
Cureus Sep 2023Background The treatment of varicose veins has undergone tremendous changes over the years. High ligation of the saphenofemoral junction (SFJ) and stripping of the great...
Background The treatment of varicose veins has undergone tremendous changes over the years. High ligation of the saphenofemoral junction (SFJ) and stripping of the great saphenous vein (GSV) have been considered standard treatments for GSV insufficiency for over a century and are still adopted as the preferred method in the majority of surgical centers in North Africa. However, the increase in minimally invasive treatments such as endovenous thermal ablation (EVTA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy, and cryo-stripping has produced excellent results. Most patients who underwent these minimally invasive treatments were satisfied with their outcomes. Methodology and results In this clinical and prospective study, 30 cases (19 male and 11 female) of primary varicose veins underwent endovenous laser ablation (EVLA), and their outcomes were reviewed, and their results were satisfying to the patients. After EVLA with or without sclerotherapy, no major complications occurred (recurrence or recanalization) at the time of the study, although minor complications were quite common and included bruising or ecchymosis, postoperative pain that required analgesics, superficial thrombophlebitis, and skin burns that were very responsive to medical treatment. Conclusion Endovenous laser ablation continues to be a valid minimally invasive method for treating varicose veins with minimal complications and a very short recovery period, which appeals to patients.
PubMed: 37842441
DOI: 10.7759/cureus.45096 -
Cureus Oct 2023Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by immune-mediated destruction of platelets, resulting in a decreased blood platelet count...
Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by immune-mediated destruction of platelets, resulting in a decreased blood platelet count (less than 100 x 10/L) in the absence of other known etiology of thrombocytopenia. ITP is uncommon in adult males. The signs and symptoms of ITP vary widely and are quite diverse. The degree of thrombocytopenia and bleeding are not always correlated. Timely diagnosis, intervention, and regular monitoring can easily prevent complications. We report a case of a 22-year-old male presented with gum bleeding along with purpura and ecchymosis over the upper limb, lower limb, trunk, and face.
PubMed: 37942396
DOI: 10.7759/cureus.46664 -
Journal of Orthopaedic Case Reports Jul 2023A Morel-Lavallée lesion (MLL) is a closed degloving injury secondary to shearing forces. MLL is a rare, easily overlooked diagnosis, especially in those without recent...
INTRODUCTION
A Morel-Lavallée lesion (MLL) is a closed degloving injury secondary to shearing forces. MLL is a rare, easily overlooked diagnosis, especially in those without recent trauma or fracture. Patients will present with ecchymosis, edema, fluctuance, and skin hypermobility or tightness. We present a case of pediatric MLL that was initially challenging to diagnose as the inciting trauma was 2 months before her diagnosis.
CASE REPORT
A 14-year-old girl presented with 5 days of left leg bruising, swelling, and pain. Two months prior, she collided with another softball player's cleat and developed a hairline fracture. Magnetic resonance imaging of the left lower extremity (LLE) showed a closed, soft-tissue degloving injury, and she was diagnosed with a MLL. Throughout her admission, she had improvement in her bruising but continued to have pain with ambulation that was somewhat alleviated with the use of a compression stocking. Pediatric Orthopedic Surgery and Interventional Radiology were consulted, and a conservative approach was recommended with 3 months of LLE compression.
CONCLUSION
MLL typically occurs in patients in their 30-40s and rarely occurs in children. Identifying MLL in children is essential as children are more susceptible to shock and multi-organ damage from blunt trauma than adults. They are also more vulnerable to fractures and deep organ injuries. In the setting of MLL, children can quickly develop hypovolemic shock due to lower blood volumes and necrosis secondary to mass effect in the dead space. MLL should be included on the differential for children with trauma or a history of a shearing injury.
PubMed: 37521378
DOI: 10.13107/jocr.2023.v13.i07.3748 -
Journal of the Korean Association of... Apr 2024External nasal splints are commonly used for immobilization following nasal fracture reduction or rhinoplasty procedures. The literature documents the use of various...
External nasal splints are commonly used for immobilization following nasal fracture reduction or rhinoplasty procedures. The literature documents the use of various materials like thermoplastic materials, aluminum, Orthoplast, fiberglass, plaster of Paris, and polyvinyl siloxane. These materials are bulky, time-consuming, expensive, and cumbersome to use, and have been associated with complications including contact dermatitis and epidermolysis. Furthermore, they cannot be retained if the situation warrants prolonged stabilization and immobilization. We introduce a new technique using readily available scalp vein catheter flanges as an external nasal stent. The technique is easy to master, inexpensive, and limits edema and ecchymosis, while stabilizing the reconstructed nasal skeleton in position during the healing period.
PubMed: 38693135
DOI: 10.5125/jkaoms.2024.50.2.116 -
Cureus Jul 2023Sclerotherapy is an accepted treatment modality for reticular varicose veins and telangiectasia. We aimed to compare the success and safety of foam and liquid...
OBJECTIVE
Sclerotherapy is an accepted treatment modality for reticular varicose veins and telangiectasia. We aimed to compare the success and safety of foam and liquid sclerotherapy in obese patients with lower extremity varicose veins and telangiectasia.
METHODS
The present study was performed in a non-randomized prospective manner, and obese patients with lower extremity varicose veins (patients with anatomy and pathophysiology classification {CEAP} class C1) and telangiectasia treated with foam sclerotherapy and liquid sclerotherapy were enrolled into the study. Patients treated with foam sclerotherapy and liquid sclerotherapy were compared with regard to preoperative parameters, procedure success, Visual Analog Score (VAS), patient satisfaction, and complications.
RESULTS
The VAS scores at the first hour and sixth hour were statistically higher in the foam sclerotherapy group (p=0.001 and p=0.001, respectively). The success rate after the first session was 88.2% in the foam sclerotherapy group and 69.4% in the liquid sclerotherapy group (p=0.008). After all sessions, the success rates were similar between groups (p=0.607). The foam sclerotherapy group required an average of 1.1 sessions, while the liquid sclerotherapy group required 1.4 sessions (p=0.001). At the third-month follow-up, the success rate was significantly higher in the foam sclerotherapy group than liquid sclerotherapy group (91.2% and 77.4%; p= 0.030). In the foam sclerotherapy group, 80.9% of the patients were very satisfied, while this rate was 58.1% in the liquid group (p=0.012). The rates of ecchymosis and hyperpigmentation in the first week after the procedure were significantly higher in the foam sclerotherapy group (p=0.003 and p=0.040, respectively).
CONCLUSION
Our findings showed that foam sclerotherapy had a significantly higher success rate after the first session, and third month follow-up with higher patient satisfaction. In contrast, liquid sclerotherapy had significantly lower VAS scores in the first and sixth hours following the procedure and had lower ecchymosis and hyperpigmentation in the first week after the procedure.
PubMed: 37637635
DOI: 10.7759/cureus.42571 -
Journal of Minimally Invasive Surgery Dec 2023These days laparoscopic inguinal hernia surgery, both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP), is a commonly performed procedure due to...
PURPOSE
These days laparoscopic inguinal hernia surgery, both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP), is a commonly performed procedure due to advancements in laparoscopic instruments and the availability of skilled laparoscopic surgeons. The purpose of this study was to compare the perioperative complications of these two procedures.
METHODS
This was a prospective observational study between July 2019 and December 2020. Perioperative complications were compared with a 6-month follow-up. It included 144 patients, of whom 71 underwent TAPP repair and 73 underwent TEP repair. The selection was based on the surgeon's choice.
RESULTS
Early postoperative complications were scrotal edema (12 cases in TEP and 16 in TAPP), urinary retention (one case in TEP), ecchymosis (six cases in TEP and two in TAPP), and scrotal subcutaneous emphysema (two cases in TEP). On follow-up, seroma was found in a total of 22 cases, of which 12 were TEP and 10 were TAPP. While only one case of TAPP developed surgical site infection. There was no statistically significant difference in hospital stay between the two groups ( = 0.58). The pain scores significantly decreased throughout recovery and were comparable between the groups. Neither group experienced a recurrence during the 6-month follow-up. Fifty-eight patients developed Clavien-Dindo grade I complications, one had grade II, and three had grade IIIa complications.
CONCLUSION
With the increasing experience of the surgical fraternity in laparoscopic surgery, TEP and TAPP were proven to be comparable in terms of duration of surgery, postoperative complications, hospital stay, pain scores, and recurrence during the 6-month follow-up.
PubMed: 38098352
DOI: 10.7602/jmis.2023.26.4.190 -
BMC Neurology Mar 2024No uniform consensus has been achieved regarding the ambulation protocol after transfemoral cerebral angiography (TFA). Until now, in most hospitals patients are...
BACKGROUND
No uniform consensus has been achieved regarding the ambulation protocol after transfemoral cerebral angiography (TFA). Until now, in most hospitals patients are prescribed 8-12 h strict immobilization along with bed rest in the supine position after TFA in China, which causes great discomfort to patients.
OBJECTIVE
To evaluate the effect of an evidence-based early ambulation protocol on the prevention of vascular complications and general discomfort in patients following transfemoral cerebral angiography (TFA).
METHODS
A prospective quasi-experimental study was conducted on 214 patients undergoing TFA with manual compression. Patients in the experimental group were placed supine position for 2 h with a sandbag placed on the wound dressing, followed by a semi-seated position for another 2 h. After this period, patients took 2 h bed rest (move freely) with the sandbag removed, and were allowed to get out of bed 6 h after TFA. Patients in the control group were restricted to an 8 h bed rest in a supine position with the affected leg straight and immobilized. The vascular complications (bleeding, hematoma, ecchymosis) and levels of comfort (low back pain, leg pain, and blood pressure) were evaluated after the procedure. Numeric Rating Scale (NRS) pain scores, systolic blood pressure (SBP); diastolic blood pressure (DBP) were measured hourly for 8 h after TFA.
RESULTS
There was no significant difference in the two groups with regard to vascular complications including bleeding events (P = 0.621), bleeding volume (P = 0.321), and area of hematoma (P = 0.156). The area of ecchymosis in the experimental group was significantly smaller than the control group (P = 0.031). Compared with the control group, the NRS score for low back pain in the 4th, 5th, 6th, 7th, and 8th hour after TFA were significantly lower (P < 0.05), and the NRS score for leg pain in the 5th, 6th, 7th, 8th hour after TFA were significantly lower (P < 0.05). The SBP and DBP in the 6th, 7th, and 8th hour after TFA were significantly lower than the control group (all P < 0.05).
CONCLUSIONS
The evidence-based early ambulation protocol can effectively and safely increase comfort and decrease the pain level for patients undergoing TFA, without change in the incidence of vascular complications.
Topics: Humans; Cerebral Angiography; Prospective Studies; Low Back Pain; Early Ambulation; Ecchymosis; Hemorrhage; Hematoma
PubMed: 38528480
DOI: 10.1186/s12883-024-03595-2