Stem cell implantation for osteonecrosis of the femoral head

What is the most effective treatment for the early stages of osteonecrosis of the femoral head? We assessed multiple drilling and stem cell implantation to treat the early stages of osteonecrosis of the femoral head. We report the clinical and radiological results of stem cell implantation and core decompression. In total, 128 patients (190 hips) who had undergone surgery were divided into two groups based on which treatment they had received: (1) multiple drilling and stem cell implantation or (2) core decompression, curettage and a bone graft. The clinical and radiographic results of the two groups were compared. At 5-year follow-up, in the stem cell implantation group, 64.3% (27/42) of the patients with Stage IIa disease, 56.7% (21/37) of the patients with Stage IIb disease and 42.9% (21/49) of the patients with Stage III disease had undergone no additional surgery. In the conventional core decompression group, 64.3% (9/14) of the patients with Stage IIa disease, 55.6% (5/9) of the patients with Stage IIb disease and 37.5% (3/8) of the patients with Stage III disease had undergone no additional surgery. Success rates were higher in patients with Ficat Stage I or II lesions than in those with Stage III lesions. There were no statistically significant differences between the groups in terms of success rate or in the clinical and radiographic results of the two methods. Essentially the same results were found with stem cell implantation as with the conventional method of core decompression.

Implante de células progenitores en cardiología: su eficacia es aún incierta / Stem cell implantation in cardiology: its efficacy remains uncertain

Para superar la capacidad endógena limitada de regeneración de miocardiocitos post infarto del miocardio, se formuló la hipótesis de que al repoblar la zona infartada con células progenitoras autólogas se podría restablecer la función cardíaca, iniciándose una intensa investigación preclínica y luego clínica. La mejoría inicial, pequeña, en la función cardíaca no se correlaciona con la diferenciación de células progenitores a miocitos. Se han propuesto efectos auto y paracrinos como alternativas para explicar efectos beneficiosos del implante de células progenitoras. Se han usado diferentes protocolos y técnicas para investigar mecanismos de acción y eficacia de los implantes mencionados pero sus resultados no son claros. Se requiere de estudios más extensos y específicos para resolver la pregunta planteada al inicio de este editorial.

In order to overcome the limited regenerative capacity of cardiac myocytes following a myocardial infarction, the implant of stem cells was proposed as a means of restablishing cardiac function. Thus, an extensive line of preclinical and clinical investigation was developed. Initial improvements, admittedly small, in cardiac function do not correlate with differentiation of stem cells to myocytes. Autocrine and paracrine effects have been proposed as an alternative way to explain beneficial effects of BMC implantation. There have been many approaches, protocols and techniques used to investigate the mechanisms of action and efficacy of BMC implant but their result continue to be controversial. Therefore, larger and more specific studies are needed to solve the question posed at the beginning of this editorial.

Masa cardíaca derecha: a propósito de un caso / Clinical case: right ventricular intracardiac mass

El presente caso clínico trata de una paciente mujer de 42 años, en quien se encuentra una masa intracardíaca del corazón derecho, que estudiada con imágenes derivadas de ecocardiografía de superficie y transesofágica lleva a la sospecha de trombo, que es confirmado tras excéresis quirúrgica. Se analizan las etiopatogenias posibles y diagnóstico diferencial de masas intracardíacas.

A 42 year old woman is found to have right ventricular of intracardiac mass through surface and transesophageal echocardiography. Characteristics of the mass suggest a thrombus which is confirmed at the time of surgical removal. Different etiologies and differential diagnosis of intracardiac masses is discussed.