Infiltración subacromial de ácido hialurónico en el tratamiento del dolor crónico de hombro. Serie prospectiva de 80 pacientes seguidos durante un año / Subacromial sodium hyaluronate injection for the treatment of chronic shoulder pain: A prospective series of eighty patients

Resumen: Objetivo: Nuestro objetivo fue evaluar la efectividad de las infiltraciones subacromiales de ácido hialurónico en el tratamiento del dolor crónico de hombro como alternativa a los tratamientos quirúrgicos y no quirúrgicos actualmente disponibles. Material y métodos: Estudio prospectivo de 80 pacientes consecutivos con dolor crónico de hombro seguidos durante 12 meses. Se realizaron cinco infiltraciones subacromiales con ácido hialurónico durante cinco semanas consecutivas y se analizaron los resultados clínicos obtenidos. Resultados: La puntuación en la escala de Constant mejoró en 7.7 puntos, el cuestionario DASH disminuyó en cinco puntos y la puntuación en la escala visual analógica para el dolor disminuyó 1.6 puntos por término medio. Los pacientes que presentaban dolor de menos de 24 meses de evolución respondieron mejor al tratamiento. Las mujeres respondieron mejor. Los pacientes con disminución del espacio subacromial o lesión del manguito rotador según la resonancia magnética mejoraron, pero los pacientes que mostraron signos de artrosis acromioclavicular en la resonancia empeoraron en todas las escalas evaluadas. Discusión: Las infiltraciones subacromiales de ácido hialurónico son especialmente efectivas en el tratamiento del dolor crónico de hombro de menos de 24 meses de evolución, con disminución del espacio subacromial o lesión parcial o total del manguito rotador, pero en nuestra experiencia, su resultado no es bueno en pacientes con artrosis acromioclavicular.

Abstract: Objective: Our purpose was to assess the effectiveness of hyaluronic acid infiltrations for chronic shoulder pain as an alternative to the non-surgical and surgical treatments that are currently available. Material and methods: This is a prospective study of 80 consecutive patients suffering from chronic shoulder pain followed for twelve months. Five subacromial hyaluronic acid injections on five consecutive weeks were administrated to all patients. Results: A significant improvement within the whole group after six months was observed. Constant score improved by 7.7 points, DASH questionnaire decreased by 5 points and Visual Analog Scale for pain decreased by 1.6 points. Patients with history of less than 24 months of pain responded better to treatment. Females responded better. Patients with decreased subacromial space or cuff tear in the MRI improved but patients diagnosed by the MRI of acromioclavicular osteoarthritis worsened in all scales assessed. Discussion: Subacromial hyaluronic acid injections are specially effective in patients with history of less than 24 months of pain, a decreased subacromial space or partial or total cuff tear but, in our experience, its result is not good in patients with acromioclavicular osteoarthritis.

Uso de ácido hialurónico en osteoartritis de articulación temporomandibular en paciente adolescente / Use of hyaluronic acid in osteoarthritis of temporomandibular joint in adolescent patient

La osteoartritis es un tipo de trastorno temporomadibular de origen articular, siendo uno de los procesos degenerativos óseos que más comúnmente afectan a la articulación temporomandibular. Se caracteriza por remodelación del hueso subcondral subyacente, deterioro y abrasión del tejido articular. Las infiltraciones intraarticulares de ácido hialurónico se consideran beneficiosas para el tratamiento del dolor y la recuperación de propiedades de los tejidos articulares. El objetivo de éste artículo es describir el uso de ácido hialurónico en el manejo de osteoartritis de articulación temporomandibular en un paciente adolescente. Paciente de sexo femenino, 15 años de edad, presenta dolor de un año de evolución en la región preauricularbilateral, con aumento de dolor en apertura máxima. Considerando el examen clínico e imagenológico se diagnostica una luxación discal con reducción con componente osteoartritico e inflamatorio bilateral. Se indica reposo mandibular, dieta líquida, AINEs y se realiza la aplicación intraarticular de ácido hialurónico(Suprahyalâ 25 mg/2,5 ml) bilateral. Se cita a control a las 2, 3 y 16 semanas donde la paciente se encuentra sin dolor espontaneo y a la palpación. El uso de ácido hialurónico es una de las alternativas terapeúticas más utilizadas para el manejo de la osteoartritis de articulación temporomandibular, sin embargo es necesario que la evidencia de su aplicación intraarticular en adolescentes y niños se consolide.

Osteoarthritis is a type of articular origin Temporomandibular disorders, being one of themost common degenerative processes affecting thetemporomandibular joint. It is characterized byremodeling of the underlying subchondral bone,deterioration and abrasion of articular tissue. Intra-articular injections of hyaluronic acid are considered beneficial for treatment of pain and recovery of joint tissues properties. The aim of this article is to describe the use of hyaluronic acid in the management of osteoarthritis of temporomandibular joint in an adolescent patient. Female patient, 15 years old,presented pain with a year of progress in the bilateral preauricular region, with increased pain at maximum aperture. Considering the clinical and imaging tests the patient was diagnosed with disk displacement with reduction with bilateral osteoarthritic and inflammatory component. Mandibular rest, liquid diet, NSAIDs were indicated and the application of intra-articular hyaluronicacid (Suprahyalâ 25 mg / 2.5 ml) bilaterally. Control was quoted at 2, 3 and 16 weeks where the patient has no spontaneous pain and tenderness. The use of hyaluronic acid is one of the most commonly usedtherapeutic alternatives for the management ofosteoarthritis of temporomandibular joint. However,further evidence of its use in intra-articular application in adolescents and children should be incorporated.

Experimental osteoarthritis model by means of medial meniscectomy in rats and effects of diacerein administration and hyaluronic acid injection / Modelo experimental de osteoartrite através da meniscectomia medial em ratos e efeitos da administração de diacereína e da injeção de ácido hialurônico

CONTEXT AND OBJECTIVE: The development of a slow and progressive mechanical model for osteoarthritis is important for correlation with clinical practice, and for evaluating the effects of disease-modifying medications. A mechanical osteoarthritis model was developed to evaluate the effects of intra-articular hyaluronic acid (HA) injection and oral diacerein administration. DESIGN AND SETTING: Experimental study at the Department of Orthopedics and Traumatology, Universidade de São Paulo. METHOD: Total medial meniscectomy was performed on seven groups of ten Wistar rats each, comprising four control groups (C) and three study groups (S). C.I: operated, non-medicated; C.II: operated, injections of HA vehicle; C.III: non-operated, non-medicated; C.IV: operated, non-medicated, sacrificed three months post-meniscectomy; S.I: operated, receiving intra-articular HA injections; S.II: operated, oral diacerein from the third to the seventh postoperative month; S.III: operated, received both medications. All the animals (except C.IV) were sacrificed seven months post-meniscectomy. All femurs and tibias were assessed histologically. RESULTS: The most severe degenerative histological changes were in the tibias of the operated knees. On the contralateral side, all groups had mild changes on the tibial surface. The femoral surface had ...

CONTEXTO E OBJETIVO: Desenvolver um modelo osteoartrítico mecânico lento e progressivo é importante para correlação com a prática clínica e para avaliar os efeitos de medicamentos modificadores da doença. Um modelo mecânico de osteartrite foi desenvolvido para avaliar os efeitos de injeção intra-articular de hialuronato de sódio (AH) e de administração de diacereína oral. DESENHO E LOCAL: Estudo experimental no Departamento de Ortopedia e Traumatologia, Universidade de São Paulo. MÉTODO: Meniscectomia medial total foi feita em sete grupos de dez ratos Wistar, sendo quatro grupos controle (C) e três grupos estudo (E). C.I: operado, não medicado; C.II: operado, recebendo injeções do veículo do AH; C.III: não operado, não medicado; C.IV: operado, não medicado, sacrificado três meses pósmeniscectomia; EI: operado, recebendo injeções de AH intra-articular; E.II: operado, recebendo diacereína oral do terceiro ao sétimo mês pós-operatório; E.III: operado, recebeu ambas medicações. Todos os animais (exceto C.IV) foram sacrificados sete meses pós-meniscectomia. Todos os fêmures e tíbias foram analisados histologicamente. RESULTADOS: As alterações histológicas degenerativas ...

Efficacy of Direct Injection of Etanercept into Knee Joints for Pain in Moderate and Severe Knee Osteoarthritis

PURPOSE: Osteoarthritic (OA) pain is largely considered to be inflammatory pain. However, during the last stage of knee OA, sensory nerve fibers in the knee are shown to be significantly damaged when the subchondral bone junction is destroyed, and this can induce neuropathic pain. Several authors have reported that tumor necrosis factor-alpha (TNFalpha) in a knee joint plays a crucial role in pain modulation. The purpose of the current study was to evaluate the efficacy of etanercept, a TNFalpha inhibitor, for pain in knee OA. MATERIALS AND METHODS: Thirty-nine patients with knee OA and a 2-4 Kellgren-Lawrence grading were evaluated in this prospective study. Patients were divided into two groups; hyaluronic acid (HA) and etanercept injection. All patients received a single injection into the knee. Pain scores were evaluated before and 4 weeks after injection using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and they were compared between the groups. RESULTS: Before injection, VAS and WOMAC scores were not significantly different between the groups (p>0.05). Significant pain relief was found in the etanercept group at 1 and 2 weeks by VAS, and at 4 weeks by WOMAC score, compared with the HA group (p<0.05). No adverse events were observed in either group. CONCLUSION: Direct injection of etanercept into OA knee joints was an effective treatment for pain in moderate and severe OA patients. Furthermore, this finding suggests that TNFalpha is one factor that induces OA pain.

Efficacy of the Mineral Oil and Hyaluronic Acid Mixture Eye Drops in Murine Dry Eye

PURPOSE: To investigate the therapeutic effects of mineral oil (MO) and hyaluronic acid (HA) mixture eye drops on the tear film and ocular surface in a mouse model of experimental dry eye (EDE). METHODS: Eye drops consisting of 0.1% HA alone or mixed with 0.1%, 0.5%, or 5.0% MO were applied to desiccating stress-induced murine dry eyes. Tear volume, corneal irregularity score, tear film break-up time (TBUT), and corneal fluorescein staining scores were measured at 5 and 10 days after treatment. Ten days after treatment, goblet cells in the conjunctiva were counted after Periodic acid-Schiff staining. RESULTS: There was no significant difference in the tear volume between desiccating stress-induced groups. The corneal irregularity score was lower in the 0.5% MO group compared with the EDE and HA groups. The 0.5% and 5.0% MO groups showed a significant improvement in TBUT compared with the EDE group. Mice treated with 0.1% and 0.5% MO mixture eye drops showed a significant improvement in fluorescein staining scores compared with the EDE group and the HA group. The conjunctival goblet cell count was higher in the 0.5% MO group compared with the EDE group and HA group. CONCLUSIONS: The MO and HA mixture eye drops had a beneficial effect on the tear films and ocular surface of murine dry eye. The application of 0.5% MO and 0.1% HA mixture eye drops could improve corneal irregularity, the corneal fluorescein staining score, and conjunctival goblet cell count compared with 0.1% HA eye drops in the treatment of EDE.

In Situ Peripheral Iridoplasty in Phakic Eyes for the Treatment of Symptomatic Peripheral Iridotomy

No abstract available.

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

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.

INTRODUÇÃO: em algumas situações, o tratamento conservador das alterações internas da articulação temporomandibular apresenta-se pouco responsivo. Nessas condições, torna-se necessária a realização de tratamentos que visem reduzir a dor e melhorar a função dos pacientes frente a disfunções temporomandibulares articulares. OBJETIVO: esse trabalho, por meio de uma revisão sistemática de literatura, teve como objetivo analisar a efetividade de infiltrações intra-articulares com corticosteroides e com hialuronato de sódio no tratamento para as alterações internas da ATM. MÉTODOS: foi feito levantamento nas bases de pesquisa MEDLINE, Cochrane, EMBASE, PubMed, Lilacs e BBO, abrangendo os anos de 1966 a outubro de 2010, com enfoque em estudos clínicos controlados randomizados ou quase-randomizados, cegos ou duplo-cegos. RESULTADOS: após a aplicação dos critérios de inclusão, chegou-se a nove artigos, sendo que sete eram estudos clínicos controlados randomizados duplo-cego e dois eram estudos clínicos controlados randomizados apenas cegos. CONCLUSÕES: pela análise da literatura, verifica-se que a infiltração intra-articular com corticosteroides e hialuronato de sódio parece ser um método efetivo no tratamento das alterações internas da ATM. Porém, são necessários mais estudos clínicos controlados randomizados, com amostras representativas e tempo de acompanhamento longo, para avaliar a real efetividade da técnica.

Effects of one-time and two-time intra-articular injection of hyaluronic acid sodium salt after joint surgery in dogs

Thirty-one dogs with patellar luxation (grades 2 and 3) were categorized into three groups. Group 1 (G.1; n = 12) had sodium hyaluronate (SHA) intra-articularly injected into the stifle joint that received surgery. Group 2 (G.2; n = 10) received SHA twice: first after surgery and then 1 week later. Group 3 (G.3; n = 9) served as a control, without injection. Blood was collected before injection and then once a week for 4 weeks after injection for evaluation of chondroitin sulfate (CS-WF6) and hyaluronan (HA). The results revealed significantly (p 0.05) was observed in serum biomarkers between G.1 and G.2. In conclusion, intra-articular injection with SHA after joint surgery may improve homeostasis of the joint, retarding the process of OA.

A clinical comparison between DisCoVisc and 2% hydroxypropylmethylcellulose in phacoemulsification: a fellow eye study

OBJECTIVE: This study sought to compare the effects and outcomes of two ophthalmic viscosurgical devices, 1.6% hyaluronic acid/4.0% chondroitin sulfate and 2.0% hydroxypropylmethylcellulose, during phacoemulsification. METHODS: This prospective, randomized clinical trial comprised 78 eyes (39 patients) that received phacoemulsification performed by the same surgeon using a standardized technique. Patients were randomly assigned to receive either 1.6% hyaluronic acid/4.0% chondroitin sulfate or 2.0% hydroxypropylmethylcellulose on the first eye. The other eye was treated later and received the other viscoelastic agent. Preoperative and postoperative examinations (5, 24 and 48 hours; 7 and 14 days; 3 and 6 months) included measurements of the total volume of the ophthalmic viscosurgical device, ultrasound and washout times to completely remove the ophthalmic viscosurgical device, intraocular pressure, central corneal thickness and best-corrected visual acuity. The corneal endothelial cell count was measured at baseline and at six months postoperatively. ClinicalTrials.gov: NCT01387620. RESULTS: There were no statistically significant differences between groups in terms of cataract density or ultrasound time. However, it took longer to remove 2.0% hydroxypropylmethylcellulose than 1.6% hyaluronic acid/ 4.0% chondroitin sulfate, and the amount of viscoelastic material used was greater in the 2.0% hydroxypropylmethylcellulose group. In addition, the best-corrected visual acuity was significantly better in the hyaluronic acid/ chondroitin sulfate group, but this preferable outcome was only observed at 24 hours after the operation. There were no statistically significant differences between the two ophthalmic viscosurgical devices regarding the central corneal thickness or intraocular pressure measurements at any point in time. The corneal endothelial cell count was significantly higher in the hyaluronic acid/chondroitin sulfate group. CONCLUSION: The ophthalmic viscosurgical device consisting of 1.6% hyaluronic acid/4.0% chondroitin sulfate was more efficient during phacoemulsification and was easier to remove after IOL implantation than 2.0% hydroxypropylmethylcellulose. In addition, the corneal endothelial cell count was significantly higher following the use of hyaluronic acid/chondroitin sulfate than with hydroxypropylmethylcellulose, which promoted an improved level of corneal endothelium protection.

Injeções intra-articulares de corticosteróides versus hialuronato de sódio para tratamento de desarranjos internos da articulação temporomandibular / Intra-articular injections of corticosteroids versus sodium hyaluronate for treatment of temporomandibular joint disorders

Desarranjos internos da articulação temporomandibular são distúrbios de etiologia complexa que acomete com bastante freqüência muitos indivíduos, sendo os principais procedimentos realizados para tratar de maneira paliativa estes pacientes, a injeção intra-articular de corticosteróides ou hialuronato de sódio.Objetivo: revisar a literatura comparando o risco-benefício, a real eficácia e a viabilidade do profissional Cirurgião-Dentista, em lançar mão das injeções intra-articulares de corticosteróide ou hialuronato de sódio para desarranjos internos da ATM.Conclusão: o hialuronato de sódio é terapeuticamente melhor que o corticosteróide para injeção intra-articular, o qual, em longo prazo, pode provocar uma série de efeitos deletérios ao paciente, apesar do custo financeiro da terapia com hialuronato ser muito maior...

The temporomandibular joint disorder, are disturbances of complex etiology that seeks very frequently many patients, being the principals procedures employed to treat as a palliative way these patients, the injection of intra-articular corticosteroid or sodium hyaluronate.Aim: review the literature comparing the risk-benefit, real efficacy and the viability of dentistry professional, to use the intra-articular injections of corticosteroid or sodium hyaluronate for the internal disordes of TMJ. Conclusion: the sodium hyaluronate is therapeutically better than the corticosteroid intra-articular, which, in a long-term, may cause many deleterious effects for the patient, in despite of the financier cost of hialuronate therapy is much higher...

Comparison of corneal endothelial cell loss during phacoemulsification using continuous anterior chamber infusion versus those using ophthalmic viscosurgical device: randomized controlled trial.

AIM: We conducted this study to evaluate and compare corneal endothelial cell loss between phacoemulsification with continuous anterior chamber infusion using anterior chamber maintainer (ACM) and phacoemulsification using ophthalmic viscosurgical device (OVD). MATERIALS AND METHODS: This was a prospective, randomized controlled trial. Fifty eyes of 47 patients of senile cataract undergoing phacoemulsification were included. Patients were randomly allocated into two groups of 25 eyes each. Cataract surgery was performed by phacoemulsification with anterior chamber (AC) continuous infusion with balanced salt solution (BSS) plus and ACM without OVD in Group A, and in Group B, phacoemulsification was performed using OVD with BSS plus. Corneal endothelial cell count and pachymetry were performed preoperatively and postoperatively on day 1, day 7, and day 30. The mean increase in pachymetry was 4.86%, 2.94%, and 1.94%, (Group A) and 5.95%, 3.94%, and 0.51%, (Group B) on first, seventh, and 30 th postoperative day respectively. The difference between the percentage increase in pachymetry between the two groups was not significant at day 1 ( P = 0.441), day 7 ( P = 0.298), and day 30 ( P =0.174) postoperatively. The density of endothelial cells decreased postoperatively (day 30) by 7.38% (Group A) and 7.47% (Group B) without any significant statistical difference ( P = 0.983) between two groups. CONCLUSION: Use of ACM for continuous AC infusion and omission of OVD during phacoemulsification did not cause significant difference in corneal swelling or endothelial cell loss in the immediate postoperative period up to one month.