RESUMO
OBJECTIVE: To investigate the factors affecting prognosis of extracorporeal shockwave therapy (ESWT) for chronic refractory Achilles tendinopathy (AT). METHODS: Thirty-six patients (48 consecutive feet) with chronic AT (>6 months) and who underwent ESWT for ‘poor’ or ‘fair’ grade in Roles-Maudsley Score (RMS) after unsuccessful conservative treatment were included in the present study. A maximum of 12 sessions of ESWT were conducted until treatment success: RMS reached ‘good’ or ‘excellent’. Termination of ESWT for no response, or ‘poor’ or ‘fair’ grade was regarded as treatment failure. Immediate outcome, long-term outcome (telephone interview after mean 26 months), and factors affecting treatment success were analyzed. RESULTS: Numeric Rating Scale was significantly decreased at immediate and long-term follow-up. Success rate was 71.1% and 90.3%, respectively. Univariate logistic regression identified that immediate treatment success was associated with retrocalcaneal enthesophyte on X-ray (odds ratio [OR], 0.06; 95% confidence interval [CI], 0.01–0.28), pretreatment abnormal ultrasonography echogenicity within Achilles tendon (OR, 18.89; 95% CI, 2.08–171.96), mean duration of ‘post-treatment soreness’ (OR, 0.55; 95% CI, 0.33–0.94), and duration of ‘post-treatment soreness after first ESWT’ (OR, 0.06; 95% CI, 0.01–0.34). The duration of ‘post-treatment soreness after first ESWT’ was found to be the only factor associated with long-term success (OR, 0.32; 95% CI, 0.10–0.99). CONCLUSION: ESWT appears to be effective in achieving long-term success in chronic refractory AT. Immediate success was associated with absence of retrocalcaneal enthesophyte on X-ray, presence of pretreatment abnormal ultrasonography echogenicity, shorter mean duration of ‘post-treatment soreness’, and shorter duration of ‘post-treatment soreness after first ESWT’. The shorter duration of ‘post-treatment soreness after first ESWT’ was identified as the only positive prognostic parameter in achieving long-term success.
Assuntos
Humanos , Tendão do Calcâneo , Seguimentos , Ondas de Choque de Alta Energia , Modelos Logísticos , Prognóstico , Tendinopatia , Falha de Tratamento , Resultado do Tratamento , UltrassonografiaRESUMO
OBJECTIVE: To investigate the changes of apoptosis related factors after denervation and disuse in skeletal muscles and to find out the role of apoptosis in atrophic process. METHOD: 30 male Sprague-Dawley rats, 8 weeks of age were treated with three different atrophy models (10 rats in each group); hind-limbs suspension (HS) as a disuse model, complete denervation by sciatic nerve transsection (CD) and partial denervation by sciatic nerve crushing (PD). At 2 weeks and 4 weeks after each experiment, both gastrocnemius were dissected and their weights were measured. Western blotting for BAX and Bcl-2 and TUNEL assay were used to assess the changes of apoptosis related factors in muscle cell. RESULTS: The muscle weight of PD and CD group decreased 38.6%, 65.6%, respectively, of intact side at 4 weeks after injuries. The loss of muscle weight in HS group was smaller than that of denervated muscles. CD group showed high expression of BAX (3.45+/-0.32-->2.87+/-0.48) and Bcl-2 (3.63+/-0.40-->3.33+/-0.50) at 2 and 4 weeks after denervation, but in PD group, BAX at 2 weeks significantly decreased at 4 weeks (3.40+/-0.55-->2.13+/-0.25). In HS group, their expressions were slightly increased only immediate after 14 days suspension (BAX: 1.30+/-0.38 and Bcl-2: 1.29+/-0.28). CD group showed higher number of positive nuclei (27.6+/-8.8%) than PD group (10.4+/-5.3%) and HS group (4.4+/-1.6%) in TUNEL assay. CONCLUSION: Unlike temporary increase of apoptosis related factors in disuse, increase of these factors are remarkable and persisted after denervation. Muscle apoptosis may be the major cause of muscle atrophy during degeneration process.
Assuntos
Animais , Humanos , Masculino , Ratos , Apoptose , Atrofia , Western Blotting , Denervação , Marcação In Situ das Extremidades Cortadas , Células Musculares , Músculo Esquelético , Músculos , Atrofia Muscular , Ratos Sprague-Dawley , Nervo Isquiático , Pesos e MedidasRESUMO
BACKGROUND: For the purpose of early detection of breast cancer, a localization biopsy is necessary in case of mammographically or ultrasonographically suspicious, but nonpalpable, breast lesions. METHODS: One hundred nine consecutive localization biopsies for nonpalpable lesions of the breast were performed upon 101 patients from May 1992 to September 1998. RESULTS: The localizations were done in 48 cases under the guidance of mammography and in 61 cases under the guidance of ultrasonography. Complications occurred in 15 cases (13.7%). The mean volume of the excised specimens was 11.6 cm3. The miss rate was 3.6% (4 cases). Malignant lesions of the breast were found in 16 cases (14.7%). Among the malignant lesions, 10 cases involved invasive ductal cancer. Among the patients diagnosed as having breast cancer, 8 patients were treated with a conservative operation, 5 patients with a modified radical mastectomy, and 2 patients with observation; 1 patient was discharged. The chance of a biopsy containing a malignant lesion was 16.7% if the biopsy was done because of mass, 9.8% for a microcalcification, and 11.1% for an abnormal asymmetric density. CONCLUSIONS: A needle localization biopsy can be performed accurately under local anethesia, and the volume of the excised specimen can be minimized, so the cosmetic effect is excellent and proper early treatment is possible in diagnosed cases of breast cancer.
Assuntos
Humanos , Biópsia , Neoplasias da Mama , Mama , Mamografia , Mastectomia Radical Modificada , Agulhas , UltrassonografiaRESUMO
OBJECTIVE: To assess the jumper's knee for the symptoms and diagnostics by MRI and ultrasonography in basket ball players. METHOD: Twenty knees of 10 basketball players with chronic knee pain were assessed by the history taking, physical examination and diagnosis by magnetic resonance imaging and ultrasonography. Their average age was 17.4 years. Stanish classification is used for grading the symptoms of jumper's knee. RESULTS: Nine proximal patellar tendons were diagnosed as jumper's knees (45%) and 11 distal tendons were diagnosed as jumper's knees (55%). In ultrasonographic findings, average proximal patellar tendon thickness was 4.5 mm+/-1.2 mm, and distal patella tendon thickness was 7.1+/-1.1 mm. Sensitivity was 63% (12/19) and specificity was rated as 100% (21/21). By the MRI findings, sensitivity was rated as 32% (6/19) and specificity was rated as 90% (16/21). Study between the patient's clinical severity level by Stanish classification and thickness of patellar tendon showed no significant correlation (<0.5). CONCLUSION: The ultrasonography to be more convenient and easier as a diagnostic method for the jumper's knee than MRI.