Ondas de choque de baja intensidad como alternativa terapéutica de la disfunción eréctil: experiencia inicial en el Hospital Italiano de Buenos Aires y revisión de la bibliografía / Low Intensity Shock Waves as a Therapeutic Alternative for Erectile Dysfunction: Initial Experience at the Hospital Italiano de Buenos Aires and Review of The Literature

Objetivos: los inhibidores de fosfodiesterasa revolucionaron el tratamiento de la disfunción eréctil. Las ondas de choque de baja intensidad emergen como una alternativa terapéutica no invasiva. Materiales y métodos: estudio de cohorte prospectiva y observacional, en el que se evaluó la respuesta de 17 pacientes sexualmente activos al tratamiento con ondas de choque de baja intensidad a los 3 y 6 meses, mediante el Indice Internacional de Función Eréctil (IIEF-6), las preguntas 2 y 3 del Sexual Encounter Profile (SEP-2 y SEP-3), y el Erection Hardness Score (EHS) para evaluar la rigidez peneana, así como una evaluación de satisfacción global con el tratamiento (GAQ) y de recomendación del mismo. Resultados: 6 pacientes presentaban disfunción eréctil leve y 11 disfunción eréctil moderada-severa. Ambos grupos mostraron diferencias estadísticamente significativas en el IIEF-6, SEP-2, SEP-3 y EHS, a los 3 y 6 meses. Sin embargo, no todos los pacientes se mostraron satisfechos o recomendarían el tratamiento, sobre todo en aquellos con disfunción eréctil moderada-severa previo al tratamiento. Conclusión: las ondas de choque de baja intensidad son un tratamiento emergente para la disfunción eréctil, aunque aun sin evidencia clara de su eficacia e indicaciones. Los dispares resultados de los grupos se han debido probablemente a la heterogeneidad de las condiciones basales de los pacientes.(AU)

Objectives: Iphosphodiesterase inhibitors revolutionized the treatment of erectile dysfunction. Low intensity shockwave therapy emerge as a non-invasive therapeutic alternative. Materials and methods: this was a prospective and observational study, in which 17 sexually active patients were evaluated 3 and 6 months after treatment with low intensity shockwave therapy, using the International Index of Erectile Function (IIEF-6), questions 2 and 3 of the Sexual Encounter Profile (SEP-2 and SEP-3), and the Erection Hardness Score (EHS) to assess penile rigidity, as well as a global satisfaction evaluation with the treatment (GAQ) and if they would recommend it to others. Results: 6 patients showed mild erectile dysfunction and 11 moderatesevere erectile dysfunction. Both groups showed statistically significant differences in IIEF-6, SEP-2, SEP-3 and EHS, after 3 and 6 months. However, not all of them were satisfied with the treatment or would recommend it to others, especially those with moderate-severe basal erectile dysfunction. Conclusion: low intensity shockwave therapy is an emergent treatment for erectile dysfunction, although there is no sufficient evidence of its efficacy and indications. The differences between groups were due probably to the heterogeneity of the basal conditions of the patients.(AU)

Intramuscular Hematoma Following Radial Extracorporeal Shockwave Therapy for Chronic Neurogenic Heterotopic Ossification: A Case Report

Extracorporeal shockwave therapy (ESWT) has been reported to be a safe and effective method for decreasing pain and relieving range of motion (ROM) limitations caused by neurogenic heterotopic ossification (NHO), though there has been no report that it might cause hematoma if applied to NHO. We hereby report a case of massive hematoma after ESWT, specifically the radial shockwave therapy (RSWT) device at both hips in a 49-year-old female patient with NHO. She had developed NHO after extensive subarachnoid hemorrhage. We had applied RSWT according to the previous report. The pain and the ROM limitations were gradually improved. Six weeks later, she reported pain and ROM limitations on the right hip. From a medial aspect, swelling and bruising of the right thigh could be seen. Magnetic resonance imaging and ultrasonography suggested a large hematoma between right hip adductor muscles. The symptoms disappeared after conservative treatment for one month, and subsequent follow-up imaging studies demonstrated resolution of the hematoma.

Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature / Tratamento por ondas de choque nas doenças musculoesqueléticas e consolidação óssea - Análise qualitativa da literatura

Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed...

O tratamento por ondas de choque é uma opção na ortopedia. O mecanismo exato pelo qual funcionam as ondas de choque para tratar doenças musculoesqueléticas não é conhecido. O objetivo deste trabalho é fazer a análise qualitativa da efetividade do tratamento por ondas de choque em pacientes com patologias musculoesqueléticas e pseudoartroses. A pesquisa foi feita nas bases de dados Cochrane Library, Medline e Lilacs. Encontrou 39 estudos que relatam o tratamento por ondas de choque de doenças musculoesqueléticas. Os resultados são muito variados, assim como os tipos de protocolo. Os estudos que avaliaram a efetividade do tratamento por ondas de choque para epicondilite lateral, tendinopatias do ombro, osteoartrose do joelho, osteonecrose da cabeça do fêmur e bursite trocanteriana relataram resultados inconsistentes para a melhoria dos pacientes. Os que avaliaram pacientes com tendinopatia calcária, fascite plantar, tendinopatia do tendão calcâneo e patelar e pseudoartrose mostraram benefício. O tratamento por ondas de choque é um método seguro e não invasivo para os casos crônicos em que os convencionais não tenham sido satisfatórios e deve ser associado aos outros métodos de tratamento das tendinopatias. Novos estudos de qualidade são necessários...

Extracorporeal shockwaves induce osteogenic differentiation of human mesenchymal stem cells by ATP release / 医用生物力学

Objective To investigate whether extracorporeal shockwave could induce differentiation of human mesenchymal stem cells (hMSCs) into osteoprogenitor cells by ATP release and the activation of P2X7 receptors. Methods Cultured bone marrow-derived hMSCs were subjected to shockwave treatment and ATP release was assessed. Osteogenic differentiation and mineralization of hMSCs were evaluated by examining alkaline phosphatase (ALP) activity, osteocalcin (OC) production, and calcium nodule formation. The mRNA expression of P2X7 receptors was determined with real-time RT-PCR. P2X7-siRNA, apyrase, and P2 receptor antagonists were used to evaluate the roles of ATP release and P2X7 receptors in shockwave-induced osteogenic hMSCs differentiation. Results Shockwave treatment released significant amounts of ATP from hMSCs. Shockwaves and exogenous ATP induced hMSC differentiation. Removal of ATP with apyrase, targeting of P2X7 receptors with P2X7-siRNA or selective antagonists prevented osteogenic differentiation of hMSCs. Conclusions Shockwaves can contribute to osteogenic differentiation of hMSCs by realeasing cellular ATP that activate signaling. These research findings provide the theoretical basis for shockwave therapy in treating fracture healing and bone nonunion.

Effects of mitogen-activated protein kinase p38 on CD3/CD28-stimulated T-cell proliferation and IL-2 expression enhauced by shockwaves / 吉林大学学报(医学版)

Objective To investigate the effects of mitogen-activated protein kinase p38(p38 MAPK)on CD3/CD28-stimulated T-cell proliferation and IL-2 expression which were enhanced by shockwaves.Methods Jurkat T cells or peripheral blood mononuclear cells(PBMC)were pretreated with the p38 MAPK-inhibitor(SB203580)(The Jurkat T cells or PBMC of the control groups were not pretreated with SB203580),then treated with shockwaves,and stimulated respectively with a suboptimal dose of anti-CD3 and anti-CD28 antibodies or PHA.Finally the IL-2 productions of Jurkat T cells or the proliferation of PBMC were respectively measured.The protein tyrosine phosphorylation of p38 MAPKin Jurkat T cells treated either with shockwaves or not was measured by Western blotting with anti-phosphotyrine antibodies(Thr180/Tyr182).The expressoins of p38 MAPK in Jurkat T cells treated either with shockwaves or not were determined by Western blotting with anti-p38 MAPK antibodies.Results Compared with negative control group without shockwave treatment,the 3H-TdR incorporation of the phytohemagglutinin-stimulated PBMC,which were treated with low dose shockwaves(LDSWs)of 100,150,200,250,300,330 impulses at(0.180?0.015)mJ?mm2,increased significantly(P